Sunday, February 1, 2009

On Anxiety

I just got a letter from Harvard Medical School. They want me to read one of their books, Coping with Anxiety and Phobias. Now why won’t I do that? Because there never is the phrase, “eliminating anxiety.” If all they can offer is coping I can do that on my own. And why can’t they offer “elimination?” Because they still don’t realize how deep and remote the origins of anxiety are. It is a pure vegetative state, mostly around the midline of the body.

Those who write about it could not imagine that sometime in the middle of gestation things happened that imprinted fear or terror. This imprint later becomes anxiety when the person’s gating system is weakened. It is imprinted at a time when the inhibitory forces of serotonin are getting organized but are not yet in full force.

If we do not understand the imprint we will never be led to origins and therefore will never get rid of this dread symptom. We see it in terms of butterflies in the stomach, cramps, pressure on the chest, breathing difficulties; all nonverbal elements that do not succumb to verbal therapies. It takes route when the lower brain centers and the brainstem are the highest level of brain function operating at the time. And, as I note, a brainstem imprint is a brainstem symptom—colitis, ulcers, breathing problems.

The answer to this is to go back in time to the brain that handled it, in the first place. Feel the terror piece by piece, and then we should not suffer any more. In my article and book on Life Before Birth, I cite a number of research studies that indicate that the physiologic status of the mother is usually paralleled by the fetus. High stress hormones in the mother will also be high in the fetus/baby. The baby gets a send-off with a predilection for anxiety just after birth. It may not show up for years as a consciously/aware symptom, but the groundwork is there from the start.

To eradicate anxiety we need a theory and therapy that understands remote origins, not the least of which is during gestation and birth, and then we need a therapeutic setting with no outside distractions so that the person can travel back in time through the vehicle of feelings. It is the factor of resonance that steers us to the right place and right time. Conventional therapists will not see nor understand it until they have a darkened silent therapy room where no great amount of verbiage can take place. In short, the patient needs to be inside herself, with the inhibitory neocortex receding so that access can be achieved.

If one does not believe in the remote past imprint then one would not devise a therapy to accommodate that goal. So much of current therapy involves verbosity ad nauseum that getting to feelings is impossible just in the structure of the therapy room.

And now the trend for anxiety cases is medication and more and different medication. And where do these medications work? Down low in the brain on the vigilance and feeling centers. That should tell us something. That anxiety results from very early trauma and is not something existential. Memory is medicine. Let us never abandon that truth.

A current situation, someone refuses to honor an application, sets off inordinate anxiety. Why? The situation resonated with very early terror, which is dredged up and inserts itself into the person’s current situation. Anxiety is the lower level aspect, the primal aspect, of the overall feeling of, “I can’t get through … to you.” It is current, resonates with parents whom could not be reached emotionally, and finally to the birth where the baby could not get through (was blocked). The radical part of this is, “I can’t get through.” That is the base, the first-line component. Later on, we add whatever circumstances compounds the feeling … to you. It gets to be anxiety when the gating system is inadequate to stem the access to lower brain levels. It is very much like need. At first there is pure need for love, for touching and holding, for caressing and warmth. When that is deprived very early on the need becomes the “need for.” It can be the need for drugs or food or gambling. But that is derivative of basic need; so when we treat these afflictions we must keep in mind that it is at bottom a real need we are dealing with.

13 comments:

  1. Thanks, I enjoyed that, though I have one question.

    Traditional therapists sometimes view anxiety, as the flight from feeling can this be so?

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  2. As someone studying Psychology at Helsinki University it is incredible how the role of 'need' is overlooked in discussions about the origins of anxiety and emotional states in general. It is almost as if past unmet needs and presently felt ones are incidental to the healthy functioning of the human organism. But I am pleased to say that on some courses this is changing. A course here on attachment(antenatal and postnatal)has been open to your ideas and those of F. Leboyer. Though I am uncertain to what extent anxiety can be 'eleminated' I think your theory makes a lot of sense.

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  3. Yeah, I just looked at the blurb on their website for the book:

    "Thankfully, never before have there been so many therapies to help control anxiety. This report will provide up-to-date information on these treatments, including medications, exposure therapy, cognitive-behavioral therapy, hypnosis, meditation, and exercise."

