Content uploaded by Martha S Turner
Author content
All content in this area was uploaded by Martha S Turner
Content may be subject to copyright.
1
Developing Hypnotic Analogues of Clinical Delusions: Mirrored Self-
Misidentification
Amanda J. Barnier¹, Rochelle E. Cox¹, Akira O’Connor², Max Coltheart¹, Robyn
Langdon¹, Nora Breen³, and Martha Turner4
¹ Macquarie Centre for Cognitive Science (MACCS)
Macquarie University
Sydney, Australia
²Leeds Memory Group, Institute of Psychological Sciences
University of Leeds
Leeds, United Kingdom
³Neuropsychology Unit
Royal Prince Alfred Hospital
Sydney, Australia
4Institute of Cognitive Neuroscience
University College
London, United Kingdom
2
Abstract
Introduction. Despite the prevalence of delusional beliefs there are currently no viable
models for studying delusions in the laboratory. However, hypnosis offers an
empirical technique for creating transient delusions that are resistant to challenge. The
aim of this study was to develop a hypnotic analogue of mirrored-self
misidentification and to explore the thoughts and explanations that “seed” the
delusion.
Methods. Twelve high hypnotisable participants received a hypnotic suggestion to see
either a stranger in the mirror, a mirror as a window, or a mirror as a window with a
view to a stranger. Participants deluded beliefs were subsequently challenged and
following hypnosis, the Experiential Analysis Technique was used to explore
participants’ phenomenological experience of the delusion.
Results. The majority of participants did not recognise their reflection in the mirror
and described the person as having different physical characteristics. These
participants also maintained their delusional belief when challenged.
Conclusions. This study suggests that the hypnotic suggestion created a credible,
compelling delusion that was resistant to challenge. Within Langdon and Coltheart’s
(2000) two-factor model of delusions, these findings suggest that Factor 2 may
involve a lowering of the criteria used to accept or reject delusional hypotheses.
3
Understanding delusions has been and continues to be of great theoretical and
clinical interest but studying delusions in isolation is difficult as they frequently occur
in association with other clinical conditions. Despite the prevalence of delusions in
schizophrenia, various psychiatric disorders, and following brain injury (Davies,
Coltheart, Langdon, & Breen, 2002), no viable models exist for testing delusions in
the laboratory. Further, since delusions are resistant to challenge and are extremely
disruptive to everyday life, a new empirically-based approach for investigating and
understanding delusions is required. The instrumental use of hypnosis provides
researchers with an innovative technique that allows delusions to be studied in the
laboratory. During hypnosis, high hypnotisable individuals come to believe that the
world is as suggested by the hypnotist. In response to hypnotic suggestions,
perceptual processing is altered in a similar way to delusional experiences. For
instance, during hypnosis, in response to suggestions from the hypnotist, individuals
are temporarily convinced that their arm is floating in the air, they can no longer say
their own name, or they feel no pain. Indeed, according to Sutcliffe (1961),
hypnotised individuals are essentially deluded about the actual state of the world.
Hypnosis is a useful technique for investigating delusions for a number of
reasons. First, hypnotic experiences share a number of features with delusions. Both
are (1) believed with absolute conviction, (2) maintained regardless of overwhelming
evidence to the contrary, and (3) resistant to rational counter arguments (Langdon &
Coltheart, 2000). According to Kihlstrom and Hoyt (1988), hypnotic phenomena
represent disorders of metacognition. During hypnosis, high hypnotisable individuals
are unaware of their own cognitive processes and the resulting influence of these
processes on their behaviour. Thus, their behaviour is influenced by beliefs about
themselves and the world that are false but are nevertheless maintained with
4
conviction. Likewise, deluded individuals maintain false beliefs with conviction and
similarly lack insight into the cognitive processes that give rise to these beliefs (even
if they often have insight that their beliefs are abnormal; Davies et al., 2002).
A second reason for using hypnosis to investigate delusions is because
extensive research indicates that hypnotic suggestions are effective at modelling a
number of clinical phenomena. For instance, in the 1960’s, Reyher and colleagues
used posthypnotic suggestions to successfully model pathological symptoms,
including repression and impulse inhibition (Burns & Reyher, 1976; Perkins &
Reyher, 1971; Reyher, 1961, 1962, 1969; Reyher & Basch, 1970). In recent years,
hypnosis has been used to model conversion hysteria (Halligan, Bass, & Wade, 2000),
auditory hallucinations (Woody & Szechtman, 2000), functional amnesia (Barnier,
2002; Barnier & McConkey, 1999; Barnier, McConkey, & Wright, 2004; Cox &
Barnier, 2003), and functional blindness (Blum, 1975; Bryant & McConkey, 1989a,
1989b).
Given that hypnotic phenomena and delusions are both essentially
characterised by distortions of reality or distorted beliefs about reality, hypnosis
should be a useful technique for investigating clinical delusions. However, there are
few studies of clinically relevant hypnotic delusions (Burn, Barnier, & McConkey,
2001; Noble & McConkey, 1995; Zimbardo, Andersen, & Kabat, 1981) and even
fewer contemporary comparisons of hypnotic and clinical cases (Kihlstrom & Hoyt,
1988). This study is part of a larger project that aims to assess the relationship
between a variety of hypnotic and clinical delusions. We hope to develop a catalogue
of compelling hypnotic analogues of clinical delusions and in doing so, explore the
parameters and processes underlying these delusions.
