AMERICAN JOURNAL OF CLINICAL HYPNOSIS

VOLUME 33, NUMBER I, JULY 1990

Dissociation and Displacement: Where Goes

the "Ouch?"

John G. Watkins
and
Helen H. Watkins
University of Montana

Hypnosis is widely used to relieve pain. Current theory emphasizes its disso-
ciative features. Multiple personality patients can eliminate pain in the primary
personality by displacing it into underlying alters. The Hilgards demonstrated
that normal hypnotized subjects can similarly dissociate pain into a covert
cognitive structural system which they called the "hidden observer." The Wat-
kins discovered that "hidden observers" appeared to be the same phenomenon
as "ego states." "Ego-state theory" assumes that human personality develops
through integration and differentiation. At one end of the continuum, "differ-
entiation" is adaptive. Ego states possess relatively permeable boundaries as
in normal moods. At the other end ego-state boundaries become less permeable.
Normal "differentiation" becomes maladaptive "dissociation" and multiple
personalities may be created. In the intermediate range of the differentiation/
dissociation continuum, "covert" ego states can be found in many normal
subjects who volunteer for hypnotic laboratory experiments. Normal individ-
uals, like multiple personalities and "hidden observer" subjects, can displace
(dissociate) pain into "covert" ego states. The pain is not eliminated. This
suggests that when we remove pain by hypnosis we may not be getting away
"scot-free."

Relief from pain has been a never-end-
ing search by mankind. We spend billions
of dollars a year on analgesics and anes-
For reprints write to John G. Watkins,
Ph.D., 413 Evans Street, Missoula, MT
59801.
Received November 2, 1988; revised April 12,
1989; second revision November 25, 1989; ac-
cepted for publication January 19, 1990.
thetics plus additional millions advertis-
ing them. Researchers seek both more
effective medications and psychological
procedures for pain reduction. Pain can
result from tissue lesions, organic dys-
function, psychological conflicts, or some
combination of these.
The power of internal conflicts to cause
a wide range of psychophysiologic dis-
orders has been well documented over the
years (Alexander, 1950; Dunbar, 1947;
2 WATKINS AND WATKINS
Lipowski, Lipsitt, & Whybrow, 1977). It
needs no further proof here. Experienced
pain may have relative physical and psy-
chological components (Sternbach, 1963).
However, psychological approaches (in-
cluding hypnosis) have been used suc-
cessfully to moderate or eliminate various
types of suffering (Hilgard & Hilgard,
1975). These include physical pain, such
as burns (Crasilneck & Hall, 1975), as
well as those of psychogenic origin.
Pain and Emotion
There is evidence that pain can be emo-
tionally initiated or aggravated in cases of
presumably physical causes, including
tissue damage (Hilgard & Hilgard, 1975).
Rossi and Cheek (1988) presented a num-
ber of clinical reports and experimental
findings demonstrating that perceived pain
(both physical and psychological) may
often be related to guilt, anger, or other
affective states, the emotional condition
frequently requiring treatment before the
pain could be alleviated. Following is a
brief example from one of our own clin-
ical cases illustrating the effect on a head-
ache of the abreactive release of anger.
This 27-year-old patient came to the
session complaining of a severe headache
and requested aspirin. Instead of giving it
to him the therapist (H. W.) promised to
remove the headache. The patient was then
hypnotized and regressed to a 3-year-old
state where he reported and re-experi-
enced abuse from his mother. Because of
his fear of the mother on whom he was
dependent, he was unable to express any
anger toward her. After the therapist al-
lied herself with the 3-year-old child state
and offered to "hold the mother" and
prevent her from striking him with his belt
(as she had so often done), he asked for
"permission" to "beat her with the belt."
On receiving this from the therapist, with
much glee and shouting he beat the ther-
apist's couch, until he spontaneously
emerged from hypnosis exclaiming,
"You're right. My headache is gone."
This example is but one of a number of
similar clinical cases we have observed.
Hypnotic Relief from Pain
In addition to pain relief with burns,
there are numerous reports of the use of
hypnosis to relieve pain in such cases as
carcinoma, rheumatoid arthritis, surgery,
whiplash, back pain, obstetrics, dentistry,
and many others. We may conclude that
psychological intervention in the form of
hypnosis has often been effective in al-
leviating pain, whether functionally or or-
ganically caused (Brown & Fromm, 1987;
Crasilneck & Hall, 1975; Hilgard & Hil-
gard, 1975; Kroger, 1977; Rossi & Cheek,
1988, to cite but a few sources).
