England and Wales High Court (Queen's Bench Division) Decisions

IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION

		Royal Courts of Justice Strand, London, WC2A 2LL
		14 August 1998

Mr Justice Toulson:

Introduction

1. Christopher Gates suffer from schizophrenia. He attributes the onset of his disease to the effects of taking part in a stage hypnosis show conducted by Paul McKenna, a well known stage hypnotist, on 10 March 1994 at the Swan Theatre, High Wycombe.
2. At the time of the show the plaintiff was aged 25. There was nothing in his past medical history to indicate a predisposition to developing mental illness. He was employed as a furniture polisher and had a steady work record. He was divorced but had formed a close relationship with Beverley Gibbs. They had separate homes but otherwise were to all intents and purposes living their lives together. She had bought the tickets for the show as an advance celebration of his birthday a fortnight later.
3. The plaintiff's evidence was that he had seen the defendant on television about three times but had never previously been to a stage hypnotic show. His former wife gave evidence that they had been to a hypnotist's show together at a holiday camp in 1989, but she could not remember the name of the performer or any details of the show. In her original statement she made a number of mistakes about the holiday, which was at a time she had been unwell. It is not suggested that either of them was being untruthful, but one of them must have a faulty memory, which is not surprising after the lapse of time. It is not a point of great significance, but I am not persuaded that the plaintiff had been to a stage hypnosis show before 10 March 1994.
4. The defendant is now aged 34. His interest in hypnosis began soon after he left school in 1979, when he saw a stage hypnotist on television. His interest became more active from 1985. He was then working as a radio disc jockey and went to see a hypnotist about a radio interview. He asked to be hypnotised and was fascinated by the experience. He started to read books on the subject and to meet other hypnotists. He began to practise hypnosis on friends, and in 1987 he put on his first public performance at a pub in Cambridge. This led to further engagements. On 30 January 1988 he put on his first theatre performance at Dunstable. In 1989 he put on his first London stage performance at the Duke of York's Theatre and in 1990 he put on a series of shows at the Dominion Theatre. In 1991 he stopped working as a radio disc jockey in order to concentrate full time on hypnosis. His first television show was on Easter Monday 1993 and was followed by a series of television shows later that year. By this time he was also touring nationally and internationally. He was performing about 150 shows a year.
5. Since the late 1980s the defendant has also been involved in publishing self help hypnotherapy tapes and videos, and he has a private hypnotherapy practice. The aims of stage hypnosis are obviously different, although they involve common techniques. The object of stage hypnosis is entertainment for entertainment's sake. The purpose of the contract under which a person buys a ticket for a stage hypnosis show is no different in that respect from the purpose of the contract under which a person buys a ticket for any other theatre or concert performance, although the form of entertainment is different. The object of hypnotherapy is to treat a patient for a condition. Experts on both sides were agreed that before a patient is treated by hypnotherapy a full history needs to be taken, because it is necessary to have an informed understanding of a patient's history and the condition requiring treatment before deciding what is the best form of treatment and embarking on it. The defendant's activities in hypnotherapy have no bearing on the issues in the present action other than to the extent that they may throw light on the question what he knew or ought to have known about possible risks of hypnosis.
6. The defendant has educated himself in the subject of hypnosis by reading widely and has had a number of mentors, including some with scientific qualifications. In 1997 he was awarded a PhD in philosophy of hypnotherapy from the University of La Salle, Louisiana, but he does not put forward the work on which his doctorate was based as a scientific work. His witness statement included quite a lot about the nature and theory of hypnosis. Those passages are relevant to his state of mind but no more than that. He puts himself forward as an expert in the art but not in the science of hypnosis, still less in the science of psychology or mental illness.
7. On the days following the show the plaintiff behaved in an increasingly odd and disturbed manner until, on 19 March 1994, he was admitted to the psychiatric unit of Amersham General Hospital. He was then suffering an acute schizophrenic episode. It is accepted on his behalf that he must have been suffering from an underlying abnormal neurophysiological condition making him vulnerable to the onset of schizophrenia, but it is alleged that this condition was activated by the events of the show.
8. To summarise the plaintiff's case, it is contended that he suffered stress during the show, partly by the revival under hypnosis of painful suppressed memory, and partly as a result of what he was made to say or do or believe at various times during the show. The defendant should have known that some stresses could be caused under hypnosis and might trigger nervous illness. In those circumstances the defendant was negligent in failing to give the plaintiff a proper warning of the risks at the outset of the show, in placing him under inappropriate stress in the course of particular routines, in subjecting him to over persuasion, in failing to keep him under proper observation and in failing to exercise proper care in taking him out of hypnosis at the end of the show. The defendant may not have had reason to foresee the nature and extent of the plaintiff's resulting illness, i.e. permanent schizophrenia, but that does not prevent the plaintiff from recovering damages in full for his illness on the principle that a wrongdoer takes his vulnerable victim as he finds him: Smith v Leech Brain & Co Limited [1962] 2QB 405.
9. The defendant's case is that the phenomena of hypnosis can be fully explained by ordinary brain processes and do not involve a special neurophysiological state in which the subject becomes an automaton. Schizophrenia is an organic illness which could not be caused by hypnosis. The plaintiff was already either suffering from schizophrenia or was on the point of doing so at the time of the show, and the connection in time between his appearance on the show and the manifestation of his illness was a coincidence. Any stress involved in taking part in the show would be no greater than the stress involved in taking part in other forms of public entertainment. By taking part in the show the plaintiff consented to participating in what were no more than a series of silly sketches, harmless in themselves. If the experience in fact caused him to suffer illness for reasons peculiar to him, it was not the fault of the defendant and not a matter which the defendant should reasonably have foreseen.