5
Mirrored self-misidentification is one of eight monothematic delusions
(delusions specific to one topic) identified by Davies et al. (2002) that may be
successfully modelled using hypnosis. Mirrored self-misidentification is characterised
by the belief that “the person I see in the mirror is not me” (Breen, Cain, Coltheart,
Hendy, & Roberts, 2000). Breen et al. (2000) described two cases of mirrored self-
misidentification. In case 1, Patient FE believed his reflection was another person who
was following him everywhere. FE attempted to communicate with his reflection and
was puzzled as to why the person never replied. Whilst looking in the mirror, FE
reported the following (from Breen et al., 2000):
FE: That’s not me. It hit’s me straight away. First of all I didn’t like
his face at all, but I’ve got used to his face and I’ll have a smile
with him if I am in the bathroom for a wash or something, but
it’s not me.
Examiner: What does that person look like?
FE: Well, he looks very much like me. I guess he could pass for
F_____ E_____
Examiner: He does look like you
FE: Yes, I see that. He’s not a bad looking fellow
Examiner: What colour is his hair?
FE: I don’t think he is as white as I am (FE has white hair and is
balding)
Examiner: Is he going a bit bald or does he have a full head of hair?
FE: Oh I think he’s about the same as mine as far as hair covering is
concerned (FE then tilts his head forward so that the top of the
head of the reflected image is visible)
6
The examiner then stood next to FE in front of the mirror with both of their reflections
visible to FE.
Examiner: (Pointing to her own reflection). Who is this, next to the
person?
FE: I don’t know
Examiner: Who does it look like?
FE: That’s you
Examiner: Me, here? (Pointing to herself). What’s my name?
FE: I don’t know, oh yes, it’s Nora
Examiner: Nora, that’s right. So that’s me in the mirror?
FE: Yes
Examiner: That’s my reflection?
FE: Yes
Examiner: And who is that? (Pointing to FE’s reflection)
FE: I don’t know what you would call him. It makes me a bit sick
because he moves about freely with us. I don’t be too friendly
because I don’t see it does him any good.
In case 2, patient TH also believed that he saw a stranger when he looked in
the mirror. TH would often talk to his own reflection and thought it rude that the
person never spoke back. TH stood at a mirror with an examiner who asked:
Examiner: At the moment in your bathroom, you have the curtain over the
mirror don’t you?
TH: Yes. There is a curtain over all the mirrors in the house
Examiner: So when you want to use the mirror, and you pull it up at the
corner, pull the curtain up, what happens? What do you see?
7
TH: As soon as you lift the corner, you see him (nodding his head at
his reflection)
Examiner: What happens when you shave?
TH: He’ll get his razor and he’ll be on the other side of the mirror,
and I’ll be on this side of the mirror, and we’ll shave at the
same time, sometimes.
It was discovered that TH suffered from mirror agnosia and no longer knew how a
mirror worked. This led to his belief that the person he was seeing could not have
been him, but a stranger who looked just like him.
Examiner: When you look in here (indicating to the mirror) tell me what
you see?
TH: I can see your reflection and I can see Tom’s reflection
Examiner: Tom who?
TH: I don’t know his second name. He’s been unable to tell me
what his second name is apparently
Examiner: Is that because he doesn’t talk to you?
TH: He doesn’t talk to anyone
Examiner: Doesn’t he?
TH: (Looking at his own reflection) Is that right? Do you talk to
anyone? Can you talk? Can you talk or have you got trouble
talking or you didn’t learn to talk, you weren’t taught? I don’t
know.
These examples illustrate the delusional beliefs that are held by individuals
with mirrored self-misidentification. Both FE and TH are convinced that they see a
stranger in the mirror and although they acknowledge that the person they see looks
8
similar to them, they nevertheless maintain that it is not them. Both FE and TH
attempted to converse with their reflected image and were perplexed when the person
in the mirror did not reply. Interestingly, when the examiner appeared in the mirror
beside them in an attempt to challenge their beliefs, both FE and TH claimed that they
could see her reflection in the mirror but continued to deny that the other person in the
mirror was themselves.
Langdon and Coltheart (2000) have proposed a two-factor theory in an attempt
to explain how monothematic delusions such as mirrored self-misidentification arise.
According to this theory, there are two factors that contribute towards the
development of delusional beliefs. Factor one involves a neuropsychological anomaly
affecting perceptual and/or emotional processing, which is responsible for the content
of delusions. For example, TH’s neuropsychological anomaly was mirror agnosia.
However, mirror agnosia can occur without delusional beliefs (Coltheart 2005), so
factor one alone is not sufficient to account for the presence of a delusion. Langdon
and Coltheart (2000; see also McKay, Langdon, & Coltheart, 2005) argued that a
second factor must be involved to convert the neuropsychological anomaly, such as
mirror agnosia, into a delusional belief. The proposed factor two involves damage to a
system of belief evaluation and is responsible for a person’s failure to reject
delusional beliefs as implausible.