The question to be posed here is whether
by such treatment we are getting off "scot-
free," with the pain eliminated, or whether
this. pain may simply be unconsciously
"displaced" to some other area in the
psychophysiologic structure of the patient
with possible sequelae.
Hypnosis and Dissociation
Recent research by Hilgard (1986) has
proposed a theory in which hypnosis is
considered as a specialized form of dis-
sociation. Ever since Janet (1907), the
close relationship of hypnosis to dissocia-
tion has been recognized, and recent clin-
ical and experimental studies with multiple
personality disorders (MPD) have re-
ported that MPD cases are characterized
by high hypnotizability (Kluft, 1987; Bliss,
1986). In fact, the disorder has even been
defined by some as one of "spontaneous
hypnosis" (Beahrs, 1982; Bliss, 1986).
However, there is little evidence that
DISSOCIATION AND DISPLACEMENT
hypnosis can "create" a true multiple
personality with its full range of behav-
iors (Braun, 1984), although it is com-
monly employed by therapists to
understand and treat MPD. Many of the
dissociative features of multiple person-
ality can be duplicated through hypnosis,
and the study of the one has enabled us
to discover characteristics of the other.
If we regard hypnosis as a controlled
dissociation, and multiple personality as
a self-induced and uncontrolled one, then
what can the study of multiple personal-
ities tell us about the dissociation of pain,
and thus the possible effects of hypnoti-
cally dissociated pain?
Dissociation by Self-Hypnosis
Many individuals are able to hypnotize
themselves, and self-hypnosis has been
added as an accepted therapeutic proce-
dure (Fromm, et. aI., 1981). Beahrs (1986)
has described the dissociative process in
multiple personalities as a form of self-
hypnosis that is designed to protect them-
selves from the pain and abuse they re-
ceived as children. In other words, when
confronted by more pain, guilt, and rage
than they can tolerate, abused children may
dissociate this mental "hazardous waste"
into alters created for the purpose of pro-
viding internal "garbage cans." The
original and primary personality now no
longer feels the misery. The mechanism
when initially employed was adaptive and
helped the child cope with an overwhelm-
ingly hostile social environment. Disso-
ciation in this more severe form, however,
has then become maladaptive and symp-
tom causing. In the true multiple person-
ality the skill of dissociating pain learned
as a child may continue to be practiced
as an adult.
Diana, the major alter in a multiple per-
3
sonality which normally did not experi-
ence much pain, complained at a therapy
session that she had a severe headache.
"Well, Diana," I (J.W.) replied, "you
know how to eliminate pain, don't you?
You have practiced this for many years. "
"Of course I do," she responded. "Well,
why don't you do that right now." Diana
closed her eyes and lowered her head. In
a few moments she looked up and brightly
volunteered, "O.K. It doesn't hurt now."
I then asked, "Is there anybody who knows
about Diana's pain?" Mary, a misery-rid-
den child alter, emerged shouting, "Damn
you, my head just started to hurt."
For years, Mary, who "lived in the (self-
house) basement," had been receiving the
pain and rage that Diana, the jolly pri-
mary state, did not want to experience.
How many sessions we had had where
Diana, with her easy-going smile and
friendly manner, reported the good events
of the day, or if they were bad, never
seeming to suffer from them. And how
many times later in that same session would
Mary appear, often spontaneously, en-
raged, crying, and suffering from these
same incidents. Since childhood, Diana
had learned to dissociate her pain and an-
ger by displacing them into other alters,
primarily Mary. Mary was both suicidal
and homicidal, and we spent many wor-
risome days and nights wondering whether
she might emerge and kill her own (Dian-
a's) children or herself.
Dissociation in Multiple Personalities
Dissociation Reinforcement in MPD
If this defensive operation of displacing
pain to an "unconscious" alter is suc-
cessful, it is reinforced by a lowering of
tension. A reinforced process is self-per-
petuating. The more adaptive it is for the
time being, the more it tends to be uti-
4 WATKINS AND WATKINS
lized. The individual begins to employ
dissociation increasingly in coping with
lesser problems, such as the need to avoid
criticism, the desire to exercise an ath-
letic, artistic, or other ability, without
cognitive dissonance from contrary mo-
tivations. More and more alters are cre-
ated to solve problems of living, and the
personality is split into ever-increasing,
discrete segments, isolated and uncom-
municative with each other. Walls of am-
nesia are erected between the different
states as the multiple personality structure
develops increasing complexity. It is like
a psychological cancer which feeds on it-
self, and yet its function is designed to be
protective of the system.