The facts

10. By the date of the Swan Theatre performance, the defendant's shows followed a standard pattern but with some variation of sketches between one performance and another. I have seen a video of a performance by the defendant at Wimbledon Theatre on 12 May 1995, which gives a general idea of the nature of the show. There are some points of disagreement about what exactly happened on 10 March 1994, but none of them affect my decision on the major issues. Where there were differences of recollection, I do not doubt that the plaintiff, Miss Gibbs and the defendant all believed that they were right and were trying to be accurate.
11. When the house lights went down, stage lights came on and music started. The plaintiff said in his witness statement that the combination of the lights and music made him feel rather strange, but it is not alleged in the pleadings that the music or lighting were of any specially disorientating kind and there is no evidence that anyone else found them strange. The lighting and music were apparently standard, and there was nothing remarkable about them on the Wimbledon video. In his oral evidence the plaintiff said that he and Beverley were sitting 5 rows back from the front and that he began to get a different feel from the music and the lights. The music was spooky and he was mesmerised by the lights, which seemed to be flickering. He felt very strange.
12. The defendant then came forward from the back of the stage and introduced himself to the audience with some jokes. In the course of his introduction he warned that certain people should not volunteer to be hypnotised, including anyone suffering from clinical depression or other psychiatric condition, although he could not be sure of his exact words. Miss Gibbs' recollection was that he used the words "chronically stressed". The warning was mixed with jokes but not given itself as a joke. He then invited the audience to carry out a suggestibility exercise which involved them closing their eyes, holding out their hands and imagining that there was a helium balloon attached to one hand and a heavy weight on the other. After that he invited anyone wishing to volunteer to be hypnotised to come up on stage "now".
13. The plaintiff's evidence was that the word "now" came to him as a word of command given by someone in authority, like an instruction from his karate teacher. He had no previous intention of going up on stage, but on hearing the word "now" he acted without thought. He said that his reaction was one of compulsion. He shot out of his chair and straight up on stage. He was the first person to do so. About 60 to 80 people followed.
14. The defendant put the volunteers through further suggestibility exercises to determine the best subjects, and gradually the numbers on stage were reduced.
15. The defendant next went through an "induction" procedure in which relaxation suggestions were put to the remaining volunteers. Under blue lighting and against a background of soft music they were told that they would obey whatever command the defendant gave them. If he told them to wake, they would wake up and be ready for his further instructions. If he told them to sleep, they would relax once more.
16. After the induction, the defendant moved on to his usual routines, starting with the simplest. As the evening progressed, the less responsive or imaginative volunteers were asked to return to the audience. In the end there were about 10 left on stage, including the plaintiff.
17. Particular criticism was made of a number of routines. In one sketch the participants were told that they would not be able to see the defendant. He then picked up a broom and walked across the stage sweeping it. The participants leapt out of the way of the broom as it was moved towards them. The plaintiff said in his witness statement that he could see only the broom and that it seemed to be moving by itself. He found this extremely disturbing.
18. There was also a satire on the television show Blind Date. It involved the imaginary prospect of an unattractive date, which the plaintiff said in his witness statement that he found rather distressing.
19. In another sketch the plaintiff was told to imagine that it was Monday mid afternoon and to do what he would normally be doing. In his case that would have been furniture polishing, which he did standing, so he stood up. He said that to his confusion and upset the defendant kept telling him to sit down and yet continued to tell him to imagine that it was Monday afternoon.
20. Before the interval the plaintiff was told by the defendant that if he was asked questions by anyone during the interval he must answer "yes". According to the plaintiff, the only exception was if the question was uncomplimentary towards the defendant. According to the defendant, he added a proviso that the plaintiff would not have to reply to any question that was inappropriate. The plaintiff said that during the interval he found himself reluctantly compelled to say yes in answer to a question whether he was gay, although this was untrue, and he found it distressing. On the point of difference about what was said, I am not persuaded that the defendant added a general proviso about not answering inappropriate questions. I doubt whether he thought it necessary. He had made a general statement at the beginning of the show that participants would not be asked to do anything inappropriate. But if participants were only going to say yes where that was appropriate, it would rob the comedy of suggesting that they were going to answer yes to everything and spoil the line about making an exception in relation to the defendant.
21. In another routine the plaintiff was given a pair of glasses and told that they would enable him t see the members of the audience naked. He put them on and could see quite clearly that they were not naked, but his evidence was that he could not help but act as if they were. When he first put on the glasses he expected to see people naked, and although it did not work, he felt embarrassed and came over hot and flustered. He took the glasses off, but the defendant told him to put them back on, and he did so. A female participant was given a similar pair of glasses and told that she could see other male participants naked. She looked at him through the glasses, and he found it very embarrassing. He turned away and crossed his arms in front of himself, but the defendant turned him back to face the audience and removed his hands to stop him covering himself up. The defendant denied turning the plaintiff to face the audience or moving his hands. He obviously has no recollection of having done so, but I think that he probably did. By all accounts the plaintiff appeared to be the star performer of the evening, and his apparent attempt to avoid being seen by the lady participant was likely to have been seen by the defendant as good entertainment.
22. The plaintiff alleged that at one stage he was put under the impression that the defendant was a priest to whom the plaintiff had just confessed something dreadful, and that the defendant was on the point of telling his dark secret to another priest unless the plaintiff gave him £5. The plaintiff said that he did not have any money, because he had given his wallet to Miss Gibbs, and the defendant said that he would let him off this time. The allegation was supported by Miss Gibbs, who said that she remembered the plaintiff putting his hand to his mouth at the time. The defendant's evidence was that he had never performed a routine involving two priests, but that he did have a sketch which involved mention of a story about a vicar and telling it to someone else unless the participant paid to prevent publication. It is difficult to be confident what was said, but I think that there probably was on this occasion some exchange involving a threat to tell the plaintiff's secrets to someone else unless he paid, but without the defendant necessarily himself pretending to be a priest.
23. At one point the plaintiff was asked by the defendant to think of something and to say what it was. The plaintiff said his dog. He was asked what type of dog, and he replied "a dead dog". This was a reference to a dog which he had grown up with and eventually had to take to the vet to be put down. That had happened when he was about 17, and he had not spoken about the incident subsequently because he found it very traumatic. His reference to a dead dog seemed odd to the defendant, who asked him to think of something nice. The plaintiff then said "ice cream". None of the witnesses could be sure exactly when this incident occurred.
24. The plaintiff was on stage for two and a quarter hours in all. The defendant ended by going back through all the sketches and telling the participants that all hypnotic suggestions were now cleared. He told them that when they woke up they would be masters of their own destiny and back to their normal selves in every way. He did a countdown and told them to wake up. He then asked the participants one by one how they felt and gave each of them a ticket for another show.
25. Afterwards the plaintiff and Miss Gibbs went to a pub for a drink. He said that his memory of things was rather hazy and he had a headache, but it did not seem particularly bad. Miss Gibbs noticed that his eyes looked slightly glazed.
26. The show was on a Thursday evening. That night the plaintiff had difficulty getting to sleep and he was awake according to his evidence until 4 am. Next day at work he talked about the show to his supervisor, Mr Fenn, who very soon noticed a marked change in the plaintiff's behaviour. He started giggling for no apparent reason and at other times showed irrational aggression. On the same day it was announced by shop stewards that there were to be redundancies, although at that stage nobody knew which departments would be affected and whose jobs were to go. The plaintiff caused surprise by reacting to the announcement as if it were amusing. After work he went out with Miss Gibbs for a few drinks. She found his behaviour out of character. He was giggly but also snappy and irritable. There were further instances of him laughing irrationally in public during the rest of that weekend.
27. Miss Gibbs next saw the plaintiff on Tuesday 15 March. That was his karate evening, so she was surprised to receive a telephone call from him asking her to come round to his flat. On her arrival she saw that his eyes were glazed, and he had written out a message saying that he could not cope and needed somebody to tell him what to do. At this stage she became worried at his behaviour. He was showing a mixture of emotions of fear, aggression and anger, in a way which she had not previously witnessed. The only cause she could think of was his recent hypnosis, so she telephoned the Swan Theatre and eventually obtained the telephone number of the defendant's agent.
28. On Wednesday 16 March the plaintiff went to work but broke down in tears in front of his workmates. He telephoned Miss Gibbs and then went to see his general practitioner, while Miss Gibbs managed to speak to the defendant. She described what had happened and the defendant gave her the name and telephone number of a therapist, Hugh Willbourn, who gave evidence. The general practitioner's notes recorded that the plaintiff presented with a strange story of being affected by a hypnotic show at the weekend and was complaining of over awareness and loss of concentration.
29. Over the next few days the plaintiff's condition became increasingly disturbed. On one occasion he telephoned Hugh Willbourn in the middle of the night. He had fears of going to sleep in case he would die. He became terrified of going upstairs because he believed that the defendant and Hugh Willbourn were waiting upstairs for him. He also felt that he was going up a set of stairs to heaven and when he reached the top he would die. He was incapable of making decisions and thought that he could stop cars with his eyes. The whole experience must have been extremely terrifying both for himself and for Miss Gibbs.
30. On Friday 18 March the plaintiff was seen as an out patient at the psychiatric unit at Amersham General Hospital, and on the following day he was admitted for in patient treatment. From that time on Miss Gibbs kept a diary of events, both as way of expressing her feelings and also because she and the plaintiff had the possibility of the present litigation in mind. She first went to see a solicitor on 23 March.
31. The plaintiff was discharged from hospital on 13 April 1994 and returned to work in the following month.
32. In June 1994 Miss Gibbs received a telephone call from a hypnotherapist, Mr Derek Crusell. He had apparently been contacted by a newspaper interested in the plaintiff's story and he offered to see the plaintiff. On 26 June 1994 the plaintiff and Miss Gibbs went to see Mr Crusell, who offered to provide the plaintiff with free treatment. The plaintiff's evidence was that he thought that Mr Crusell helped him, but unfortunately he found himself in the position of being given conflicting advice. Mr Crusell wanted the plaintiff to stop his medication and threatened not to treat him unless he did so, whereas the advice of the consultant psychiatrist in charge of his case was that he should continue to take anti-psychotic medication.
33. The plaintiff came off his medication in about August 1994. Sometime afterwards his thought disturbances began to increase, culminating in a second acute schizophrenic attack. On 19 November 1994 his general practitioner referred him back to the psychiatric unit at Amersham General Hospital. He was told at the hospital that he need not be readmitted if he went back on his medication and was able to stay with Miss Gibbs. The plaintiff took this advice and the episode passed. The relapse led to him being off work, but he was referred to a day centre called Harlow House for occupational therapy. In January 1995 he was made redundant from his employment as a furniture polisher, and he has not since been employed.

