Words were originally magic, and to this day words have retained much of their ancient magical power.—Sigmund Freud102
Imagine for a moment that you, as a health professional, are given a tool that if used correctly could:
Would you use it?
Now, imagine you have a tool that if used incorrectly could:
Would you use it?
As you’ve probably guessed, it’s one and the same tool. The good news is that it’s a tool you already have. In fact, it came free in the genetic package you received at birth, along with the color of your eyes and the size of your feet. The bad news is: it didn’t come with an instruction manual.
We’re talking about language and its effects—what Professor Stephen Pinker calls that ‘extraordinary collection of hisses and hums and squeaks and pops’103 that not only transfers packets of information, simple and complex, between each other, but also binds us to others of our species.
Language, if some linguists are correct, is an innate capability in our species. We are born hardwired to communicate, to rapidly acquire the syntax (the rules) of our native tongue, and thereby connect with those around us in order to have them meet our needs. If we fail to bond, or lose those connections important to us, we may sicken and die.104
The suggestion that language can affect our health is the fundamental proposition of Medical NLP, and we are aware that it will be deeply challenging to some. To others, especially those at the receiving end of clumsy or malevolent communication, there’s a visceral recognition that it’s true.
Two anecdotes come to mind.
Case history: The 82-year-old mother of a friend had just been passed ‘in pretty good condition’ by the young intern who had examined her.
As she got ready to leave with her husband, a sprightly four years her senior, the physician patted her arm and said, ‘But, I want you to hold on to your husband’s arm whenever you go out. You’re pretty fragile, and if you don’t you’ll trip and fall and break a hip.’
On the way out, her husband offered her his arm. The lady pulled away and said sharply, ‘I haven’t needed to hang on to you in 50 years of marriage, and I’m not going to start now.’
As she stepped out of the front door of the clinic, she tripped and fell—and broke a hip.
The story is true. And, unfortunately, so are many we hear from patients who have had similarly accidental, but negative, encounters with slipshod communicators. Some years ago, when Aids first made its appearance in the West, statistics indicated that mean survival from diagnosis to full-blown disease was roughly 2.5 years.
Case history: Two patients, both of whom were HIV-positive but uncharacteristically asymptomatic, were examined by the same attending physician, a newly fledged ‘expert’ in this new and mysterious disease. ‘Technically’, he said, ‘you’ve passed the deadline. According to the statistics, you shouldn’t even be alive now.’
Within two weeks, both were dead. Nobody in the immediate vicinity was remotely surprised. After all, everyone knew a diagnosis of Aids was a death sentence. The only anomaly was that their symptoms had taken so long to develop.
In both cases, the physicians acted with every positive intention, but little mindfulness. The intern’s comments, intended to avoid accidents, contained a sub-text: ‘If you don’t do this, you will fall.’ The Aids expert’s comments not only emphasized that this terrible disease had a ‘deadline’, which the patients were flouting, but also implied the patients had no right to survive and upset the statistical equilibrium.
These comments—however well intentioned—may be seen as triggering a ‘nocebo effect’. Even though the nocebo is more usually an inert substance that triggers adverse responses in the subject, communication at all levels, including the non-verbal, can negatively impact the listener. Even reading about diseases, or watching TV documentaries, can trigger adverse responses, new research has revealed.
Since the publication of the first edition of Magic in Practice, Dr. Michael Witthöft of Johannes Gutenberg University, Mainz (JGU), has completed an important new study in what has been dubbed the ‘Wi-Fi syndrome’ at London’s King’s College. ‘The mere anticipation of possible injury may actually trigger pain or disorders. This is the opposite of the analgesic effects we know can be associated with exposure to placebos,’ he says.
Curious about reports of an increase in ‘electromagnetic sensitivity’, Dr. Witthöft and his colleagues showed news reports about the purported health risks of Wi-Fi signals to one group of volunteers. A second, control group was shown a documentary on mobile phone security that included no reference to electromagnetic ‘pollution’. Then, each participant in turn was exposed to dummy ‘amplified Wi-Fi signals’ and their responses were monitored.
