On one, I want you to do

one thing: Look up.

On two, do two things:

Slowly close your eyes and take

a deep breath.

On three, do three things:

Breathe out, relax your eyes, and

let your body float.

Imagine you are floating in

a bath, a lake, a hot tub,

or just floating in space.

Each breath is getting

deeper and easier . . .

The patient is 80 years old. She is lying under the bright lights of an operating room at Harvards Beth Israel Deaconess Medical Center, where radiologist Elvira Lang is about to thread a catheter through her arteries. The tiny tube will work its way to one of the womans kidneys, where it will block the organs blood supply. A surgeon is scheduled to remove the kidney the next day. Embolizing the kidney will help keep the operation simple, safe, and tidy. But the woman is running a fever, and her kidney may be infected. Because she ate earlier in the day, she cant be given a sedative. What should have been a routine procedure has become an ordeal.

This is your safe and pleasant place to be, one of Langs associates reads from a laminated card. You can use it in a sense to play a trick on the doctors. Your body has to be here, but you dont.

Brain scans have shown that a hypnotized patient like Zoraida Smith, 83, cant tell the difference between reality and an image that has been planted in her mind. Smith is being treated with hypnosis for chronic fatigue.

Lang is one of a growing number of hospital physicians who use hypnosis in addition to anesthesia. Together with David Spiegel, a professor of psychiatry at Stanford University School of Medicine, she has conducted extensive studies of hypnosis in the operating room, often with dramatic results. Hypnosis and interventional radiology interest Lang for the same reason: Both are ways of making a visit to the hospital less horrific. A tiny incision is all thats required. By threading a stent into an artery, for example, Lang can help her patients avoid far more invasive surgery. Im your medical plumber, she says. By adding hypnosis, she can make an operation shorter, less painful, and less dependent on drugs. The hardest part of the procedure is getting other doctors to accept it.

Over the years, a number of rigorously controlled studies have proved that hypnosis reduces pain, controls blood pressure, and can even make warts go away. But because very few studies have attempted to find out how it works, most scientists are skeptical of its power. Critics suggest hypnosis is no different from the placebo effect. They both use the power of suggestion to get the mind to heal the body; both are no substitute for medicine.

That skepticism has driven Spiegel and other researchers to take a hard look at what happens in the brain during hypnosis. Trance, theyve found, opens a window onto the nature of the imagination. Through it, we are beginning to glimpse how the mind distinguishes daydreams from reality.

Spiegel is a second-generation hypnotist. His father, Herbert Spiegel, is a psychiatrist who first used hypnosis as a battlefield surgeon in World War II. In 1943 he even used the technique on himself when he was struck by a mortar from a German tank in Mateur, Tunisia. A steel shell fragment protruded from his ankle, but he managed to tune out the pain.

Soon after returning home, Spiegel was hired as a professor of combat psychiatry at the School of Military Psychiatry at Mason General Hospital in Brentwood, New York. There, he treated hundreds of returning veterans with hypnosis, becoming ever more convinced of its effectiveness. At the same time, the first clinical studies of hypnosis began to appear. In 1961 psychiatrist Ralph August published a study of 850 women who gave birth under hypnosis. Only 4 percent34 womenrequired painkillers. Other studies found that hypnotized subjects could resist intense pain for a full minute longer than those who werent hypnotized, and for 30 seconds longer than those who had been given a placebo painkiller.

By the 1960s, Spiegel was teaching clinical hypnosis at Columbia University, and his son was among his students. David Spiegel went on to attend medical school at Harvard and to specialize in psychiatry and clinical hypnosis as his father had. In 1978 the two Spiegels coauthored the standard textbook in the field: Trance and Treatment: Clinical Uses of Hypnosis.

Now 58, David Spiegel is tall and a bit disheveled, with his fathers oval face and serene features. He speaks in complex but reasoned sentences and listens with the stoic patience of a man who has faced many disbelievers. Hypnosis has been controversial since the beginning, he says. The thing is, it just wont go away. Theres so much about the phenomenon thats interesting. Among researchers in the field, Spiegel says, there are two schools of thought and a growing chasm between them. One school claims that hypnosis fundamentally alters a subjects state of mind; the other believes that hypnosis is simply a matter of suggestibility and relaxation. Spiegel belongs to the first school, and over the years he has had a running debate with two scientists on the other side: Irving Kirsch, a psychologist at the University of Connecticut at Storrs, and Stephen Kosslyn, a professor of psychology at Harvard.

Psychiatrist David Spiegel has Zoraida Smith roll back her eyes to test her hypnotizability. Hypnosis is poised between two sacred cows, he says, that the body is a machine and that we are individuals.