    This marketing technique is really the selling of hope, and I'm sure that's why it works as well as it does. Basically, the message you get from reading that is that you will never exhaust the many possible ways of treating your ailment, so you will never feel tapped out and doomed. It doesn't matter that no claims of effectiveness are bundled in. Note, in fact, how they've steered completely away from even mentioning effectiveness.

    I wonder, was the book sent to you for endorsement by a seasoned professional in the field, or as just another attempt to sell a book? It would be interesting if they were looking to you for endorsement.

    Walden

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  4. There are a couple of studies in which they chemically interfere with protein synthesis needed for reconsolidation of a reactivated memory. Until recently it was believed that once a memory is consolidated, it is permanent. But recent experiments show that memory, upon reactivation, becomes labile again, almost as it was prior to initial consolidation, and unless a reconsolidation process occurs, the memory will be lost (erasure).


    One of the things that's so interesting here is that without reactivation of the original memory, the chemical intervention of the experiments (used to prevent protein synthesis) has no effect. The parallel to Primal Therapy there is obvious and striking. The paper that deals with second order conditioning and associative networks of fear is also significant in the context of Primal, in the sense that the first order conditioning is the "primal" one, and unhinging it via activation and interference of reconsolidation is sufficient to take out the entire network, so to speak.


    In these studies, they artificially interfere with reconsolidation using a protein synthesis blockade chemical. Obviously, you don't do that in Primal Therapy. So, one has to wonder what natural process they are approximating with their blockade. The "hippocampus" paper has a section near the end where they discuss extinction and reconsolidation as processes that possibly compete for newly synthesized proteins. That's very intersting, and supports my intuition that primal patients do not experience sudden nondeclarative memory erasure as a result of primaling, but instead they experience a continuum that is made of the combined effects of extinction (short term) and erasure via aborted reconsolidation (long term), and moreover that the former may be part of the mechanism that hog the proteins that would have supported the latter. But I suspect there are other factors also at work (and I'm not an expert on any of this), which are as yet not known.


    All of this work comes out of experiments in classical conditioning, which seems insufficiently complex to model the development of emotional dysfunction in developing humans. Still, though, "at the end of the day", if there is such a thing as contextual or declarative memory "shorn" of its power, then we have to be talking about a mechanism something like what they describe in these papers, don't we?


    Another note: one wonders, in evolutionary terms, how it is that reactivation of long term memory places it in a labile state, and why such a thing would be true unless the mammalian (especially human) body has a way to exploit that for survival. This is just to say that there must be a (missing) natural process whereby irrelevant or non-adaptive memory gets erased, and just like the use of morphine was followed by the discovery of endorphines, these experiments in reconsolidation blockade should be followed by the discovery of their natural analogs, be those chemicals synthesized in the brain, or just processes that compete for proteins in short supply. In any event, that would be the chemistry/process that Primal Therapy exploits in achieving long term effects, I think.


    There are other papers, but these should do for now. I'll be interested to hear what you think of all this.

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  5. REPOST: Sorry, just some corrections/clarifications.

    Walter,

    You can't know if you have erased a memory, or just [apparently or temporarily] erased conscious access to it. A memory could still affect our brain even if we don't have direct conscious access to it. In fact that's a premise of primal theory.

    I understand that primal therapy does not eradicate memory at all, but alters the way that we respond to a memory - that is, the emotional response to the memory becomes rational. The memory of being terrified, for example, does not make us feel terrified if the terror has been "integrated" i.e. put in its proper rational context within our brain. Memories of the past should not make us feel like we are actually *still in* the past. The latter is the neurotic response to a memory.

    Memories are clearly and primarily affected by consciousness. We learn (and that means change and develop from our memories) where we are conscious. It should not surprise anyone that for memories to be created and "edited" and "integrated" they have to be experienced in consciousness and likewise felt - and that, quite simply, just means putting the full (including the emotional component) memory into consciousness.