Dissociation of Organic Pain in MPD
It may be argued that Diana's "head-
ache" was probably a functionally caused
pain. What would happen if it had a dem-
onstrated organic origin? Shortly after-
ward, Diana provided some data on this
question. She reported that the day before
she had burned a finger on her hand by
touching a frying pan on the stove. In
fact, it was severely blistered. Her im-
mediate reaction on feeling the pain was
to "turn it off," which she described as
her habitual response to discomfort. Be-
cause of our previous experience with the
headache, which had been displaced to
Mary, I asked Diana just who had re-
ceived the burn pain. She didn't seem to
know. Accordingly, she was hypnotized
and we "polled" the other alters. To my
surprise we discovered that the pain had
been sent first to Mary who refused to
take it. It was then transferred to Karl, a
4-year-old child alter. Karl "cried and
yelled so loud" that Danny, a 12-year-
old alter who was characterized by his
toughness and courage, shouted to Karl,
"Shut up! I'll take it." And there the pain
remained - in Danny. Later that day the
patient went bowling. Neither Diana nor
" Alex," the adolescent athlete alter who
did most of the bowling, experienced any
pain in handling the ball, even though the
blister broke in the process. Danny had
the pain, and he wasn't "present" during
the bowling.
David, a multiple personality, had an
alter, "Dr. Paul," who was developed
when David as a teenager had served on
a ski patrol. There he learned first aid by
reading medical books, sometimes even
setting broken limbs. David was amnesic
to the times when Dr. Paul was "out"
but through therapy had recovered some
of the events which took place at that time.
Many hate and rage abreactions were
undertaken as part of our treatment. Dr.
Paul was most helpful in letting us know
just how much suffering David could con-
front at anyone time, and he regulated
the intensity of these experiences. Once,
he even prescribed a day of rest.
Three years earlier with another thera-
pist David had discovered a 6-year-old al-
ter by the name of "Davy." Ever since
the activation of Davy, he had suffered
recurrent headaches and tinnitus. During
a recent session he recovered an event from
the age of 6. While playing tag with his
sister, she threw a blanket over his head,
and he had run into a large maple tree
knocking himself unconscious. He had
been amnesic to this incident for almost
30 years.
As he recalled the experience his tin-
nitus returned. His shoulder and left foot
hurt, and he began suffering a very severe
headache. It was apparent that he was now
re-experiencing the headache pain, the
tinnitus, plus the shoulder and foot pains
which had been dissociated into "Davy"
since the age of 6. The original creation
of the Davy alter was actually an exercise
DISSOCIAnON AND DISPLACEMENT
in pain control by self-hypnosis, and the
suffering of that period had never been
eliminated, only dissociated and post-
poned for 30 years.
David had been refusing the nurse's of-
fer for Tylenol. "Dr. Paul," the wise in-
ner-physician alter, said, "If multiple
personalities are medicated they don't ex-
perience the feelings they should feel to
get well." We initiated pain abreactions,
which David experienced and worked
through. His tinnitus ceased. His suffer-
ings diminished and soon after disap-
peared. Diana, too, found medication
(Tylenol, aspirin) of much less help than
dissociation in relieving all kinds of pain.
It should not be surprising that multi-
ples can dissociate pain into underlying
alters. They were created in the first place
to deal with unbearable child abuse -
physical, sexual, and psychological. The
essence of therapy for the integration of
multiples is that the primary personality
must re-assume responsibility and control
of its own memories, experiences, and
feelings, especially the pain, fear, and rage
with which it could not cope as a child.
"Diana" must take back the pain and an-
ger which resulted from abuse, and she
must likewise assume responsibility for
pains coming from the present. She must
cease pushing these down into "Mary"
or "Danny" if integration is to be
achieved. Diana reluctantly accepted the
pain back from Danny, and in time it went
away.
We shall not pursue the treatment of
Diana or David further. But what has all
this to do with pain that has been elimi-
nated in "normals" through hypnosis?
Perhaps experiments on ego states (Wat-
kins & Watkins, 1979-80, 1980) and the
"hidden observer" phenomenon (Hil-
gard, 1986) may provide some relevant
data on this question.