Hypnotism Act 1952

34. The Hypnotism Act was passed, as its preamble indicates, to regulate the demonstration of hypnosis phenomena for purposes of public entertainment. The method of statutory control is through local authorities. Some time was taken upon the effect of the statute and whether there had been a breach of the relevant controls, but those questions are peripheral to the pleaded issues and I do not therefore propose to go into them.
35. Reference was also made during the trial to the definition of hypnotism in the Act, to a Home Office circular containing recommended model conditions to be attached to public entertainments licences, and to a report dated 11 October 1995 by a panel of 4 experts appointed by the Home Secretary in December 1994 to consider the effects of participation in performances of stage hypnotism. The panel was appointed after an adjournment debate in the House of Commons to discuss public concern about alleged harm suffered by some participants in public performances of stage hypnotism.
36. Its terms of reference were to conduct a review of documented cases, to assess the degree of risk of serious harm to the public from the performances of stage hypnotists and to make recommendations for any changes necessary to protect the public from serious harm. The panel consisted of a clinical psychologist, a research psychologist, a psychotherapist and a psychiatrist. They placed advertisements in five professional journals asking clinicians to submit any relevant medical evidence for the panel's consideration. The Home Office also contacted people who had indicated that they had been victims of stage hypnosis and asked for authority to obtain their medical case notes. The panel's assessment of the evidence of the cases reported to them was that the personal accounts of those involved showed that there was a risk of humiliation, embarrassment or irritation, and that the risk might, for some people, have psychological sequelae, but that the numbers concerned were very small. The panel also considered some research literature (listed in an annex to the report), parts of which have also been referred to by the experts in the present case. The panel concluded that none of the studies could claim to have shown anything more than a plausible connection between the stage hypnosis and the trauma described, but that this was unsurprising given the number of variables which might conceivably have played a part. A reasonable assertion from the available material was that some unwanted effects associated with stage hypnosis had been experienced by a very small number of subjects, with even fewer examples of untoward or long-lasting impact. The cases of alleged harm represented a tiny minority when compared with the number of people who had participated in such shows.
37. The panel did not attempt its own research studies, and while its appraisal of the evidence which it considered is not without interest, the expert evidence on which I must concentrate is that of the experts who have been called as witnesses in the case and have had their views probed by cross examination.

