10.

The Independence of Suggestibility, Placebo Response,

and Hypnotizability
F.l. EVANS

Introduction

Suggestibility has been an important concept in the history of psychology and psychiatry. In
addition to being equated with gullibility and persuasibility (Abraham, 1962), the concept of
suggestibility has been central to the historical development of hypnosis (Weitzenhoffer, 1953),
has been used to explain the placebo response in psychopharmacology (Trouton, 1957), and has
been employed as a measure of personality characteristics, particularly neuroticism (Cattell,
1957; Eysenck, 1947). This review evaluates contemporary attempts to classify different types of
suggestibility, and the relationship between suggestibility, hypnotizability, and the placebo
response.

Classification of Suggestibility

Eysenck (1943; 1947), Furneaux (1946; 1952), and Eysenck and Furneaux (1945) presented
empirical evidence demonstrating that there is no general, unitary trait of suggestibility. Two
factors, or possibly more, were necessary to account for the intercorrelations among tests
traditionally regarded as measures of suggestibility. The main factor, primary suggestibility,
involved the subject's responding to direct (verbal) suggestions of occurrence of specified bodily
or muscular movements without his/her active volitional participation. The Body-Sway and
Chevreul Pendulum tests are familiar examples. The second factor, secondary suggestibility, is a
more elusive entity involving "indirection" and "gullibility." Eysenck (1947) has described it as
"the experience on the part of the subject of a sensation or perception consequent upon the
direct or implied suggestion by the experimenter that such an experience will take place, in the
absence of any objective basis for the sensation of perception" (p. 167). The Ink Blot, Progressive
Lines, and Odor tests are typical examples.

Without empirical support, Eysenck (1947) also referred to tertiary suggestibility, apparently
involving attitude change consequent upon persuasive communications originating from a
prestige figure.

Contemporary Evidence

The classification presented by Eysenck and Furneaux (1945) has been widely accepted.
Subsequent attempts to corroborate the original factorial studies of Eysenck (1943) and Eysenck
and Furneaux (1945) have, however, produced equivocal results. Grimes (1948) found no

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© Springer-Verlag Berlin Heidelberg 1989
evidence of a secondary suggestibility factor among 16 tests of suggestibility administered in
group settings to 233 orphan boys varying in age from 8 to 15 years. The tests were mainly of the
indirection, gullibility, or prestige types.

Benton and Bandura (1953) objected to generalizing from the neurotic army population used in
the studies by Eysenck (1943) and Eysenck and Fumeaux (1945). They administered tests of
suggestibility to 50 undergraduates. The intercorrelations were mostly insignificant, and no
evidence of either factor was found. Unfortunately, the sample was highly selected both in
intelligence and in suggestibility. Similar criticism can be made of studies by Duke (1964) who
administered nine suggestibility tests to veterans.

Factor analytic studies from three separate correlation matrices were reported to Stukat (1958).
Sixteen variables were administered to 67 elementary school children, averaging 8.6 years of age;
24 variables were administered to 187 ll-year-old school children; and 24 variables were given
to 90 adults in their early twenties. A factor identified as primary suggestibility was isolated in all
three factorial solutions. Secondary suggestibility, as described by Eysenck and Fumeaux (1945),
was not confirmed. Several small factors were found, usually defined by very few variables with
low factor loadings.

Administering 15 suggestibility tests to 63 undergraduates, Hammer et al. (1963) reported two

orthogonal factors from a factor analysis of the tetrachoric intercorrelations. One factor was
identified as primary suggestibility, but there were no grounds for identifying the second factor
with Eysenck's concept of secondary suggestibility. Three variations of the Heat lllusion test,
together with a rating of the vividness of imagery in a suggested hallucinatory situation, defined
the second factor. It was tentatively interpreted as an "imagery" factor. Some tests which were
similar to secondary suggestibility tests in the classification of Eysenck and Fumeaux (1945) did
not load significantly on the imagery factor.

Subsequently, two parallel batteries of tests, similar to those usually administered during
hypnosis, were given in the waking state to 50 undergraduates (Evans, 1967a). Tests similar to
"secondary suggestibility" measures were not well represented. Of the five factors matched across
the two sessions, three were identified as "primary suggestibility," "challenge suggestibility," and
"imagery." The latter factor involved measures similar to the Heat Illusion.

Suggestibility

There has been a failure to replicate in exact detail the procedures employed by Eysenck (1943)
and Eysenck and Fumeaux (1945) in all these studies. The classification originally presented by
Eysenck (1943) was based upon an examination of the intercorrelations among eight
suggestibility tests, including two linearly and experimentally dependent methods of scoring both
the Progressive Weights and Progressive Lines tests. Recognizing the limitations of this
investigation, Eysenck and Fumeaux (1945) replicated the study, administering suggestibility
tests to 60 hospitalized soldiers.

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