5
Dissociation and Displacement
Dissociation as a psychological defense
mechanism is not restricted only to mul-
tiple personalities. Disorders with a pri-
marily psychological etiology can be
"displaced" from one system to another
in patients having nothing to do with mul-
tiple personality. A previously unreported
case of "neurodermatitis" was aggres-
sively treated by the dermatological spe-
cialist in a V.A. hospital. He would recover
from his skin disorder only to manifest an
overt psychotic reaction. This condition
could be relieved in our psychiatric ser-
vice by electroconvulsive therapy, where-
upon his skin would break out again. Some
individuals seem able to displace dys-
function from one organ system to an-
other-even as the multiple displaces
(dissociates) pain from the primary per-
sonality into an alter.
Ego States: Theory and Therapy
Ego-state theory starts from the as-
sumption that personality develops by two
basic processes: integration (a putting to-
gether) and differentiation (a separation
or taking apart). Through a "putting to-
gether" of cat, dog, cow, and other ani-
mals, the child learns the concept of
"animal." Through differentiation he
learns to discriminate between a cat and
a rabbit or between what is good to eat
and what is not. As he integrates and dif-
ferentiates he develops into an increas-
ingly complex personality.
Most psychological processes (anxiety,
depression, motivation, etc.) are not an
either-or; they exist on a continuum. And
most in their lesser intensities (like anxi-
ety) are constructive. It is their excesses
that are destructive. Differentiation (the
separating process) up to a certain point
is adaptive. Beyond that, it becomes de-
6 WATKINS AND WATKINS
fensive, then increasingly maladaptive.
When still further intensified we call it
"dissociation." It becomes pathological
and in its extreme form results in multiple
personalities.
Federn (1952) held that personality is
organized into patterns which he called
"ego states." We (Watkins & Watkins,
1981, 1982, 1986) have defined an ego
state as "a body of behaviors and expe-
riences bound together by a common
principle and separated from other such
entities by a boundary which is more or
less permeable." At the lower end of the
distribution the boundaries between ego
states are very permeable, and each may
be more like a normal mood that varies
from time to time. One ego state may be
activated Tuesday at work and another be
"executive" at a party Saturday night,
which is why we feel, think, and behave
differently at one time than another. Nor-
mal ego states may be compared to geo-
graphic states, like school districts, cities
or geographic states (Montana or Idaho).
They are differentiated and adaptive for
administrative efficiency. Their bounda-
ries are not rigid. Mutual awareness and
communication between them relatively
prevails.
We have many recorded excerpts which
show that ego states, when activated, be-
have in very surprising ways that are fre-
quently quite contrary to therapist
expectations or requests (Watkins & Wat-
kins, 1980). Their responses indicate that
they are much more than suggested arti-
facts. As the rigidity of their boundaries
increases, awareness and communication
between them deteriorates, and normal
differentiation changes into dissociation.
In the extreme form, multiple personali-
ties, little or no mutual awareness or com-
munication takes place (as in East and West
Germany during the days of the Berlin
Wall).
Ego-state theory will not be pursued
further here except to note that the inter-
mediate range on the differentiation-dis-
sociation continuum contains ego states
which, unlike multiple personality alters,
do not emerge overtly, spontaneously.
They require hypnotic activation and, when
so discovered by hypnotherapists, are often
mistakenly diagnosed as "multiple per-
sonalities." These entities, however, do
function like "covert multiples" with dis-
cernable boundaries, contents, and ident-
ities. "Ego-state therapy" is the use of
group and family therapy techniques
(usually under hypnosis) to resolve con-
flicts between the different ego states which
constitute a "family of self" within a sin-
gle individual. The previously cited ref-
erences by Watkins and Watkins discuss
this theory and therapy in much greater
detail with research findings and case il-
lustrations. Suffice it to say that ego states
are frequently found in the hypnothera-
peutic treatment of many problems, rang-
ing from normal (stop smoking, weight
reduction, study habits) through various
neurotic and psychophysiologic condi-
tions to true multiple personalities (Edel-
stein, 1982; Newey, 1986; Torem, 1987;
Watkins & Watkins, 1981, 1982, 1988).
Experimental.support for the existence and
behavior of ego states comes from the
Stanford studies on "hidden observers."
The "Hidden Observer" Phenomenon
In the Stanford studies Hilgard and Hil-
gard (1975) discovered that painful stim-
uli, such as that imposed by restriction of
circulation or by immersion in ice water,
could still be perceived "unconsciously"
after hypnoanesthesia had apparently ren-
dered the subject pain-free. Hilgard at-
DISSOCIATION AND DISPLACEMENT
tributed this awareness to an underlying,
covert "cognitive structural system" which
he called "the hidden observer." Beahrs
(1982) termed this phenomenon "co-con-
sciousness," one segment of "the self"
being aware of the pain, while simulta-
neously another segment (the normally
conscious part) was unaware of it.