    Finally; in my opinion neurosis, amongst other attributes, works as a crude learned-defense to a traumatic situation. That's what an over-reaction is. It's natures very 'rough' way of helping to ensure that the original infliction never happens again. The problem is, as I said, it's a crude and maladaptive defense. You probably have to integrate the pain driving the over-reaction to allow a more rational and adaptive defense develop.

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  6. Walter: I'm no neurobiologist or biochemist but as a person with some reliving experiences on my own I would say that memory proteins are no proper model to explain how a traumatic imprint is stored in the nervous system. A much more dynamic model is needed, one that matches with the power often showing in a Primal.

    I believe the reverberating nerve circuit as described by Arthur Janov, Allan Schore and others can well explain how the energy of an early trauma can endure for a lifetime.

    "Memory erasure" in Primal Therapy isn't a sudden event but rather a long lasting process and it clearly has a lot to do with primaling. Trauma resolution has a lot to do with reliving early events, reorganizing the brain, rewiring nerve networks and forming healthy nerve circuits that will finally connect different levels of the brain and the two hemispheres with each other (see Dr. Janov's Primal Healing). The whole brain and body system may be involved and not only memory proteins.

    Incidentally, memory is not completely erased in Primal Therapy. The trauma will be shorn of its power, as you said, but it will persist as "normal" memory. Thus, even decades after having relived my birth I could give you a good description of what had happened at my birth. Primal Therapy doesn't result in amnesia.

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  7. Some of the striking informative tidbits associated with the anti-anxiety medication valium make it apparent that valium is a prescription-based drug for treating anxiety, it belongs to the medicine group termed as benzodiazepines and is duly approved by the FDA (Food and Drugs Administration) for treating anxiety disorders.

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  8. Hi,
    What are primal needs? Secondary or derivated needs are for gambling, eating great amounts of food, need for medications...Where is the line beetwen normal need for food and what I can say overeating? Is there any sharp line? I think no, NO and no. Maybe because standards are individual. Eating-overeating: just a little modificated but different.. Overeating is relative word, an so on some one will not admitt he is overatin even if it is obvious for somebody. We can use basic needs little modificated for defense.
    I have anxiety. I think I was abandoned for couple hours right after my dificultt birth, because my mother was too bad. so, I was alone in critical situation, and today , when I am alone I have something in my stomach, something is happening there. Problems with breathing, too. My birth was lasted for9 hours, cord around neck, bottom came out first, local anaesthesia... and whole my life there are problems.

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  9. Dr.,
    You make a lot of sense to me, in so many ways.

    I have a question, being someone with PTSD and anxiety. I never suffered with anxiety or PTSD either one, until traumatic incidents happened in later child years (around 9 years old). I can see where how we are born can affect us later in life with anxiety; however, I wonder how anxiety remains dormant until the point of a traumatic event, and never shows its face at all until then. What keeps it away?

    Thanks.

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  10. dedanna1029, scary memories can be repressed with the help of various defences so that they remain unconscious while they continue to damage the body with permanently high cortisol levels for example.
    further trauma can strain the defences to the point where you start to feel some leaks. some anxiety is felt but the memories remain hidden.
    with janov's primal therapy a memory is experienced fully so that it's associated anxiety is relieved permanently. and as each anxious memory is resolved, safely, over many months or years, the total amount of repressed anxiety is diminished.
    the primal center measures your stress hormones and vital signs to check for permanent improvement.

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  11. dedanna1029, i remember being hit by a car when i was ten years old. immediately after the worst of the accident, i sat in the middle of the halted traffic, and strangely, i had no memory of flying through the air. i have never been able to remember that part of the accident. but i clearly remember every other detail....i remember watching the car approaching and slamming into my leg (i was on the back of a bicycle - my friend was steering). there were many witnesses who were sure that i never lost consciousness at any stage, and i was sure of that too - yet there was a strange hole in my memory. i couldn't remember that brief moment when i was hurled into oncoming traffic - and i'm sure that would have been the most dangerous and helpless moment.
    if that part of the event was blocked from my consciousness, it's likely that it has been stored as a terrifying memory, and is helping all the other repressed memories to keep my cortisol levels permanently elevated. repressed memories are always sending out signals which affect hormone levels.
    i never felt terrified at any stage of the bicyle accident, so... perhaps i didn't fully experience all those details that i remember well. i probably need to feel terrified. that would be the appropriate feeling.
    my internal body seems to be permanently anxious, but not terrified. my heart is always beating above 90 bpm, i get shortness of breath and purple hands which tremble sometimes....but i rarely feel noticeably anxious. i can't feel what my body is saying.
    if i take prescribed drugs, i will become even less conscious of those signals that are begging to be resolved. i don't want to be less conscious - i want to be more alive - so primal therapy is my only option.