Thus, in mirrored self-misidentification, factor one may involve a problem
processing familiar faces. Due to brain injury or a psychological disorder one’s own
face appears unfamiliar. Consequently, one’s own reflection is interpreted as a
stranger’s face. Additionally, due to damage to a system of belief evaluation, the
explanation that one’s own reflection is a stranger is not rejected and the deluded
belief is maintained. Conceptualised within this two-factor account, hypnosis offers a
9
powerful means to create and investigate delusions such as mirrored self-
misidentification. A hypnotic suggestion can influence perceptual processing in a
similar way to delusions whilst also altering belief evaluation. Hypnotised individuals
accept as real, seemingly implausible events and when challenged, hypnotised
individuals maintain their suggested experiences and process information in a way
that supports their beliefs (Burn et al., 2001). Thus, hypnosis has excellent
“instrumental” value as a laboratory analogue of clinical delusions.
This study used a hypnotic technique known as the Experiential Analysis
Technique (EAT; Sheehan & McConkey, 1982) to explore the phenomenological
experience of participants. Hypnotic responding is typically indexed by observable,
behavioural responses but the EAT allows the private experience of the individual to
be explored. To implement the EAT, the hypnosis session is videotaped and after
hypnosis, the participant and a second, independent experimenter watch the
videotape. Whilst watching the videotape, the participant is invited to comment on
their experience of particular suggestions. The EAT examines the private experience
of the individual and provides information on affect, imagery, intensity, effort,
strategy, and volition associated with hypnotic responding (Barnier & McConkey,
2004).
The primary aim of this study was to create a viable hypnotic analogue of
mirrored self-misidentification as part of a larger catalogue of hypnotic delusions. A
group of talented high hypnotisable participants received a hypnotic suggestion to
either see a stranger in the mirror, to see a mirror as a window, or to see a mirror as a
window with a view of a stranger on the other side. The latter two suggestions were
based on the clinical patient TH, who believed that a mirror functioned like a window
and that his reflection was a stranger outside the window. Based on previous hypnotic
10
sex-change studies (Burn et al., 2001; Noble & McConkey, 1995), participants were
expected to experience a subjectively compelling mirror delusion. Within the two-
factor model, factor two is thought to involve the failure to reject implausible beliefs.
Therefore, this study explored the types of thoughts and explanations that “seed” the
delusion. In the EAT inquiry, participants were asked to explain their thoughts and
beliefs at various stages throughout their suggested delusional experience. Finally,
given that delusions are extremely resistant to challenge, this study also examined the
circumstances under which a hypnotic delusion can be breached. During the
suggested delusion, participants were administered two challenges, a contradiction
and a confrontation, based on techniques used by Noble & McConkey (1995) and
Burn et al. (2001) in studies of hypnotic sex-change. Following a suggestion to
become the opposite sex, Noble & McConkey (1995) and Burn et al. (2001)
administered a contradiction by asking participants what they would say to a
hypothetical doctor who can find no reason for them to be the suggested sex. They
also administered a confrontation by asking participants to open their eyes, look at
themselves on a monitor and describe what they were experiencing as they did so.
The present study modified these challenge techniques in an attempt to breach the
suggested delusion. Given that delusions are typically resistant to challenge and that
hypnotised individuals develop strong belief in the genuineness of their suggested
experiences, participants were expected to maintain their deluded belief in response to
these challenges.
Method
Participants
12 high hypnotisable participants (6 male and 6 female) of mean age 22.82
(SD = 11.87) years participated in the experiment. Participants were undergraduate
11
psychology students at the University of New South Wales, who received credit
towards their psychology course for their involvement. They were selected on the
basis of their extreme scores on a modified 10-item version of the Harvard Group
Scale of Hypnotic Susceptibility, Form A (HGSHS:A; Shor & Orne, 1962) and the
12-item Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C; Weitzenhoffer &
Hilgard, 1962). All participants scored in the range XX-XX on the HGSHS:A (M=
XX, SD = XX) and XX-XX on the SHSS:C (M= XX, SD = XX).
Apparatus
A Panasonic video camera was used to record the hypnosis and EAT sessions
onto Sony digital video discs. A Panasonic television monitor was used during the
EAT to playback the recording of the hypnosis session.
Procedure
The experiment involved two independent experimenters in either the
experimental or the EAT session.
Experimental session. Following informed consent procedures, participants
were administered a standard hypnotic induction (based on Weitzenhoffer & Hilgard,
1962) and then received one of three versions of the delusion suggestion: (1) self in
mirror as a stranger, (2) mirror as a window or, (3) mirror as a window to a view of a
stranger. Participants in the “self in mirror as a stranger” condition were told that
when they opened their eyes and looked in the mirror they would see a stranger rather
than themselves reflected in the mirror. Participants in the “mirror as a window”
condition were told that when they opened their eyes they would see a window
through to another room and would be able to see what was on the other side of the
window. Participants in the “mirror as a window to a view of a stranger” were told
12
that when they opened their eyes they would see a window and through the window
they would see a stranger.
Following the suggestion, participants were asked either what they could see
in the mirror or what they could see through the window. They were asked to provide
a detailed description of the person they could see, their gender, whether they had
seen the person before and if so, who they thought it was, or if not, whether the person
reminded them of anybody. They were asked to describe the ways in which the person
they could see looked similar to them, the ways in which the person looked different
to them, and how it was possible that the person they could see looked so similar to
them.