The relevant finding here is that pain
which has apparently been eliminated by
hypnotic suggestion is still retained within
a covert "cognitive structural system."
This dissociation (or displacement) of pain
was demonstrated with normal volunteers
(college students) who were not multiple
personalities. It occurred to us that this
"cognitive structural system" might well
be one of the "ego states" with which we
had been working therapeutically.
Ego States and Hidden Observers
We (Watkins & Watkins, 1979-80;
1980) activated hidden observers using
Hilgard's cold-pressor pain procedure on
five subjects previously treated a year ear-
lier by ego-state therapy. Anesthesia was
suggested in the hypnotized subject's right
hand, and it was thrust into ice water with
instructions to remove it when the cold
could no longer be endured. One subject
kept the hypnotically anesthetized right
hand in the ice water five times as long
as he did with the unanesthetized left hand
and then developed a severe stomach ache.
The pain had apparently been displaced
from the hand to the stomach. A recorded
excerpt from this case is as follows:
A known ego state, "Old One," pre-
viously studied in therapy, emerged and
reported that the hypnotic instructions were
that he would not feel any pain "in the
hand," so when he did feel it, it was in
the stomach. When asked whether "some
other part" experienced the pain, another
7
known ego state, 3-year-old "Sandy,"
emerged and said, "Yeah." "Tell me
about it, Sandy," I said. "Well, it hurt."
"It did?" "Yeah! What do you expect?
lese." "Well, Ed" (the overt subject)
"didn't seem to feel pain in his hand."
"Well, I did," Sandy complained, "and
I didn't like it at all."
The patient, Ed, was not a multiple
personality but a college student who came
to therapy to resolve certain neurotic
symptoms including an inability to con-
centrate on his studies. His various ego
states could be contacted only under hyp-
nosis. His study problems were found to
stem from interference by Sandy who re-
sented not being able to "play." They
were resolved when the therapist (H. W.),
using ego-state therapy, arranged to have
Sandy's play needs satisfied. In this case
we see a pain being displaced from one
bodily organ to another (hand to stomach)
and also displaced from the primary cog-
nitive structural system (Ed) to other
"hidden observers" or ego states (Old One
and Sandy).
That pain is not necessarily eliminated
by hypnotic suggestion but may be dis-
placed into other segments of the person-
ality has many implications, not only for
the treatment of multiples, but for the
therapy of pain in general. Such displace-
ments seem more widely possible since
ego states have been found to be a part
of normal adaptation in many individuals
who have come to us for relatively non-
pathological conditions: study habits, stop
smoking, or weight reduction and in some
cases professional therapists who merely
wished to improve their own functioning,
as do analysands who take "training"
psychoanalyses.
An interesting situation occurred with
Wendy, a 35-year-old woman who suf-
fered continuous abdominal pain related
8 WATKINS AND WATKINS
to a clostridium condition in the bowel.
To control the pain, and to help her re-
duce the use of medication, she was taught
self-hypnosis. Wendy was not a multiple
personality, but she was aware of a child
ego state, called "Sally," which she had
discovered under hypnosis. Wendy and
Sally became close, affectionate friends,
communicating with each other, but only
under hypnosis.
It was very distressing to Wendy when
she discovered that if she, Wendy, re-
lieved her pain through self-hypnosis, Sally
when activated would emerge weeping,
bitterly complaining of severe suffering.
Sally then would seek support and nur-
turance from the therapist. Wendy, her-
self, rarely cried.
Wendy decided consciously that her re-
lationship with her own "child ego state"
was so important that she would use self-
hypnosis to lessen but not eliminate the
pain, thus giving only part of it to Sally.
Subsequently she used self-hypnosis
merely to take the severe edge off the pain,
making it tolerable - and Sally ex-
pressed gratitude to Wendy that her se-
vere suffering was lessened.
Wendy told us she felt that if she trans-
ferred all the pain into Sally she would be
"denying" Sally and that in time she
would become increasingly separated and
"lose all contact with her." This obser-
vation is an interesting bit of insight by
the patient, suggesting an awareness that
if she practiced greater dissociation she
might become a true multiple.