Causation

38. The plaintiff's experts advanced different theories of causation.
39. Professor Gruzelier is professor of psychology and head of the behavioural and cognitive sciences division of neuroscience and psychological medicine at Imperial College School of Medicine. His scholarship is unquestioned. His proposition, as ultimately formulated in his evidence, was that psychologically distressing aspects of the stage hypnosis acted as a stressor on an existing vulnerability in the plaintiff's brain structure/function; which, when taken in conjunction with the close similarities in the neurological underpinnings of schizophrenia and hypnosis, resulted in the possibility that (whether or not the brain was returned to his pre-hypnotic stage) his vulnerability to schizophrenia could be unmasked, and so could have triggered the schizophrenic episode. He would not go so far as to say that this was more likely than not, but he put it forward as a possibility. The plaintiff submits that in view of the time sequence it should be regarded as a probability. The defendant's experts reject it as a theory lacking any scientific base.
40. The theory leads unavoidably into the question what is meant by a person's brain being in a hypnotic stage. It is common ground that there is no definitive physiological indicator whether a person is or is not in a "hypnotic stage". But Professor Gruzelier suggests that there is evidence from electrophysiological testing that there is an altered programme of brain activity in a state of hypnosis which bears some resemblance to that of a schizophrenic person. In particular, he referred to changes in the inhibitory influences of the frontal lobes of the brain, which control the planning of behaviour, and to changes in perception such as enhancement or blocking of sensory stimulation. However, he accepted that there can be ordinary conditions where frontal lobe inactivity will be found. If a person is in a very relaxed state, not having to plan, it is reasonable to suppose (all other factors apart) that he will have lower frontal lobe activity. Whether there is in truth enhancement or blocking of sensory stimulation under hypnosis is a complex and controversial subject.
41. On the narrow matter of changes in electrical activity, the defendant called Professor Sedgwick, who is professor of clinical neurophysiology at Southampton University and whose work lies principally in the field of EEGs. He was somewhat critical of the methodology of the work relied upon to support the suggested similarities in the programme of brain activity between hypnosis and schizophrenia, but his principal point was that any suggested similarities were trivial compared with the major differences. Schizophrenia is a lifelong socially debilitating disease, genetically determined and involving structural abnormality of the brain. It responds to anti-psychotic medication. He was unaware of any comparable abnormality under hypnosis or of any scientific evidence to show that the brain of a normal person under hypnosis presented any neurophysiological abnormality.
42. Profesor Gruzelier also relies on comparisons between the sensations of people under hypnosis and sufferers from schizophrenia to conclude, firstly, that there are close similarities in the neurophysiological underpinnings of schizophrenia and hypnosis, and secondly, that a consequence of inducing a state of hypnosis, or not returning the brain to its prehypnotised state, could be to unmask a vulnerability to schizophrenia. The particular parallels which he draws are auditory and visual misperceptions (seeing or hearing something not there or failing to see or hear something that is there); alterations in sense of one's relatedness to the world; delusions of control, such as beliefs that a person's actions are wilfully controlled by an outside force or power; automaticity or compulsion of behaviour; dissociation of emotion from the appropriate context; and delusions of identity.
43. The proposition that these are common symptoms of schizophrenia is uncontroversial. Whether the brain enters a similarly disordered state under hypnosis is another matter.
44. The word hypnosis was invented in the 1840s by a Scottish surgeon, Jams Braid. He took it from the Greek word hypnos (sleep) as a term for a sleeplike state but in which a wide range of behavioural responses could be elicited by suggestions from the hypnotist. However, interest in the subject goes back long before Braid. Modern interest began with the work of Dr Franz Anton Mesmer (1734 to 1815), who gave his name to the words mesmerise and mesmerism.
45. The subject has long been a source of controversy. Dr Mesmer was accused by Viennese physicians of practising magic and was forced to leave Austria in 1778. This may have been due to understandable scepticism about his theory and means of practice. His theory was that a person could transmit universal forces to others through a form of megnetism, and his sessions involved patients sitting around a vat of dilute sulphuric acid, holding hands or grasping iron bars protruding from the solution. Exiled from Austria, he settled in Paris but the controversy continued. In 1784 Louis XVI appointed a commission of scientists and physicians (among them Benjamin Franklin) to investigate his methods. The French revolution drove him to England, where his work excited the interest of Braid. It also excited considerable popular interest among the Victorians. When Freud developed his ideas of psychoanalysis, he became interested in hypnosis as a technique in the treatment of neurotic disorders. All that is now history, but it has left behind it a sense of magic or mystery, which has coloured modern popular perception of the subject.
46. Among scientists controversy continues. The traditional view of hypnosis as a special condition of the brain that is manifested in a sleeplike state, or trance, in which subjects essentially become automata (i.e. they lose volition and come under the power of the hypnotist, who can make them do things which would not otherwise be possible) is now widely rejected by the scientific community. But some theorists (sometimes called state theorists) still see hypnosis as an "altered state", which can produce alterations of perception and behaviour not capable of being induced by "normal" human processes. Others (non-state theorists) argue that the phenomena associated with the term hypnosis can be mundanely explained in terms of ordinary human psychological processes such as imagination and relaxation, and that it essentially involves a form of strategic role enactment. For them, hypnosis comes like Father Christmas only to those willing to believe in him and remains only for as long as they are willing to act out such belief.
47. The difference is significant in this case for two reasons. Firstly, Professor Gruzelier relies on the perceptions experienced by people under hypnosis to support his suggestion that schizophrenia and hypnosis have common neurophysiological underpinnings. Secondly, it is a material part of the plaintiff's case that he experienced differences in visual stimuli (for example, he could not see the defendant holding the broom, and this made him frightened) and that his actions were involuntary.
48. To a detached critic, perhaps the most striking example of the apparent ability of a person under hypnosis to perform surprising feats is that referred to as catalepsy. That is a state in which a person lies between two objects, head on one and heels on the other but without support for the rest of the body, and adopts a posture so rigid as to be capable of supporting heavy weights. It might be thought hard to imagine how that could ordinarily be done, but I was told by the defendant's expert on hypnosis, Dr Wagstaff, who is a reader in psychology at Liverpool University and has been involved in hypnosis research for over 20 years, that it is simple. He has done it himself without hypnosis and he used to show students how it was done, but he has stopped doing so because of the possible risks of damage to the back.
49. Study of behavioural characteristics under hypnosis has also involved study of whether visual and auditory stimuli are in truth capable of being modified by hypnosis. Reports of negative and positive auditory or visual hallucinations under hypnosis are common. Less common have been attempts to test them scientifically, but some have been documented in papers to which I was referred in the course of the experts' evidence.