The delusion was then challenged with a contradiction and a confrontation
based on techniques used by Noble & McConkey (1995) and Burn et al. (2001). In the
contradiction, participants were asked “if a close friend or member of your family
came into the room now, how would they be able to tell you apart from the person
you see?” In the confrontation, participants were asked to touch their nose whilst
looking in the mirror, describe what the person in the mirror or window did and
explain why they did it. Finally, participants were also asked why the person they
could see always did what they did.
Following this, the suggestion was cancelled and a standard hypnotic de-
induction administered (based on Weitzenhoffer & Hilgard, 1962). The first
experimenter then left the room and a second experimenter entered to conduct the
EAT.
EAT session. The second experimenter (who was not aware of participants’
hypnotisability) informed participants that she would show them the videotape of the
hypnosis session they had just completed, stop the videotape at various points, and
13
ask them about their experiences. After watching a replay of the delusion suggestion,
the second experimenter asked “what went through your mind as you listened to the
suggestion?”, “what did you expect to happen?”, and “how did you go about having
this experience?” Participants then watched a replay of themselves looking into the
mirror for the first time following the suggestion. They were asked: “what thoughts
did you have when you looked in the mirror?”, and “how did that make you feel?”
Next, participants watched a replay of the questions they were asked during the
delusion including the challenge procedures. The second experimenter asked: “what
thoughts and feelings did you have when you were being asked these questions?”
Finally, participants watched a replay of the cancellation and were asked: “what was it
like when the hypnotist said this to you” and “how did you feel about what you had
experienced?” At the completion of the EAT session, participants were invited to ask
questions, debriefed, and thanked for their time.
Results
Response to the Suggestion
Participants were scored as passing the suggestion if they did not recognise
their own reflection in the mirror. This was based on Noble and McConkey (1995)
who scored participants as passing a sex-change suggestion if they did not deny their
suggested sex. Table 1 presents the number and percentage of participants in each
delusion condition who passed the suggestion. Collapsed across delusion conditions,
66.7% of participants passed the suggestion. The self in mirror as a stranger version
and the mirror as a window to a view of a stranger version were more successful than
the mirror as a window version. When participants initially looked in the mirror and
were asked who they could see, the majority described another person in the mirror.
The following is a transcript of one participant’s compelling experience”
14
Hypnotist: Tell me, what do you see?
Participant: (Participant looks behind him). Who’s that?
Hypnotist: Tell me about what you see
Participant: Another person
Hypnotist: Tell me about the person
Participant: They’re wearing a purple shirt, they’ve got a big nose, got a
mole on their neck
Hypnotist: Is the person you see a male or a female?
Participant: Male (Participant looks behind him)
Hypnotist: Tell me more about what they look like
Participant: They’ve got short, curly hair, brown eyes, brown hair.
Hypnotist: Have you ever seen this person before?
Participant: No (Participant looks behind him)
Hypnotist: Does this person remind you of anyone?
Participant: I think I’ve seen him before at school
Hypnotist: Tell me about that….where you might have seen him.
Participant: I think he was in the year below me….yeah I knew there was
something
Hypnotist: What do you think his name is?
Participant: Anthony
Hypnotist: In what ways does this person look like you?
Participant: Same coloured hair. I’ve got hazel eyes
Hypnotist: And what colour eyes does he have?
Participant: Brown
15
Hypnotist: In what ways does the person you can see look different to
you?
Participant: Different coloured eyes. I think my nose is smaller….got
bigger lips
Hypnotist: He has or you have?
Participant: I have….and I’ve got more freckles
Hypnotist: What is he doingat the moment?
Participant: Looking into the mirror. I don’t know where he is though
(participant looks behind him and around the room)
Hypnotist: Is he doing anything in particular or saying anything in
particular?
Participant: Just looking at me. He’s saying something but I can’t
understand
Hypnotist: Why can’t you understand?
Participant: Because I can’t lip read
Hypnotist: Can you hear him?
Participant: No
Hypnotist: How come?
Participant: Because I can only see him
This participant appeared to experience a subjectively real and compelling
delusion. He displayed initial surprise at seeing the person in the mirror and appeared
to be so convinced that it was a stranger that he frequently looked behind him in an
attempt to find the person.
--------------------
Insert Table 1 about here
16
--------------------
Table 1 also presents the number and percentage of participants who described
different physical characteristics for the person in the mirror. Collapsed across
delusion conditions, 75.0% of participants described the person in the mirror as
having different physical characteristics. When asked in what ways the person looked
different to them, participants made comments such as “she looks different from me
because her face is sort of a bit collapsed and her hair is longer” and “her eyes are
different, her nose is bigger, her face is round.”
Although some participants did recognise themselves in the mirror, the
majority (83.3%) nevertheless referred to their reflection in the third person (see
Table 1). For instance, when describing what they saw in the mirror/through the
window, participants said “she looks a bit sad,” and “he has the same hair”. When
asked whether they had seen the person in the mirror/through the window before,
58.3% of participants said they had seen the person before. Of these participants,
57.1% identified the person as themselves, 14.3% identified the person as a relative,
and 28.6% had seen the person before but didn’t know who they were. Participants
who had not seen the person before were asked whether the person reminded them of
anybody. Of these participants, 50% said they reminded them of a friend and 50%
said they didn’t remind them of anyone.
To index any strategies used, participants were asked during the EAT inquiry
how they went about having the suggested experience. The majority of participants
(66.7%) described using some type of strategy. Of those who used a strategy, 50%
reported focusing on particular features and altering their perception of those features.
