Meetings of the Psychoanalytic Association of New York

December 14, 1964. ON ALTERATION IN THE STATE OF CONSCIOUSNESS AND ITS DEFENSIVE FUNCTION: A HYPNOID STATE. Robert Dickes, M.D.

The author suggests that certain phenomena, usually termed fatigue, drowsiness, or sleepiness, are actually manifestations of a hypnoid state which is a special alteration in the state of consciousness and should be distinguished from hypnagogic phenomena, fugue states, etc. The hypnoid state is not uncommon during an analytic hour and may be noted also in other life situations which involve the patient in a struggle with unacceptable sexual and aggressive impulses related to repressed memories. Dr. Dickes described several severe cases where the hypnoid state was used defensively by patients exposed to major trauma in childhood. The recognition of the defensive nature of the alteration in consciousness does not obscure the fact that it may also signify a fantasied gratification of an underlying wish, since all symptoms represent both drive and defense.

A theoretical discussion of the hypnoid state included consideration of classical hypnosis and sleep. Sleep, hypnosis, and hypnoid state may be phenomenologically similar, but the term 'sleep' should be reserved for true sleep and a qualifying term should be used to identify the route by which the sleep state has been reached. Freud and Ferenczi considered hypnosis distinct from sleep, emphasizing the unconscious intrapsychic factors. The hypnotic relationship depends on a parent-child relationship of love or fear, with convictions of infallibility and omnipotence. Classical hypnosis, however, may aid discharge of affect and recovery of memories, while the hypnoid state prevents this. Autohypnosis more closely resembles the hypnoid state and is related to an internalized parent-child relationship. Freud discovered that the hypnotist replaced the superego of the hypnotic subject, pointing to the important role of the superego in instigating both hypnosis and hypnoid state. While it