50. In one line of research (discussed in Hypnosis and Imagination, by Kunzendorf, Spanos and Wallace) hypnotic subjects were administered suggestions for deafness and then tested by receiving delayed auditory feedback. They wore headphones while they read aloud, and at the same time their voice would be tape recorded and played back over the headphones. When a slight delay was introduced between what the subjects were reading and what they were hearing over the headphones, subjects with normal hearing would begin to pause and stutter. Deaf subjects would not be affected. Hypnotic subjects who were given deafness suggestions, and who claimed not to be able to hear, nevertheless stuttered during the experiment in the same way as subjects with normal hearing.
51. Another line of research (described in a Sociocognitive Approch to Hypnosis, by Spanos) was aimed at testing hypnotic blindness and post-hypnotic amnesia. In one part of the study highly hypnotisable subjects were given the negative hallucination suggestion that when they opened their eyes they would see a black piece of paper. On the paper was drawn a large number 8. When they opened their eyes and looked at the paper, 15 of the 45 subjects stated repeatedly that the paper was blank. The paper was then removed from their view and the hypnotic procedure and blindness suggestion were cancelled. The 15 subjects who had claimed blindness were then interviewed by a second experimenter. She told them that people who attempted to fake hypnosis always insisted that they had seen nothing on the paper, whereas deeply hypnotised subjects initially saw a figure which then gradually faded from view. The subjects were asked to draw what they had seen on the paper at different intervals, so that she could determine how the figure had faded from view over time. Subjected to that non-hypnotic suggestion, 14 out of the 15 subjects who had previously claimed that the paper was blank drew a number 8.
52. In a different test 8 highly hypnotisable subjects who had consistently described their responses to suggestions as involuntary were told, not under hypnosis, that during hypnosis hidden parts of their mind remained aware of things that they could no longer consciously remember. They were told that one hidden part remained aware of everything that occurred in their right hemisphere, while a different hidden part remained aware of everything in their left hemisphere. The subjects learned a list that contained abstract and concrete words. Half were told that abstract words were stored by their right hemisphere and that concrete words were stored by their left. The others were given the opposite information about storage location. Following a hypnotic suggestion to forget the words learned, all subjects showed high levels of amnesia. But before cancelling the suggestion, the experimenter successively contacted each subject's right and left "hidden parts". All subjects recalled all of their right hemisphere words but none of their left hemisphere words when contact was made with their "right hidden part", and showed the opposite pattern of recall when contact was made with their "left hidden part". In other words, they breached their hypnotically suggested amnesia in response to a pre-hypnotic induced belief about the response to be expected from excellent hypnotic subjects. The author concluded that these findings did not necessarily mean that amnesiac subjects were simply lying. Some may have succeeding in convincing themselves as well as their audience that they "really couldn't remember", but to say that they were in fact unable to remember was inaccurate.
53. In a further variation of these experiments, highly hypnotisable subjects were given a hypnotic suggestion that the page which they were about to be shown was blank. In fact it had the number 18 printed on it. After they had looked at it, the page was removed. Half of the subjects who reported that the page was blank were then given instructions implying that the hidden part of their brain in fact knew the number that had been on the page. The other half were told that their hidden part reversed everything that it saw. The former then reported having seen an 18 and the latter an 81. Because the page had been removed before they were given the hidden part instructions, they could only comply with those instructions if they in fact knew that the page contained an 18.
54. The experiments to which I have referred are merely examples. The central thesis advanced by Dr Wagstaff was that the phenomena which can be produced by hypnosis can be produced equally by suggestions made without hypnosis. Hypnotic amnesia is not something which happens to people; but in response to appropriate suggestions people behave as if it did. Hypnosis itself does not "work", any more than Dr Mesmer's magnetised metal bars; but as with Dr Mesmer's bars, so with hypnosis, what matters is the subject's belief and willingness to act in accordance with his belief.
55. As with other hypnotic phenomena, so also with analgesia. There is evidence that hypnosis can be effective as a preanaesthetic procedure, often resulting in a decrease in the amount of anaesthetic drugs needed to achieve the same anaesthesia without hypnosis. Many mothers have found it helpful in childbirth. However, several studies have suggested, and it was Dr Wagstaff's evidence, that it is no more effective than similar suggestions made without hypnosis.
56. As I have indicated, Professor Gruzelier's theory was opposed on matters neurophysiological by Professor Sedgwick and, insofar as it assumed an abnormal state theory of hypnosis, by Dr Wagstaff. It was also opposed by Dr Reveley, a consultant psychiatrist at the Maudsley Hospital, where she is lead consultant on the National Psychosis Unit. Besides her clinical work, during the last 20 years Dr Reveley has been involved in research work centred on the aetiology and genetics of schizophrenia. She said that it is now accepted that schizophrenia is a biological brain disease. This is based on incontrovertible findings that there is a substantial genetic contribution to the disorder; that the drugs used to treat the illness produce their antipsychotic effect by blockading the dopamine receptors in the brain; and that a number of structural brain abnormalities are routinely seen in schizophrenia. Her evidence on those points was not challenged. She sees it as a genetically mediated neuro-developmental disorder and believes that the reason why it typically presents between late adolescence and the mid twenties is that the brain is the last organism to mature. Thus the layer of myelin found around the nerve pathways in adults is not found in children.
57. Schizophrenia affects about 1% of the population and takes up over 5% of the National Health Service budget. There has therefore been a great deal of world research into the subject with many thousands of articles published.
58. Dr Reveley's evidence was that there is no serious body of modern research investigating neuropsychological parallels between schizophrenia and hypnosis. She did not believe that there was any scientific basis for any meaningful neuro-psychological parallel between schizophrenia and hypnosis of the type suggested by Professor Gruzelier. She observed that hypnosis is a common therapeutic tool, but the possibility of triggering schizophrenia was not considered as a side effect of its use. No other case had been reported in which hypnosis had supposedly unmasked or triggered schizophrenia (other than the plaintiff's own case, which was reported in a paper by Dr. Allen, the consultant psychiatrist at Amersham General Hospital under whose care he first came). This would be remarkable if there were a neurophysiological link of the kind postulated by Professor Gruzelier, given the fact that schizophrenia is a very common disorder and the fact that hypnosis has been widely used in therapeutic and other settings for many years. Professor Gruzelier's response to the last point was that in the clinical field people would avoid use of hypnosis in the case of anyone who it was thought might be psychotic. As for stage hypnosis, he thought that a person having the schizotypal pensonality thought to be a precursor of schizophrenia would be likely to suffer from social anxiety and would therefore be an unlikely volunteer for stage hypnosis.