For example, one participant in the stranger condition said “I think I mainly
17
concentrated on the features….they seemed a bit exaggerated like pieces cut out of a
magazine.” Another said “Just to pick out things that were different from what I
thought I would look like. Some people think they look skinnier or fatter or whatever
so I picked those things out, accentuated them, and then said that’s where the
difference was.” The other type of strategy reported by participants involved using
visual imagery (50%) such as “I was trying to picture somebody there” and “I
pictured an office through the window and I was watching what was going on inside
of an office.”
Participants were also asked during the EAT how they had felt upon looking
into the mirror. The majority of participants (83.3%) described the experience as
strange and/or uncomfortable. They made comments such as “it felt strange and
almost disbelief that this person could look like me but not be me”, and “I felt quite
tense…..I was thinking why should this stranger look like my mother? It was a bit
scary.” One participant in the stranger condition said “I just thought he was an idiot.
He just kept looking at me from the corner of the mirror…..I just wanted him to go
away. He didn’t really look like anyone you could make a friend with because he just
stared at me.”
Response to Challenges
Participants’ responses to the challenge procedures focused on the 8
participants who passed the suggestion. During the contradiction, participants were
asked how a close friend or a member of their family would tell them apart from the
person they could see. In response to this question, 100% of participants continued to
state that they saw a different person in the mirror/through the window. The majority
of participants said that a close friend or family member would be able to tell them
apart by their different features (62.5%). Another 25.0% of participants said that their
18
friends and family would just know that the person in the mirror was someone else,
and 12.5% said they did not know how their friends and family would tell them apart.
The following transcript illustrates one participant’s response to the contradiction:
Hypnotist: If a close friend or family member came into the room how
would they be able to tell you apart from the person you see?
Participant: They would know by the quality of my skin and my
features…..and the colour and style of my hair and my voice.
During the confrontation, when participants were asked to touch their nose,
100% of participants who passed the suggestion claimed that the person they could
see was also touching their nose. Further, 100% of participants who passed the
suggestion continued to maintain that they could see another person in the
mirror/window. When asked why the person they could see also touched their nose
66.7% of participants said that the person was copying them, 16.7% of participants
said the person touched their nose because they did, and 16.7% of participants did not
know why the person touched their nose. The following is a transcript of one
participant’s response to the confrontation:
Hypnotist: I’d like you to touch your nose with your finger
Participant: He’s copying me (participant laughs)
Hypnotist: What did he do?
Participant: He touched his nose (participant laughs and looks behind him)
Hypnotist: What do you think he did that?
Participant: Maybe he’s trying to make me seem like I’m crazy or
something.
Thus, in response to both the contradiction and confrontation procedures, all
of participants who passed the delusion continued to maintain that they could see a
19
stranger in the mirror/through the window. Participants’ EAT comments highlight
their conviction in their suggested experience. When asked what they had been
thinking and feeling during these challenge procedures, participants made comments
such as “I remember thinking I wanted her (the hypnotist) to ask me more questions
so I could work out what I was feeling and why it felt so bizarre” and “It was as if you
were sitting there and you don’t like someone and somebody gets a big photo of them
and sticks it right in front of you and then makes you answer questions about it and
you think oh I’d rather it was someone else.” When describing her experience of
touching her nose, one participant said “It made it more immediate because the hands
were going up at the same time and it wasn’t as if it was a picture…..it was like a real
person.”
Beliefs, Thoughts, and Explanations
During the suggested delusion, participants were asked to explain how it was
possible that they looked so similar to the person they could see in the mirror/through
the window. Although 1/3 of participants did not formally pass the suggestion only
18.2% responded to this question by stating that the person they could see was
themselves. A further 27.3 % could not provide an explanation. Of the explanations
provided, the most common was that the person co-incidentally had similar features
(36.4%). Other explanations were that the person was a relative (9.1%), or that they
were copying the participant (9.1%).
During the EAT inquiry, participants were asked what thoughts and
expectations they had as they listened to the suggestion. One participant in the
window to a view of a stranger condition said “I thought there was going to be an
actual window…..I had a vivid image of a stranger….like a criminal.” One participant
in the stranger condition said “I thought that if it was a stranger I would probably do
20
things with my hands to see if he’s copying me.” Participants were also asked what
thoughts they had when they first looked in the mirror. One participant in the window
to a view of a stranger condition said “I thought wow there’s an actual person behind
that window…..I didn’t know who she was and why she kept looking at me.” Another
participant in the same condition said “It was a stranger and the features reminded me
of my mother……and just the sort of feeling of dread, you know….what’s she going
to do? Break through the window?” One participant in the stranger condition said “the
more I looked the more I saw someone else just looking back at me and I just thought
it was a weirdo.” One participant in the stranger condition looked around the room a
number of times for the ‘stranger’ during the suggested experience. During the EAT
he said “I really thought it was someone else in the mirror. That’s why I looked
behind me…..I thought someone was standing there and hence their reflection was in
the mirror.”