Unlike the control group, more than half the participants who had viewed the report on the dangers of electromagnetic exposure reported experiencing characteristic symptoms, including agitation and anxiety, loss of concentration, or tingling in their fingers, arms, legs, and feet. Two participants quit the study because they were afraid to expose themselves to further ‘radiation’.105
One man doubtlessly would be unsurprised by these findings. John Bargh is an American social psychologist, a gifted, respected, and unorthodox researcher in the field of language and influence.
One of his experiments stands as a warning to all those professionals entrusted with the health and wellbeing of others. Bargh gave two groups of subjects a collection of five-word sets with the instructions that they were to make grammatical four-word sentences out of each set. An example of these Scrambled Sentence Tests might include the words: apple, give, an, me, red. The correct sentence would be ‘give me an apple’, the word, red being redundant. One of Bargh’s groups, however, was given sets that included words that might be associated with old age and its symptoms—grey, wrinkled, tired, etc—but never explicitly in that context.
The results were astonishing. The group exposed unconsciously to ‘age’ words were observed to move more slowly than before and reported that they were lacking energy and enthusiasm. The words they were exposed to literally made them temporarily older.106
Bargh and his colleagues have repeated the exercise in many different forms, always with the same results. The conclusions are inescapable: we unconsciously extract meaning from the words to which we are exposed and react according to the perceived meaning. This is known as priming.
Let’s try a little experiment. Complete each step before moving on to the next.
Stand, feet shoulder width apart, with your right arm and forefinger extended directly in front of you.
Without moving your feet, turn your upper body around to your right, following your pointed finger, as far as you can comfortably go. Find a mark that will let you know where your limit was. Return to the front and drop your arm to your side.
Now move on.
Close your eyes, and in your imagination only, repeat the exercise without actually moving your body. Mentally follow your pointing finger around, right up to the point you last reached, and then some considerable distance past.
Pause for a moment before continuing.
Now, open your eyes, extend your arm and forefinger again, and turn your body around to the right as far as you can, and notice this time how far your new limit has been re-set to.
The exercise is simple but enlightening. Although demonstrations like this often feature in business and self-development seminars as ‘proof’ of the ‘power of the mind’, the real wonder is in the mechanisms that underlie the phenomenon. Priming, the ability of the brain to recognize and respond to words and images smuggled in beneath the subject’s perceptual radar, is one of the great curiosities of psychological and neurological research. If you found you could easily reach beyond your earlier attempt, you were effectively primed—in other words, your brain was set up by words alone to perform differently … and, your muscles, tendons, and joints unquestioningly obliged.
The words and phrases used to trigger this effect were presuppositional—that is, they assumed, without overtly stating, that your second performance would be an improvement on the first: comfortably go, far, new limit, re-set etc.
Nor should you be too embarrassed at the ease with which the effect is achieved. It simply means you’re human.
Hypnotists, salespeople, and parents who use their offspring’s full names to signal Something Very Serious Is About to Happen have all intuitively understood the power of priming for many years. Bargh and his colleague, Ohio State University psychologist Tanya Chartrand, estimate that around 95% of all behavior is automated, and have repeatedly demonstrated how easy it is to influence subjects to respond to certain unconsciously delivered cues, such as touching their elbows or scratching their noses.107
But pointing or touching your nose is entirely different from emotions, and emotions are distinct from physical health, are they not?
Well, not exactly.
For the past two centuries, the so-called Cartesian split between mind and body was unquestioned in scientific thought. Then, in 1985, Georgetown University School of Medicine psychopharmacologist Candace Pert published a ground-breaking paper, co-authored by Michael Ruff. It revealed the existence of an interactive ‘psychosomatic network’ buzzing with informational substances—peptides, hormones, and neurotransmitters—which acted in concert to maintain or impair the health and integrity of the individual.108
Pert, since credited as the discoverer of the opiate receptor, went on to extend her research into the multiple psychophysiological feedback loops modulated by what she has dubbed ‘the molecules of emotion’. Furthermore, she found receptors for these molecules were not confined to the brain, but were distributed over almost every cell in the body.