59. On Professor Gruzelier's theory of causation, I found the evidence of Dr Reveley, Professor Sedgwick and Dr Wagstaff more cogent. I am not persuaded that any meaningful neuro-physiological link between hypnosis and schizophrenia has been demonstrated. Nor am I persuaded that a person under hypnosis is an automaton or in some distinctively abnormal neurophysiological state or capable of behavioural responses which cannot be invoked by non-hypnotic suggestion.
60. In fairness to Profesor Gruzelier, I have said that he did not advance his theory as probable in the legal sense of being more likely than not. The plaintiff's submission was that if I accepted the theory as scientifically likely, I should conclude that it was factually the probable explanation. Having considered all the evidence, I am not persuaded that it is scientifically likely or factually the probable explanation.
61. The plaintiff's alternative theory of causation was that, without there being any specific neurophysiological linkage between hypnosis and schizophrenia of the kind put forward by Professor Gruzelier, the onset of his disease was nevertheless triggered by the stresses generated by his experience of hypnosis. The plaintiff relied on the evidence of Dr Hallstrom, honorary consultant psychiatrist of Charing Cross Hospital and honorary senior lecturer at the Institute of Psychiatry and Imperial College Medical School, Dr Kraft, a consultant psychiatrist in private practice, and in part on the evidence of Professor Gruzelier relating to stress.
62. Dr Hallstrom's evidence was in summary that illnesses such as schizophrenia are often precipitated by "life events or environmental stressors", and that on this occasion the probable trigger was the hypnotic show. He accepted that schizophrenia is an organic disease which could only manifest itself if the plaintiff already had the necessary underlying genetic predisposition. But genes do not appear to be the sole factor which determine whether a person suffers schizophrenia. The concordance rate for schizophrenia in identical twins is about 50%, and while that is very high, the other side of the coin is that for every identical twin who suffers from schizophrenia his sibling with the same genes is as likely not to develop the disease as he is likely to develop it. Dr Hallstrom's opinion was that there was nothing to indicate that the plaintiff would have developed schizophrenia for any other reason. Dr Hallstrom's first involvement with the facts of the present case came when he was approached for his views by a newspaper which was running an article about the plaintiff's experience. He understood that his name had been given to the paper by the Royal College of Psychiatrists. He was not prepared to comment without seeing the plaintiff's medical notes. After reading them he made a positive attribution on the basis of the material which he had seen. He had not at this stage seen the plaintiff or specifically researched the literature on the subject. Having later seen the plaintiff and considered the matter further, his opinion was reinforced.
63. Dr Kraft's report advanced an essentially psycho-dynamic theory of the cause of the disease. He noted that the plaintiff had been brought up in a strict authoritarian household, where he had to obey every command. At the age of 22 he started karate training, where again he had to obey instantly the commands of his teachers. That background tied in with his taking the defendant's statement that volunteers should come up on stage "now" as the word of command. The events on stage unlocked painful repressed memories in relation to the death of his dog, and the sketch involving the glasses may well have reactivated the anxiety felt by him when he was involved in a sexually embarrassing experience at the age of 15. He was also put under stress by being given conflicting cues, as in the routine where he was told that he was supposed to carry out his work and at the same time to sit down. Dr Kraft said that it was well known in the psychotherapeutic literature that the basis of schizophrenia is rooted in the "double-bind" instructions which are given to the child, the "double-bind" being a situation where the child is simultaneously given opposing cues. Dr Kraft also thought it probable that the plaintiff was not adequately brought out of hypnosis, perpetuating his lack of proper hold on reality.
64. Dr Reveley's evidence was that this psychoanalytical approach, including the "double-bind" theory, as a means of explaining the cause of schizophrenia has been superseded by a large body of psychiatric research and runs counter to the current approach to causation adopted by the Royal College of Psychiatrists. She referred on this subject to the Oxford Textbook of Psychiatry, 3^rd edition (1996). Her evidence on this subject was not seriously challenged in cross examination, and I accept it.
65. On the subject of life events, Dr Reveley accepted that all illnesses are potentially susceptible to precipitation by every day life events. Schizophrenia does not require any precipitating life event and most people who suffer the disease are unable to point to any such event. But there is a body of research that life events may operate as a precipitant of schizophrenia, as of other illnesses. In her first report she drew attention to research showing that the schizophrenic breakdown rate of US army recruits was much higher in their first month of military service than at any time in the next two years, suggesting that the stress involved in the transition from civilian to army life was contributing to the time of onset of their schizophrenia. She also referred to research in 1968 by Brown and Birley, who looked at the nature of life events happening to 50 schizophrenic patients with illness of recent onset and compared this sample with 400 controls from the same locality. They found that the schizophrenics had experienced significantly more life events than the controls in the 3 weeks leading up to the onset of the illness.
66. Dr Reveley said that in life event theory it does not matter whether the event was pleasant or painful provided that it was emotionally charged. For example, life events might include getting married or divorced, suffering a bereavement, having a car accident, losing a job or moving home. It has been reckoned that a person has an average of 3 life events a year.
67. Dr Reveley considered that the development of schizophrenia in the plaintiff at his age was unfortunately all too common and that he is typical of many cases she sees in her clinical practice. She thought it very unlikely indeed that the stage hypnosis was causally implicated in his illness in any way. If she had been asked on the day before the plaintiff went on stage whether hypnosis could cause schizophrenia, she would have said no, and her answer would be the same today. Had it been otherwise, she would have expected there to have been a body of reported cases by now. The plaintiff's description of his feelings at the beginning of the show made her think it likely that he was already unwell. If not, and if one were to assume the involvement of a life event, there was no more reason to identify the stage hypnosis than the redundancy meeting on the following day; but the probability was that he suffered the natural onset of a pre-determined neuro-developmental disorder. If the hypnosis did operate as a trigger factor, she believed that it did no more than precipitate the manifestation of that which was due to appear in any event.
68. My rejection of the idea that the plaintiff was in a helpless state of automatism does not, of course, mean that he could not be subjected to pressures during stage hypnosis. Quite the reverse. If the plaintiff had been an automaton in a state of trance, he would presumably have had no will to disobey the defendant's suggestions. Since he had a choice how to respond to them, he potentially had a dilemma how to make up his mind. Dr Wagstaff referred to the social pressures of stage hypnosis in part of his report where he said:-