Kirsch often uses hypnosis in his practice, and he doesnt deny that it can be effective. With hypnosis you do put people in altered states, he says. But you dont need a trance to do it. He likes to illustrate the point with an ancient talisman of the hypnotic trade: the pocket watch hanging on a chain. Put your elbow on a table, he says, holding the chain between your thumb and forefinger, and let the weight swing freely. Now, keeping your hand as steady as possible, imagine that the pendulum is moving back and forth parallel to your chest. Just focus on it moving in that direction. Side to side, he says. Ignore everything else and imagine it going side to side at its own rhythm. Once its swaying that way, and it inevitably will, imagine it swinging another wayclockwise, say, or toward youjust to prove to yourself that its not a coincidence. Once again, the weight will obey your mind. This little trick works on even the most skeptical and unhypnotizable of people. You dont have to enter a trance for your subconscious and your bodyin this case, the tiny muscles in your fingersto respond to a suggestion. I could have hypnotized you and done the same thing, but it wouldnt have been a result of the hypnosis, Kirsch says. It would have been a result of your focusing on moving it in a particular direction.

Spiegel disagrees. One of his best-known studies found that when subjects were hypnotized and given suggestions, their brain-wave patterns changed. He admits that suggestion alone is a powerful tool but believes that hypnosis magnifies its effects. In another of Spiegels studies, people under hypnosis were told their forearms were numb, then given light electrical shocks to the wrists. They didnt flinch or respond in any way, and their brain waves resembled those of people who experienced a much weaker shock.

To Kirsch, this still wasnt enough to prove the power of trance, but Stephen Kosslyn was willing to be convinced. Kosslyn is an exceedingly polite man, with a gray, philosophical beard and perpetually raised eyebrows. The hypnosis literature is rife with examples of subjects aping what they believe is hypnotic behavior, he says. Such demand effects are exactly what make placebos so effective. As for the brain-wave study, other events in the labsuch as interaction with the investigatorscould have caused the shift in the subjects state of mind. Is it just playacting? Kosslyn wondered, when he first saw Spiegels data. Or is there something really going on in the brain?

To find out, Spiegel and Kosslyn decided to collaborate on a study, focusing on a part of the brain that is well understood: the fusiform circuit. Located on the occipital lobe, the circuit has been found to process the perception of color. Neuroscientists zeroed in on it by placing subjects in a positron-emission tomography (PET) scanner to measure blood flow in the brain, then having them look at cards with color rectangles. Spiegel and Kosslyn wanted to see if subjects could set off the same circuit by visualizing color while under hypnosis.

The first step was to find the right study subjects. Only a small fraction of the populationknown as highs in hypnotic circlescan enter a deep trance, just as only a few people cannot be hypnotized at all. The rest of us fall on a spectrum in between. (See Can You Be Hypnotized? page 60.) Spiegel and Kosslyn selected eight people from a pool of around 120 subjects, then Kosslyns team ran the experiment at Massachusetts General Hospital in Boston. As in the previous studies, subjects were put inside a PET scanner, shown a slide with color rectangles, and their brain activity was mapped. Then they were shown a black-and-white slide and told to imagine its having a color. Both tasks were repeated while under hypnosis.

The results, published in the American Journal of Psychiatry in 2000, were striking. When the subjects truly saw the color rectangles, the fusiform circuit lit up on both sides of their brain; when they had to imagine the color, the circuit only lit up in the right hemisphere. Under hypnosis, though, both sides of the brain became activejust as in regular sight. Under hypnosis, imagination seemed to take on the quality of a hallucination.

After the experiment, Kosslyns raised eyebrows, for once, came down. Im absolutely convinced now that hypnosis can boost what mental imagery does, he says. It sort of gives it a shot of vitamin A or something. But Kirsch remains skeptical. The color experiments demonstrate that people are really experiencing the effects of hypnotic suggestion, Kirsch says, but not necessarily that they enter a trance. The subjects were told to see the card in color when they were hypnotized but only to imagine it in color when they werent, Kirsch points out. Being told to pretend that youre having the experience is a very different thing than the suggestion to have the experience.

Technically, hes right, Kosslyn says. Because the eight subjects were all highly hypnotizableor at least highly suggestibleKosslyn and Spiegel were afraid that if the subjects were told to see the color, just as they had been when hypnotized, they would slip into a trance. Kosslyn doubts that changing the wording would have made a difference. The hypnotized people would tell you that they could literally see. Lows couldnt even do the task. They simply couldnt do it.