In order to examine the thoughts and explanations that ‘seed’ the delusion,
participants were asked during the suggested delusion why the person they could see
always did what they did. Of those who passed, 83.3% continued to maintain that they
were seeing another person and 16.7% said the person always did what they did
because it was their own reflection. The most common explanation was that the
person was copying them. Other explanations included “maybe he’s trying to make
me seem like I’m crazy”, “he’s cheeky” and “she’s outside and wants to come in so
she’s imitating me so I’ll feel closer to her.” Thus, participants had no difficulty
eliciting explanations to justify their deluded belief.
Cancellation
Following cancellation, 100% of participants saw their own reflection in the
mirror. During the EAT they were asked to describe their reactions to the cancellation
21
instructions. One participant said “It was so good because I knew in the mirror I’d see
myself and I could relax.” Another said “I didn’t recall the past times when I saw a
different person….I didn’t want to remember it because I would’ve seemed like an
idiot.” Participants also described their thoughts and feelings upon looking into the
mirror after the suggestion had been cancelled. Participants made comments such as
“I just felt kind of relieved that there was no stranger staring back”, “I looked in the
mirror and I was expecting to see this other guy again but that other guy was actually
me and I kind of realised that there wasn’t another guy before” and “it made sense
again. It was kind of a relief. I had a bit of understanding about what I was seeing in
the last one too.”
Discussion
This study suggests that hypnosis is a useful analogue for creating a
subjectively compelling mirrored self-misidentification delusion in high hypnotisable
individuals. This study lays the groundwork for a larger project that aims to develop
hypnotic analogues of a variety of monothematic delusions. Findings from this study
indicate that the features of hypnotic mirrored self-misidentification are strikingly
similar to clinical cases. The majority of participants did not recognise their reflection
in the mirror, referred to themselves in the 3rd person, and described the person in the
mirror/through the window as having different physical characteristics. Similarly,
when their suggested delusion was challenged, all of the participants who passed
continued to maintain that they did not recognise their reflection in the mirror.
Finally, upon cancellation, participants expressed relief at no longer seeing a stranger.
These findings suggest a number of parallels between the features of hypnotic
and clinical mirrored self-misidentification. Both are characterised by strong
conviction that the person they see in the mirror is not them. During the EAT inquiry,
22
a number of participants in this study commented on the compelling nature of their
experience and expressed strong belief that they were really seeing a stranger in the
mirror. Although both clinical patients and hypnotic participants can often point out
physical differences between themselves and the person they see in the mirror, both
groups are also willing to acknowledge that the person they see looks similar to them.
A number of hypnotic participants made comments such as “he probably looks a bit
like me” and “she looks like me….because of the face and structure of her cheeks.”
Interestingly, both clinical patients and hypnotised individuals also display elements
of covert recognition (Breen et al., 2000). For example, when FE was asked what
colour hair the person in the mirror had, he tilted his head forward to examine his hair
in the mirror before replying that the person was not as white as him. Similarly, when
TH was asked if the person he could see in the mirror was bald he replied, “yes, he’d
have to be”. This indicates that at an implicit level, FE and TH may have had some
awareness that the person in the mirror was actually their own reflection. Likewise, a
number of hypnotic participants also displayed some level of covert recognition,
making comments such as “he’s not me but there are bits and pieces. I can see bits
and pieces…..” Additionally, one participant said the person she could see had the
same first name as she did, indicating some awareness that it was her reflection.
Another similarity between hypnotic and clinical cases of mirrored self-
misidentification involves the issue of conversing with the person in the mirror. Both
the clinical patients TH and FE expressed frustration at not being able to converse
normally with the person they saw in the mirror. One hypnotic participant described a
similar experience during the suggested delusion saying, “he’s saying something but I
can’t understand.” When asked why he couldn’t understand he said, “because I can’t
lip read.” During the EAT inquiry, one participant said “I could hear my voice but I
23
could see him in the mirror moving his lips….I couldn’t connect that to him being
me.” Another participant described how he had completely focused on the eyes and
said “I’m sure if I had focused on something else I would’ve noticed the mouth was
moving and stuff and I would’ve been like, he’s talking but I can’t hear him.”
Both clinical patients and hypnotised individuals also expressed discomfort at
seeing a stranger staring at them in the mirror. TH had a curtain covering all the
mirrors in the house and said that whenever he lifted up the corner of a curtain he
could see the stranger peering out at him. Similarly, one hypnotised participant
commented, “when I can’t see him, he can’t see me.” Another said, “I was poking my
head around as if I was sort of looking at someone secretly.” Additionally, FE
mentioned that the stranger made him feel a bit sick because he moved about so freely
with him. A number of hypnotised participants reported similar feelings of discomfort
during the EAT claiming, “I felt kind of weird seeing someone just stare at me that
close”, and “I didn’t trust the other person.”
A final similarity is that both clinical and hypnotic individuals maintain their
mirrored self-misidentification delusion in the face of challenge. Thus, despite being
presented with evidence and rational counterarguments contrary to their beliefs, these
individuals continue to believe that they are seeing a stranger. The clinical patients
TH and FE were challenged when the examiner appeared in the mirror alongside them
and asked them who they saw in the mirror. Although both patients could identify the
examiner in the mirror, they continued to claim that their own reflection was a
stranger. Likewise, during the contradiction and confrontation procedures in the
current study, hypnotised individuals also maintained their belief that they were
seeing a stranger, stating that their friends and family would have no trouble
distinguishing them from the stranger and that the stranger was simply copying their
24
actions. Thus, these individuals were able to generate reasons that justified their
deluded belief and were able to explain why the person they were seeing always did
what they did.