"Stage hypnosis, like a game-show, or many domestic situations, can be a powerful social situation in which people feel a strong social obligation to do what they are told (which increases the more things they actually consent to do). It has what psychologists term powerful "demand characteristics". Thus, having volunteered, its subjects are then told to do something which they for some reason find embarrassing (such as do an impression of a pop star, at which they are very poor), they may feel socially obliged to do it, but also apprehensive about what they may be asked to do next, and annoyed to find themselves in this situation. Occasionally, therefore, some hypnotic subjects may report feeling "embarrassed", "out of control" and "annoyed", and, because they underestimate the influence of social or situational pressures, they may even express some surprise at their compliance, and attribute it to some feature of "hypnosis".

However, I know of no evidence to show that the pressures to perform in a stage hypnosis demonstration of the kind performed by the defendant are any different from those in many other situations, such as television game shows. Indeed, it could be argued that hypnotic subjects have a better opportunity to back out; they can save face by playing the role of the "insufficiently hypnotised" person (an opportunity of which some participants clearly take advantage)."

I accept that evidence, which seems to me to accord with common sense. It is also well recognised by psychologists and is a matter of ordinary human experience that some people have more compliant personalities than others.

69. The plaintiff was asked to do several things which were silly, and some may have embarrassed him, but he was not asked to do anything humiliating. The plaintiff volunteered to take part, knowing in advance the sort of things which the defendant did from having watched his television shows, although he did not know what it felt like to participate. I am not able to accept that the plaintiff was under any hypnotic compulsion to come on stage, as was suggested, although he certainly believes now that he felt under an inner compulsion to do so. I am doubtful whether his memory is reliable about that, and I think that it is more likely to be reconstruction in the aftermath of a serious illness. On the other hand if he is accurate in his description of his thoughts and feelings when he went up on stage, and particularly his reaction to th word "now", that would tend to suggest that he was already ill, as Dr Reveley was inclined to conclude, although that cannot be more than a matter of supposition since the plaintiff was not medically examined or his condition diagnosed until sometime later.
70. Since I do not believe that hypnosis can truly cause hallucinatory blindness, I do not accept that the defendant was invisible to the plaintiff or that the plaintiff was really frightened of the broom, although he has convinced himself otherwise. Similarly I do not accept that the plaintiff believed in truth that he could be seen naked by another participant wearing glasses. He knew that when he himself put on the glasses which the defendant gave him they made no difference to his sight. Nor do I accept that the other routines caused him any serious anxiety.
71. I accept that immediately after the show the plaintiff had a headache, but that was not surprising after spending over 2 hours on stage and it was not bad enough to stop him from going for a drink with Miss Gibbs. I accept that he had difficulty in getting to sleep that night, but there could be a number of reasons for that. He may have been over excited after being the apparent star of the show or it may have been part of the crescendo of abnormal behaviour which developed over the following days. I have no doubt that during the next few days the plaintiff and Miss Gibbs for good reason became alarmed and frightened by his increasingly disordered thought processes and behaviour, and they understandably attributed this dramatic change in his personality and behaviour to the effects of stage hypnosis. As Dr Reveley commented in her report, it is a natural fact that people who become suddenly ill seek an explanation for their illness and, in their "effort after meaning", will often fix on a recent unusual event as the cause. This factor is one of the difficulties of life event research in schizophrenia. It is all the more natural that the plaintiff and Miss Gibbs should have made the connection in view of the popular mystique attached to hypnotism, which it is in the commercial interests of stage hypnotists like the defendant to encourage. A stage hypnotist who introduced his show by telling the audience that they had bought tickets for something which could be done equally well without hypnosis would not expect full houses.
72. The defendant has published a number of books, tapes, cassettes and website material which make extravagant claims for the powers of hypnosis. In his evidence he recanted or qualified those views to a considerable extent. Not surprisingly he was cross examined about extracts from his publications in some detail. My impression was that they contain a mixture of what he believed and an element of advertising hype. But I have to decide whether the plaintiff's illness was caused by his experience of stage hypnosis, looking at the matter clinically and objectively on the basis of the expert evidence which I have heard.
73. I have already indicated that I accept the evidence of Dr Wagstaff, who was an impressive witness, on the nature of hypnotic phenomena. I accept that the plaintiff probably found his experience of stage hypnotism both exciting and stressful to a degree, but no more so than was to be expected or than would be so in the case of other forms of public entertainment often shown on television.
74. Among the psychiatric experts I was most impressed by the evidence of Dr Reveley. Although she has not studied hypnosis, the aetiology of schizophrenia has been the focus of her research work for many years and she is highly knowledgeable about the present state of medical opinion on that complex subject. I found her evidence balanced and compelling.
75. I conclude that it is highly improbable that the onset of the plaintiff's schizophrenia had anything to do with his participation in the hypnotism show in which he took part. The only conceivable way in which there could be a causative link would be by classifying the experience as a life event and postulating that the stress which it generated was responsible for triggering the disease. Research in this area is incomplete, but the absence of any previously recorded similar case makes it unlikely. Even if there were a connection, the strong probability must be that the plaintiff was on the point of manifesting the illness in any event and that the most that the incident could have done was to affect its timing.
76. The argument that since the plaintiff had survived previous life events (such as his divorce and a road accident which resulted in a driving disqualification for 18 months) without developing the disease, he would therefore have been unlikely to develop the disease in future but for this episode, is fallacious, for it overlooks the neuro-developmental nature of the illness. Dr Reveley drew an analogy with a man with a heart condition making him liable to a heart attack at any time and who then suffers a traumatic event which precipitates a heart attack. The fact that the plaintiff had not had a schizophrenic episode in the past shows no more than that his underlying condition had not yet reached that stage. To say that he was not going to do so in the future would be a non sequitur.
77. It is also fallacious to say that, because for every person with schizophrenia there is a 50% probability of another person with a similar genetic pattern never developing the disease, it is therefore equally likely that the plaintiff would not have developed the disease in future. For the non-sufferer in that argument is someone who never has and never will reach the stage of development at which the disease is triggered by a life event, despite normal exposure to life events. The plaintiff is not such a person, for (according to this argument) an event involving not a particularly high level of stress has triggered the onset of the disease. If so, common sense and reason would suggest that his condition must have reached the stage at which it could be easily triggered and therefore would either have manifested itself without any triggering event or would have been triggered by any other life event involving comparable stress.