In psychoanalytic therapy it has been a
matter of established belief that repressed
anxiety (as opposed to consciously acti-
vated, "worked-through," and released
anxiety) may permit the patient to feel
better for the present but at the cost of
energy tied up in the repressing process,
hence leaving less energy for other things
and lowering the efficiency of living. A
similar situation may exist when pain is
repressed (or dissociated) rather than con-
fronted and "worked-through."
We are left with an intriguing question.
How many people with normal ego states
relieve their sufferings (current or "mem-
ory" pains) by aspirin, Tylenol, Advil,
hypnotic suggestion, or self-hypnosis,
rather than by confronting and wearing
them out. Could it be that patients whose
pain has been removed by hypnotic sug-
gestion (or even by pharmacological in-
tervention) may merely be postponing
suffering by dissociating it into covert
"cognitive structural systems," thus stor-
ing up future "ouches," reducing their
energy for living, and simultaneously
reinforcing emotional immaturity in their
own selves?
Summary
That emotions and conflicts can create
or increase painful symptoms has been well
established. Hypnotherapy has been widely
used to alleviate both physically caused
and psychogenic pain. This includes self-
hypnosis. Recent developments in hyp-
nosis theory have placed increasing em-
phasis on its dissociative features. Some
theorists have considered it a "controlled
dissociation" as contrasted to multiple
personality, which is an "uncontrolled
dissociation." Multiple personality cases
have been presented here showing that they
are capable of eliminating pain in the pri-
mary personality by displacing it into
covert alters. This process may involve a
kind of self-hypnosis. When the alters are
then activated they often report having
"received" the pain and complain bit-
terly.
The Hilgards demonstrated that normal
experimental subjects, when hypnotized,
can similarly dissociate or displace pain
DISSOCIATION AND DISPLACEMENT
into a covert cognitive structural system
within the personality. They termed this
phenomenon "the hidden observer."
Working hypnoanalytically with pa-
tients (and with volunteer experimental
subjects) the Watkins, (who started with
the theoretical concepts of Federn, a close
associate of Freud's) discovered that ego
states, internal personality segments, be-
haved both like Hilgard's hidden observ-
ers and "covert" multiple personalities.
The ego states demonstrated behavioral
and experiential content and when inter-
viewed under hypnosis reported individ-
ual self-identity. Moreover, they could also
dissociate (or displace) pain from the nor-
mally primary or "executive" state to sub-
states (cognitive structural systems)-even
as did "hidden observers" and true mul-
tiple personalities.
A therapeutic system was developed
which the Watkins called, "ego-state
therapy." This technique involved the
resolution (primarily under hypnosis) of
conflicts between the various ego states
that were causing symptoms and mala-
daptive behaviors. The approach has been
effective in treating a number of disorders
and behavioral problems, ranging from
unsatisfactory study habits, smoking,
obesity, or various psychophysiologic and
neurotic disorders, up to and including true,
overt multiple personalities.
"Ego-state theory" is based on the as-
sumption that human personality structure
develops through integration and differ-
entiation, hence putting together and sep-
arating apart. Out of these processes
personality segments arise for purposes of
adaptation and defense. Most psycholog-
ical processes exist on a continuum. They
tend initially to be adaptive but become
less so when excessive (e.g., anxiety). So
also it is with integration and differentia-
tion.
9
At one end of the continuum, differ-
entiation is adaptive with personality seg-
ments (ego states) possessing relatively
permeable boundaries through which
communication and constructive interac-
tion can take place-as in normal mood
states. As the segmentation becomes more
defensive, the boundaries separating ego
states become more rigid and less perme-
able. At the other end of the continuum
we call the separating process "dissocia-
tion." The ego states are no longer aware
of or in communication with one another,
and true, overt multiple personalities may
be created.
Covert ego states, representing the in-
termediate range of the differentiation-
dissociation continuum, can be found in
many normal subjects who volunteer for
hypnotic laboratory experiments, as well
as in patients in psychotherapy. Dissocia-
tion is associated with hypnotizability.
Hence, the ability to displace pain into
sub ego-states may inhere in many normal
individuals who are hypnotically treated
for pain.
This suggests that when we remove pain
by hypnosis we may not be getting away
"scot-free." Perhaps it is being displaced
into underlying ego states and stored there
with the possibility of noxious sequelae
or later return in some other undesirable
form. Such a possibility needs further in-
vestigation if we are to use hypnosis for
the relief of pain, whether physically or
psychologically caused. It also raises
questions about suffering that is alleviated
by the many pain medications now mar-
keted.
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