Within the context of Langdon and Coltheart’s (2000) two-factor model, in
mirrored self-misidentification factor 1 is thought to involve a problem processing
familiar faces such that one’s own face appears unfamiliar. Interestingly, a number of
participants made comments during the EAT inquiry about recognising their own face
during the suggested delusion. One participant said “I felt I didn’t know that
person…..or I didn’t think that it was familiar”, and another said, “usually when I
look in the mirror I perceive myself as a whole but when I was looking at this….it
was just like key bits that didn’t really seem to fit together.” Following cancellation,
one woman said “I had a great feeling of relief…..it was familiar.” Thus, as in clinical
cases, a hypnotic mirrored self-misidentification delusion also appears to impair
feelings of familiarity about one’s own face. Consequently, in both hypnotic and
mirrored self-misidentification, impaired familiarity about one’s own face may cause
an individual to develop a delusional hypothesis that the person they see in the mirror
is a stranger. According to Langdon and Coltheart (2000), delusional hypotheses such
as this are accepted as beliefs due to a deficit in belief evaluation (factor 2).
In addition to impairing feelings of familiarity about one’s own face, the
hypnotic mirrored self-misidentification delusion appeared to create a deficit in belief
evaluation (factor 2). In order to understand the factor 2 deficit, this study examined
the thoughts and explanations generated by participants that “seed” their delusional
beliefs. When participants were asked why they thought the person they could see
always did what they did, the majority said that the stranger they could see was
copying them. This somewhat simplistic explanation appeared to satisfy participants.
25
In fact, during the EAT one participant said that whilst listening to the suggestion he
kept thinking that it wouldn’t be effective. When he initially looked in the mirror he
actively tried to convince himself that he was looking at his own reflection. However,
when he touched his nose and saw the person in the mirror do the same he thought the
person was copying him and could no longer convince himself that it was his own
reflection. His belief that the person in the mirror was copying him appeared
sufficient to convince him that he was looking at a stranger. This suggests that
deluded individuals may indeed have a deficit in belief evaluation. The deluded
beliefs of the hypnotised individuals in this study appeared to be heavily influenced
by seemingly poor quality evidence. It is suggested that these participants may have
lowered the criteria that they would normally use when weighing up evidence to
develop beliefs.
Breen et al., (2000), have suggested that factor 2 may involve a failure to be
influenced by evidence which would contradict or override a delusional hypothesis.
Findings from this study suggest that in addition to this, deluded individuals may also
have less stringent criteria for evaluating delusional hypotheses. Thus, deluded
individuals may uncritically accept delusional hypotheses based on poor quality
evidence. This is consistent with findings indicating that delusional individuals
exhibit biases in their reasoning processes and often jump to conclusions (Bentall,
Kinderman, & Kaney, 1994; Garety & Freeman, 1999). Studies have demonstrated
the deluded individuals gather less evidence before reaching a conclusion and do not
consider alternative explanations (e.g., Gartey & Freeman, 1999; Stone & Young,
1997). It may be that deluded individuals do not consider alternative explanations
because poor quality evidence that slightly favours a delusional belief is interpreted as
overwhelming evidence due to less stringent belief evaluation criteria. Thus, factor 2
26
may involve a lowering of belief evaluation criteria such that poor quality evidence is
accepted as sufficient justification for a deluded belief.
This study is the first in a series of experiments that will be used to develop a
catalogue of hypnotic analogues of clinical delusions. In developing this catalogue we
will examine the features and parameters of hypnotic delusions, the impact of
challenging the delusions, and whether role-playing participants display the same
behaviour as genuinely hypnotised participants. This initial study indicates that
hypnosis is a useful and effective analogue of mirrored self-misidentification
delusion. The hypnotic delusion was credible, compelling, and resistant to challenge.
In addition to modelling the features of delusions, we also aim to identify the
cognitive processes that may be occurring during a delusion. For instance, we will
explore the impact of a suggested delusion on information processing and memory
with a particular focus on selective facilitation and inhibition of information. In
addition to investigating the parameters of hypnotic delusions, this program of
research will also provide scope to empirically test theoretical accounts of delusions,
such as the two-factor model. Thus, we hope to establish hypnosis as a new
empirically-based framework for investigating and understanding delusions.
27
References
Barnier, A.J. (2002). Posthypnotic amnesia for autobiographical episodes: A
laboratory model of functional amnesia? Psychological Science, 13, 232-237.
Barnier, A.J., & McConkey, K.M. (1999). Autobiographical remembering and
forgetting: What can hypnosis tell us? International Journal of Clinical and
Experimental Hypnosis, 47(4), 346-365.
Barnier, A.J., & McConkey, K.M. (2004). Defining and identifying the highly
hypnotisable person. In M. Heap, R.J. Brown, & D.A. Oakley (Eds.), The
highly hypnotizable person: Theoretical, experimental and clinical issues (pp.
30-61). East Sussex, England: Brunner-Routledge.
Barnier, A.J., McConkey, K.M., & Wright, J. (2004). Posthypnotic amnesia for
autobiographical episodes: Influencing memory accessibility and quality.
International Journal of Clinical and Experimental Hypnosis, 52(3), 260-279.