Pert’s discoveries were hugely challenging to the establishment. She endured criticism, marginalization, and even an attempt to hijack her research. But she held fast and has since been proved correct.
Her findings were largely responsible for transforming the newly emerging field of psychoneuroimmunology (PNI), the study of the relationship between the brain and health, from a little-known area of research into a fully fledged science. No longer could it be credibly argued either that the brain was merely a troublesome appendage to a mechanical body, or that the body was little more than a convenient perch for the patient’s neck-top computer.
One problem, though, persisted in the field: if PNI could demonstrate the interaction of brain on body and body on brain, how did the brain acquire the information to trigger the process?
Operating outside the mainstream medical paradigm, thinkers, including Alfred Korzybski, Milton Erickson, and Richard Bandler and colleagues, had long concluded that communication was the key—permutations of the many ways in which we impart and process information, between each other and within ourselves. Since then, psychologists have largely concurred, but their evidence is often dismissed as ‘soft’ by their medical counterparts or, more commonly, is simply ignored.
Enter Dr. Richard Davidson and his team of researchers from the University of Wisconsin-Madison. Armed with the newly developed ‘hard’ research tool of functional magnetic resonance imaging (fMRI), which provides a convenient real-time ‘window’ on brain functions, they set out to discover whether ‘emotion’ was registered by the brain. They found more than this. Not only were specific areas of the brain seen to light up in response to certain emotion-laden words, but the body responded—just as Pert and her colleagues had been suggesting.
Davidson and his team monitored the responses of a group of asthmatics as they were exposed to three different categories of word: asthma-related words such as ‘wheeze’; negative, but functionally unrelated words, such as ‘loneliness’; and neutral words such as ‘curtains’. At the same time, the subjects were given known allergens—dust-mite or ragweed extracts—to inhale. When the asthma-related words were encountered, not only did significant areas of the brain (the anterior cingulate cortex and the insula) show increased activity, but the volunteers promptly suffered asthma attacks.
The team, who have since embarked on large-scale studies, believe they have found hard evidence that certain emotions can cause flare-ups of the disease. This is something doctors have suspected for some time. However, and this is the important point, the ‘allergen’ inducing the asthma attacks was not simply the extract of dust-mite or ragweed, but one of those ‘hisses and hums and squeaks and pops’. The subjects had been physically harmed by a word.109
Actually, even Sigmund Freud knew this was true. His comment, immediately following the one at the top of this chapter, is, ‘By words one person can make another blissfully happy or drive him to despair.’
Any discussion about language and suggestibility would be incomplete without reference to two significant subjects: hypnosis and brainwashing.
Even after two centuries of effective application, hypnosis remains a controversial topic in mainstream medicine. This is a shame. We strongly believe that, in order to practice in the best possible interests of the patient, all health practitioners should understand hypnosis and hypnotic phenomena and regard them as unavoidable components of their daily consultations.
Hypnosis—if, by that, we mean states of increased suggestibility—occurs naturally, whether or not the practitioner has developed the sensory acuity to notice it. As we suggest later, spontaneous trance states can be utilized adjunctively in the treatment process. Meanwhile, practitioners need to be aware of the potential risks attached to unrecognized trance and trance phenomena when they occur during the consultation process.
Milton Erickson defined hypnosis in terms of a progressive narrowing of attention. The inference here is that the subject’s ability to create new patterns of experience and function depends on eliminating the ‘noise’ of competing sensory data in favor of the ‘signal’ of the hypnotic suggestion. Erickson entertained certain presuppositions by which he operated and, as a result of which, many thousands of patients benefited.