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  12. Thank you for your responses, Richard. They make sense, and put the experience of primal therapy more into perspective. The logic and reasoning is easy to see of it the way you've presented it.

    The questions may keep coming, however. For instance, is this why sometimes we forget afterwards, that we have been in a PTSD incident (hyperarousal) or panic attack, and what we were reliving we can't remember as well? The pushing away of it by our subconscious/unconscious mind? I do this a lot. I remember going into the incidents, and go through a lot of the aftermath; the crying for days, resulting depression, but sometimes don't remember the PTSD incident itself or what I was reliving at the time. It happens similarly, but not quite to the same extent, as when I get a panic attack; there are portions of them too, that I can't seem to recall.

    I can *guess* what the incidents are/were about due to things that have transpired throughout my lifetime, but can't recall reliving them any more (I used to but don't now). All I can remember is the very scary feeling that gives the flight response in the first place, and then the aftermath itself is traumatic in its own way, as it renders one unable to function until it's "over" so to speak; the depression, crying, etc. are uncontrollable for extended periods of time.

    I can see the benefits of primal therapy for those who can not remember, and am thinking on the option of it myself; hence the questions. Please forgive any ignorance here. It's an attempt to learn about a different form of therapy, that could turn out in the end to be a very important one for many.

    Thank you so much again.

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Review of "Beyond Belief"

This thought-provoking and important book shows how people are drawn toward dangerous beliefs.
“Belief can manifest itself in world-changing ways—and did, in some of history’s ugliest moments, from the rise of Adolf Hitler to the Jonestown mass suicide in 1979. Arthur Janov, a renowned psychologist who penned The Primal Scream, fearlessly tackles the subject of why and how strong believers willingly embrace even the most deranged leaders.
Beyond Belief begins with a lucid explanation of belief systems that, writes Janov, “are maps, something to help us navigate through life more effectively.” While belief systems are not presented as inherently bad, the author concentrates not just on why people adopt belief systems, but why “alienated individuals” in particular seek out “belief systems on the fringes.” The result is a book that is both illuminating and sobering. It explores, for example, how a strongly-held belief can lead radical Islamist jihadists to murder others in suicide acts. Janov writes, “I believe if people had more love in this life, they would not be so anxious to end it in favor of some imaginary existence.”
One of the most compelling aspects of Beyond Belief is the author’s liberal use of case studies, most of which are related in the first person by individuals whose lives were dramatically affected by their involvement in cults. These stories offer an exceptional perspective on the manner in which belief systems can take hold and shape one’s experiences. Joan’s tale, for instance, both engaging and disturbing, describes what it was like to join the Hare Krishnas. Even though she left the sect, observing that participants “are stunted in spiritual awareness,” Joan considers returning someday because “there’s a certain protection there.”
Janov’s great insight into cultish leaders is particularly interesting; he believes such people have had childhoods in which they were “rejected and unloved,” because “only unloved people want to become the wise man or woman (although it is usually male) imparting words of wisdom to others.” This is just one reason why Beyond Belief is such a thought-provoking, important book.”
Barry Silverstein, Freelance Writer

Quotes for "Life Before Birth"

“Life Before Birth is a thrilling journey of discovery, a real joy to read. Janov writes like no one else on the human mind—engaging, brilliant, passionate, and honest.
He is the best writer today on what makes us human—he shows us how the mind works, how it goes wrong, and how to put it right . . . He presents a brand-new approach to dealing with depression, emotional pain, anxiety, and addiction.”
Paul Thompson, PhD, Professor of Neurology, UCLA School of Medicine