Negligence

78. If I am right in my conclusion that the plaintiff has not established that his schizophrenia is in any way attributable to his experience of stage hypnotism, the question of negligence does not arise as a live issue. If I am wrong, the allegations of negligence nevertheless fail in my judgment for two reasons.
79. Firstly, I do not consider that the defendant had reason to foresee a risk of the plaintiff suffering schizophrenia or any lasting physical ill effects from the experience. Reference has been made to a number of papers reporting various ill effects suffered by a small number of hypnosis subjects. I accept that when Dr Reveley said in her evidence that if she had been asked whether hypnosis could cause the onset of schizophrenia, her answer would have been no, she was reflecting what would have been mainstream opinion within her profession. It is argued on the plaintiff's behalf that it is sufficient that some physical or nervous ill health might have been foreseen, but (leaving aside any risk of a physical accident which can always happen on stage, but is not relevant in this case) I am not persuaded that it was reasonably foreseeable that an adult in apparent good health would have been at risk of suffering anything more than possible transient upset or discomfort from the experience, as distinct from physical or mental illness.
80. Secondly, I am not persuaded that the defendant failed to do, or did, anything which a reasonably careful exponent of stage hypnotism ought to have done or omitted.
81. It is not alleged that the defendant was wrong to conduct a stage hypnotism show, but it is alleged that he failed to give an appropriate warning about the risks and that his conduct was at fault in the other respects to which I referred in the introductory part of this judgment. On the matter of a warning, the plaintiff's pleaded case is that defendant should have given a serious warning that adverse and serious side effects could occur in a small minority of subjects. The defendant warned the audience that people under 18 were not allowed to volunteer and that people should not volunteer if they were suffering from various physical or mental conditions, none of which would have been believed by the plaintiff to apply to him. He was in apparent good heath. Since I do not accept that there was in truth a foreseeable risk of him suffering serious adverse side effects, it follows that I do not accept that there was a duty so to warn him.
82. As to the other criticisms, I am not persuaded that the defendant subjected the plaintiff to inappropriate stress in particular routines, or over persuaded him, or failed properly to observe him during the show or failed to act properly at the end of the show. On the one occasion when the plaintiff behaved in a frankly odd fashion on stage, by making the remark about the dead dog, the defendant handled the situation quite sensibly by asking him to think about something nice.
83. In summary, the defendant provided what was intended to be a form of family entertainment, in which the plaintiff willingly participated. I do not believe that he can be fairly criticised for his conduct of the show, or that he or anyone could reasonably have been expected to foresee the disastrous consequences which it is alleged to have had for the plaintiff.

Conclusion

84. My decision will be a disappointment to the plaintiff and Miss Gibbs, who believe that his illness was the defendant's fault. I have set out at length my reasons for reaching a different view. His misfortunate in developing the disease, which I am sure was of natural origin, was made worse after he had recovered from his initial acute attack and had returned to work by being persuaded to give up his medication, with the result that he suffered a relapse. The downward spiral continued when he lost his job through redundancy. Nor has the litigation helped. On 11 March 1997 he told his community psychiatric nurse that he did not want to work in case it damaged his chances in court. On 11 November 1997 he told a doctor at Harlow House he could not start looking for even part time employment because if he earned any money he would lose the legal aid he needed for his court case. The plaintiff in his evidence admitted making those statements, but he said that they were not accurate and that he was simply wanting to get off his back the people who were encouraging him to look for work. This was the one part of his evidence where I felt that he was less than fully forthcoming. I believe that the litigation has been a focus of attention for him and has affected his willingness to respond to help in getting him back to work.
85. On the positive side, the plaintiff and Miss Gibbs clearly have a strong attachment to one another. Their relationship has seen them through a very difficult time together. They have a young baby whose birth was planned. His former employers' evidence was that his redundancy resulted from a recession in the furniture industry, but that as and when they have a need to re-employ good furniture polishers, he would certainly be someone that they would consider if his health were restored. The plaintiff's schizophrenia has now been under reasonably stable control for some time, but the experts on both sides are agreed that he is not presently on the best medication. Having seen the plaintiff and listened to the medical evidence, I do believe that with professional help and the support and encouragement of Miss Gibbs he does have a reasonable prospect of getting back to work. However, I do not propose to lengthen this judgment further by going into the details of quantum issues in view of my decision on liability.