Among these was the existence of an ‘unconscious’ mind. As a medical doctor and psychiatrist, he was fully aware that this was a metaphor—a convenient term for all the physical and psychological functions that operate below the level of immediate conscious awareness. Erickson also believed these ‘other-than-conscious’ functions exhibit intelligence (although not necessarily the deductive intelligence of the ‘conscious’ mind), metaphoric and analogical processing (much of his work was carried out obliquely, through stories and anecdotes), and also—in some cases—an almost child-like literal responsiveness to what it perceives as a ‘command’.
In terms of outcome, there appears to be little distinction between hypnosis and priming, except that the latter occurs without the induction of ‘formal’ trance or through the medium of well-crafted suggestions. Either way, it is possible to deliver influential and potentially negative messages to the patient’s unconscious—whether or not they are intended by the speaker. We explore this phenomenon, together with its antidote, in the chapter that follows.
Forcible or surreptitious ‘thought-changing’ is popularly regarded as brainwashing. Commonly associated with extreme political groups and cults, heightened suggestibility is also known to be induced by trauma, fear, and confusion. The late Margaret Thaler Singer and Janja Lalich identified a number of key prerequisites to successful thought-changing. Simply put, thoughts, values, behavior, allegiances, and beliefs may be substantially altered in conditions where the subject is deprived of his or her own clothing, familiar foods, timetable, and sense of control.
The effect is magnified when the victim is exposed to, but often excluded by, a highly specialized language, is required to submit to the ‘wisdom’ of a superior ‘sacred’ science, is discouraged from asking questions or making objections, and is constantly aware (or, at least believes) that the perceived authorities have the power of life or death.110
Now, compare these conditions to what can happen when a patient is facing a challenging consultation, has been admitted to hospital, or is facing a battery of complex tests.
Food, clothing, and contact with the outside world may be strictly controlled. The ‘experts’ use unfamiliar and distinctive terminology derived from an arcane science. Often the patient is kept in the dark about the significance of medical or surgical procedures. The doctors and nurses may be perceived as mysterious and powerful figures with the authority to decide who lives or dies. Questioning or criticism, especially of senior clinical personnel, is discouraged or ignored.
If it can be assumed that these conditions have the potential significantly to increase the patient’s susceptibility to suggestion (and, we strongly suggest you take this as fact), consider the potential impact of some of the phrases collected by (real) patients from their practitioners:
‘This is very serious surgery and there are risks attached to it. You will experience pain afterwards and it will be several weeks before you’ll be able to move around comfortably.’ (A surgeon to a pre-surgical patient.)
‘You can’t possibly be ready to deliver. You’re not in enough pain yet.’ (A midwife to a woman in labor.)
‘People who take this medication often have dizziness or tingling in the hands and feet. Read the list of other side-effects inside the box and tell your doctor about any others you get.’ (A druggist dispensing prescribed medication.)
‘We’ll get the results of the tests next week, but I can assure you, there’s nothing to worry about yet.’ (An ophthalmologist to a patient worried about anatomical changes to her retina.)
All the professionals above would argue that their intentions were impeccable and that they were obliged by law to deliver the information contained in their statements—and, we would agree. However, in the light of everything discussed so far, we would strongly caution all health practitioners to assume that the patient in front of them is in an altered and highly suggestible state and proceed accordingly.
All the medico-legal requirements of informed consent, ‘safety netting’ (instructions given to the patient for action to be taken should the condition worsen or persist), and discussion of side-effects, can be met and simultaneously tempered by the judicious use of positive semantic priming and ‘hypnotic’ suggestion.
Accomplishing this easily and elegantly requires planning and practice. We suggest you write out as many examples as possible; this makes it easier to tailor the language patterns to the individual patient and to deliver them confidently and effortlessly. Spend some time on the exercises at the end of this chapter before proceeding on to the next chapter. But, just before doing that, compare the statements above with the re-cast versions below:
The surgeon: ‘This is serious surgery and there are risks, but we have a highly trained and experienced team looking after you. Some people have some discomfort afterwards, but it may well be less than expected, and we’ll do everything we can to have you up and about as soon as possible.’