Bentall, R.P., Kinderman, P., & Kaney, S. (1994). The self, attributional processes
and abnormal beliefs: Towards a model of persecutory delusions. Behaviour
Research and Therapy, 32, 331-341.
Blum, G.S. (1975). A case study of hypnotically induced tubular vision. International
Journal of Clinical and Experimental Hypnosis, 23, 111-119.
Breen, N., Caine, D., Coltheart, M., Hendy, J., & Roberts, C. (2000). Towards an
understanding of delusions of misidentification: Four case studies. Mind and
Language, 15(1), 74-110.
Bryant, R.A., & McConkey, K.M. (1989a). Hypnotic blindness, awareness, and
attribution. Journal of Abnormal Psychology, 98, 443-447.
28
Bryant, R.A., & McConkey, K.M. (1989b). Visual conversion disorder: A case
analysis of the influence of visual information. Journal of Abnormal
Psychology, 98, 326-329.
Burn, C., Barnier, A.J., & McConkey, K.M. (2001). Information processing during
hypnotically suggested sex change. International Journal of Clinical and
Experimental Hypnosis, 49, 231-242.
Burns, B., & Reyher, J. (1976). Activating posthypnotic conflict: Emergent
uncovering psychopathology repression, and psychopathology. Journal of
Personality Assessment, 40(5), 492-501.
Coltheart, M. (2005). Delusional belief. Australian Journal of Psychology, 57(2), 72-
76.
Cox, R.E., & Barnier, A.J. (2003). Posthypnotic amnesia for a first romantic
relationship: forgetting the entire relationship versus forgetting selected
events. Memory, 11, 307-318.
Davies, M., Coltheart, M., Langdon, R., & Breen, N. (2002). Monothematic
delusions: Towards a two-factor account. Philosophy, Psychiatry, and
Psychology, 8(2-3), 133-158.
Garety, P.A., & Freeman, D. (1999). Cognitive approaches to delusions: A critical
review of theories and evidence. British Journal of Clinical Psychology, 38,
113-154.
Halligan, P.W., Bass, C., & Wade, D.T. (2000). New approaches to conversion
hysteria. British Medical Journal, 320(7248), 1488-1489.
Kihlstrom, J.F., & Hoyt, I.P. (1988). Hypnosis and the psychology of delusions. In
T.F. Oltmanns & B.A. Maher (Eds.), Delusional Beliefs (pp. 66-109). Wiley
series on personality processes. Oxford, England: John Wiley & Sons.
29
Langdon, R., & Coltheart, M. (2000). The cognitive neuropsychology of delusions.
Mind and Language, 15, 184-218.
McKay, R., Langdon, R., & Coltheart, M. (2005). “Sleights of mind”: Delusions,
defences, and self-deception. Cognitive Neuropsychology, 10(4), 305-326.
Noble, J., & McConkey, K.M. (1995). Hypnotic sex change: Creating and challenging
a delusion in the laboratory. Journal of Abnormal Psychology, 104, 69-74.
Perkins, K.A., & Reyher, J. (1971). Repression, psychopathology and drive
representation: An experimental hypnotic investigation of impulse inhibition.
American Journal of Clinical Hypnosis, 13(4), 249-258.
Reyher, J. (1961). Posthypnotic stimulation of hypnotically induced conflict in
relation to psychosomatic reactions and psychopathology. Psychosomatic
Medicine, 23, 384-391.
Reyher, J. (1962). A paradigm for determining the clinical relevance of hypnotically
induced psychopathology. Psychological Bulletin, 59(4), 344-352.
Reyher, J. (1969). Comment on “Artificial induction of posthypnotic conflict”.
Journal of Abnormal Psychology, 74(4), 420-422.
Reyher, J., & Basch, J.A. (1970). Degree of repression and frequency of
psychosomatic symptoms. Perceptual and Motor Skills, 30(2), 559-562.
Sheehan, P.W., & McConkey, K.M. (1982). Hypnosis and experience: The
exploration of phenomena and process. Hillsdale, NJ: Erlbaum.
Shor, R.E., & Orne, E.C. (1962). The Harvard Group Scale of Hypnotic
Susceptibility, Form A. Palo Alto, CA: Consulting Psychologists Press.
Stone, T. & Young, A. (1997). Delusions and brain injury: The philosophy and
psychology of belief. Mind and Language, 12, 327-364.
30
Sutcliffe, J.P. (1961). “Credulous” and “skeptical” views of hypnotic phenomena:
Experiments in esthesia, hallucination and delusion. Journal of Abnormal and
Social Psychology, 62, 189-200.
Weitzenhoffer, A.M., & Hilgard, E.R. (1962). Stanford Hypnotic Suscpetibility Scale,
Form C. Palo Alto, CA: Consulting Psychologists Press.
Woody, E., & Szechtman, H. (2000). Hypnotic hallucinations: Towards a biology of
epistemology. Contemporary Hypnosis, 17(1), 4-14.
Zimbardo, P.G., Andersen, S.M., & Kabat, L.G. (1981). Induced hearing deficit
generates experimental paranoia. Science, 212, 1529-1531.
31
Table 1
Experiencing the Delusion
Stranger Window Window + Stranger
Passed 3 (75%) 1 (25%) 4 (100%)
3rd Person 3 (75%) 3 (75%) 4 (100%)
Physical Diffs. 2 (50%) 4 (100%) 3 (75%)
