me is profoundly altered in illness versus health, to
the extent that I might even stop believing I could
exist without the illness.
[T]o me, ‘Emily’ became nothing more or less
than anorexic Emily. My blank or distraught
or irritable or fragile moods, my need for
routine and privacy, my slight figure, my
lack of friends and my worship of academic
achievement, all seemed like innate parts of
me, and there seemed no reason to believe
that eating breakfast or lunch would make a
difference to any of them. The extent to which
‘I’ was the product of years of malnutrition
and the rigid, ritualised mental life and
physical limitations that malnutrition itself
created was not something I was capable of
comprehending, since to do so I would have
had to imagine my life as otherwise than it
was – and I had neither the ability nor the
desire to do that. It was a perfect vicious circle:
the anorexia had become so completely what
I was that I couldn’t see how completely it had
taken over ‘Emily’, nor could I therefore have
any motivation to try to find her again.
(Troscianko, 2012, p. 242)But does this mean that we should think of the ill-
ness as itself an ASC, or as something which brings
about an ASC (or multiple ASCs)? For Antti Revonsuo
and colleagues (2009),
the definition of an ASC refers to the
temporary (as opposed to permanent)
nature of alterations in the representational
mechanisms of consciousness. The altered
state commences at some specifiable
time-window, and the normal state of
consciousness and brain returns at some
later time.
(p. 196)This means that if psychosis such as schizophrenia
were a permanent pathological state, it could not be
an ASC, but temporary episodes within it could be.
Any neat distinction between permanent and
temporary, illness and episode, is easy to ques-
tion: does it really make sense to separate the
ongoing distortions brought about by chronic
semi-starvation in anorexia, for example, from the‘it is not the state itself that
is producing heightened
suggestibility but rather
the person’s perception of
being in an altered state’(Kirsch, 2011, p. 359)hypnotised subjects seem able to accept illogicalities in a way
that fakers cannot. For example, when asked to hallucinate a
person who is actually present, they may see two people while
simulators tend to see only one. When regressed to child-
hood, they may describe feeling simultaneously grown-up
and child-like, while simulators claim to feel only like a child.
similar trance logic can be seen in some drug states, dreams
(Chapter 15), and mystical experiences (Chapter 18).
In the mid-1990s, British psychologist Graham Wagstaff
concluded that ‘in over one hundred years we seem to be
no further forward in deciding whether there is an altered
state of consciousness that we can call “hypnosis” ’ (1994,
p. 1003) and the debates continued (Kallio and Revon-
suo, 2003, with peer commentaries and response, 2005).
Research has found changes in neural activity, such as
changes in anterior cingulate related to reduced pain in
hypnosis (Faymonville et al., 2000), but the relation-
ship between these changes and the hypnotic induction
remains unclear (mazzoni et al., 2013).
A veteran of hypnosis research, Irving Kirsch, has called
the disagreements ‘needlessly vociferous’ and lacking in
‘heuristic value’, arguing that the more interesting and
important question is ‘how highly suggestible subjects are
able to experience sometimes profound subjective alter-
ations’ (2011, p. 353). He concludes that what produces
heightened suggestibility may be the person’s perception
of being in an altered state, rather than some state in
itself. this way of thinking challenges the idea that a
‘state’ of consciousness can be distinguished from what
the person experiencing it wants or believes it to be.FIGURE 13.8 • The hidden observer. Although a hypnotic subject with his hand in freezing
water may claim to feel no pain, Hilgard discovered that by giving an
appropriate signal, he could talk to a hidden part of the person who was
in pain. This forms part of the evidence for neo-dissociationist theories.