The midwife: ‘Not everybody’s as relaxed as you seem to be when they’re ready to deliver, and you seem really comfortable. Let’s check and see how close you are now so we can make sure it continues to go smoothly.’
The druggist: ‘Some people who take this have dizziness or tingling in the hands and feet, but most people find it very easy to take. The drug companies have to list all possible side-effects, even when only a few people might have had them. Read the list and tell your doctor about any you might have, but most people only have good results.’
The ophthalmologist: ‘I’m sure from what I’ve seen that everything is fine. The tests you’ve had are very thorough and when we get the full results in a week, we’ll know for sure if there’s anything more that needs to be done.’
All communication is an attempt to influence. When you say, ‘Good morning’ to a colleague, you expect some kind of response, preferably one that recognizes you as someone worthy of acknowledgement. A curt nod from the boss may leave you with a sense of annoyance, frustration—or, even concern about whether you’re about to lose your job.
The problem with this is that most attempts to influence are done without clear purpose or design. Our intention is to focus your awareness on the process of communication—including unconscious and non-verbal communication—so that you can gain effectiveness and control.
The following section offers a number of powerful techniques of persuasion. The reader should bear in mind that these patterns are processed unconsciously by the listener, so it is important to adhere to the same ethical standards you would use in other areas of your practice.
Notice in the revised versions of instructions delivered above how many words implying success are used compared with the original examples, where the emphasis is on negative experiences. Some words and phrases used include: ‘smoothly’, ‘looking after you’, ‘comfortable’, ‘relaxed’, ‘really helps’, etc.
Presuppositions are statements that assume something that is actually not verbalized. The subject must accept the presupposition in order to understand the statement, thereby ‘bypassing’ conscious resistance. An example is, ‘When you take the medication regularly, you will find your symptoms come under control.’ That the medication will be taken regularly is presupposed; the patient’s attention is diverted on to the second part of the sentence.
Embedded commands are self-standing ‘orders’ or ‘instructions’ hidden within a larger sentence. The example above also contains two embedded commands: ‘Take the medication regularly’, and ‘Find your symptoms come under control’.
Since people tend to remember and respond to the first and/or the last of a set of statements, ensure that the most important instruction is delivered or repeated last.
Words such as ‘but’ and ‘however’ are what we call ‘turning words’ (also sometimes known as ‘exclusive words’), and have the effect of minimizing the impact of the clause immediately preceding it—for example, ‘You’re an intelligent and thoughtful person, but you need to pay more attention.’ Our natural response is to ignore the ‘compliment’ and focus on whatever qualifying statement follows. Even though we hear everything that is said, turning words make distinctions between what is to be regarded as in a class or category and what is not.
Another example: ‘We’ve examined Johnny and we’re confident he’s fine, but if you have any worries during the night, you can always call our emergency number.’
Doctors delivering instructions in this way often report an increase in unnecessary calls or visits by worried patients; therefore you should always be aware of the message that precedes the turning word and ensure that you wish to reduce its impact.
Here’s a revised version, which conveys all the necessary information, meets all medico-legal requirements, and reassures the anxious parents: ‘If you have any worries, you can call our emergency number at any time during the night, but we have examined Johnny and we’re confident he’s fine.’
(Note: This is entirely contextual. Please do not turn into a linguistic fascist and call yourself, or everyone else, to task, every time the word ‘but’ is used. In ordinary conversation you need only to remain mindful of the effect your communication is having, and adjust if necessary.)
Review and then write out as many patterns related to your specialty as you can. We advise keeping a file of your efforts and adding to it as new ideas and situations occur. See how many of these words you can introduce into your consultations without interrupting the flow.
1. First, make a list of as many synonyms as you can for states of comfort, ease, peace, calm, relaxation, and relief, etc. Then, when you have at least 20, practice creating sentences that impart the required information but orientate the patient towards positive experiences and outcomes. Layer your synonyms for an amplified effect (for example, ‘You’ll notice how comfortably or easily or smoothly or effortlessly you can move your arm the more you exercise …’)
2. Now, create more sentences using these primes, only this time make sure the primes you use don’t refer overtly to the patient’s condition (for example, ‘Since we refurbished the reception area, people can come and go more comfortably and easily and everything seems to work more smoothly or effortlessly …’)
Practice your priming with your patients and notice their response.
Presuppositions most commonly start with words such as, ‘when’, ‘after’, ‘before’, ‘as’, ‘during’ etc. Immediately following these is the primary injunction you wish to deliver, followed by a phrase that diverts conscious attention away from the injunction. The intention is to smuggle the suggestion in under the radar of the left hemisphere’s critical analysis.
Example:
‘Before you start your new eating plan, make sure you’ve already bought all the food items you need.’
Starting the new eating plan is the more important part of the sentence, but conscious attention is directed towards shopping for the foods, prompting the unconscious mind to proceed as if the new plan is already a fact of life.
Decide on your embedded command, and then create a secondary sentence within which it can be embedded while still making sense. When they are delivered, embedded commands should be analogically marked—that is, spoken slightly more loudly or softly, with a gesture or a slightly more emphatic tone, etc—to mark them out to the patient’s unconscious processes as significant.
Example:
Command—‘Complete the full course of pills.’
Secondary sentence—‘Everyone needs to make sure the infection is properly under control.’
Analog marking—‘Everyone needs to complete the full course of pills to make sure the infection has been brought properly under control.’
Summarize the main thrust of your message. Deliver the message, then repeat your summary. This will ensure that the most important point(s) will be more easily retained by the listener.
List a number of instructions (especially ‘safety netting’ advice) that involve turning words. An example might be, ‘This is an effective drug, but you might experience side-effects.’
In order to minimize overreaction to adverse but unlikely possibilities or experiences, place them first in the sentence, followed by a turning word, then a qualifier that presupposes a more positive outcome. Therefore, a revised version of the above examples might be, ‘Some people have side-effects when taking this drug, but mostly we find it very effective.’
102. Sigmund Freud © Copyrights, The Institute of Psycho-Analysis and The Hogarth Press for permission to quote from The Standard Edition of the Complete Psychological Works of Sigmund Freud, translated and edited by James Strachey. Reprinted by permission of the Random House Group.
103. Pinker S (new ed 1995) The Language Instinct: The New Science of Language and Mind. London: Penguin Books Ltd
104. House JS, Landis KR, Umberson D (1988) Social relations and health. Science 241: 540–5; Hafen Q, Karren KJ, Frandsen KJ, Smith NL (1996) Mind/Body Health: The Effects of Attitudes, Emotions and Relationships, Boston: Allyn & Bacon; The GUSTO Investigators (1993) An international randomized trial comparing four thrombolytic studies for acute myocardial infarction. New England Journal of Medicine 329: 673–82.
105. Witthöft M, Rubin GJ (2013) Are media warnings about the adverse health effects of modern life self-fulfilling? An experimental study on idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) Journal of Psychosomatic Research 74(3): 206-212.
106. Bargh JA, Chartrand TL (1999) The unbearable automaticity of being. American Psychologist 54(7): 462–79.
107. Ibid.
108. Pert CB, Ruff MR (1985) Neuropeptides and their receptors: a psychosomatic network. Journal of Immunology 135(2): 820–6.
109. Rosencranz MA et al (2005) Neural circuitry underlying the interaction between emotion and asthma symptom exacerbation. PNAS 102(37): 13319–24.
110. Thaler Singer M, Lalich J (1996) Cults in Our Midst. Hoboken, NJ: Jossey Bass/Wiley.