Art Janov, one of the pioneers of fetal and early infant experiences and future mental health issues, offers a robust vision of how the earliest traumas of life can percolate through the brains, minds and lives of individuals. He focuses on both the shifting tides of brain emotional systems and the life-long consequences that can result, as well as the novel interventions, and clinical understanding, that need to be implemented in order to bring about the brain-mind changes that can restore affective equanimity. The transitions from feelings of persistent affective turmoil to psychological wholeness, requires both an understanding of the brain changes and a therapist that can work with the affective mind at primary-process levels. Life Before Birth, is a manifesto that provides a robust argument for increasing attention to the neuro-mental lives of fetuses and infants, and the widespread ramifications on mental health if we do not. Without an accurate developmental history of troubled minds, coordinated with a recognition of the primal emotional powers of the lowest ancestral regions of the human brain, therapists will be lost in their attempt to restore psychological balance.
Jaak Panksepp, Ph.D.
Bailey Endowed Chair of Animal Well Being Science
Washington State University

Dr. Janov’s essential insight—that our earliest experiences strongly influence later well being—is no longer in doubt. Thanks to advances in neuroscience, immunology, and epigenetics, we can now see some of the mechanisms of action at the heart of these developmental processes. His long-held belief that the brain, human development, and psychological well being need to studied in the context of evolution—from the brainstem up—now lies at the heart of the integration of neuroscience and psychotherapy.
Grounded in these two principles, Dr. Janov continues to explore the lifelong impact of prenatal, birth, and early experiences on our brains and minds. Simultaneously “old school” and revolutionary, he synthesizes traditional psychodynamic theories with cutting-edge science while consistently highlighting the limitations of a strict, “top-down” talking cure. Whether or not you agree with his philosophical assumptions, therapeutic practices, or theoretical conclusions, I promise you an interesting and thought-provoking journey.
Lou Cozolino, PsyD, Professor of Psychology, Pepperdine University


In Life Before Birth Dr. Arthur Janov illuminates the sources of much that happens during life after birth. Lucidly, the pioneer of primal therapy provides the scientific rationale for treatments that take us through our original, non-verbal memories—to essential depths of experience that the superficial cognitive-behavioral modalities currently in fashion cannot possibly touch, let alone transform.
Gabor Maté MD, author of In The Realm of Hungry Ghosts: Close Encounters With Addiction

An expansive analysis! This book attempts to explain the impact of critical developmental windows in the past, implores us to improve the lives of pregnant women in the present, and has implications for understanding our children, ourselves, and our collective future. I’m not sure whether primal therapy works or not, but it certainly deserves systematic testing in well-designed, assessor-blinded, randomized controlled clinical trials.
K.J.S. Anand, MBBS, D. Phil, FAACP, FCCM, FRCPCH, Professor of Pediatrics, Anesthesiology, Anatomy & Neurobiology, Senior Scholar, Center for Excellence in Faith and Health, Methodist Le Bonheur Healthcare System


A baby's brain grows more while in the womb than at any time in a child's life. Life Before Birth: The Hidden Script That Rules Our Lives is a valuable guide to creating healthier babies and offers insight into healing our early primal wounds. Dr. Janov integrates the most recent scientific research about prenatal development with the psychobiological reality that these early experiences do cast a long shadow over our entire lifespan. With a wealth of experience and a history of successful psychotherapeutic treatment, Dr. Janov is well positioned to speak with clarity and precision on a topic that remains critically important.
Paula Thomson, PsyD, Associate Professor, California State University, Northridge & Professor Emeritus, York University

"I am enthralled.
Dr. Janov has crafted a compelling and prophetic opus that could rightly dictate
PhD thesis topics for decades to come. Devoid of any "New Age" pseudoscience,
this work never strays from scientific orthodoxy and yet is perfectly accessible and
downright fascinating to any lay person interested in the mysteries of the human psyche."
Dr. Bernard Park, MD, MPH

His new book “Life Before Birth: The Hidden Script that Rules Our Lives” shows that primal therapy, the lower-brain therapeutic method popularized in the 1970’s international bestseller “Primal Scream” and his early work with John Lennon, may help alleviate depression and anxiety disorders, normalize blood pressure and serotonin levels, and improve the functioning of the immune system.
One of the book’s most intriguing theories is that fetal imprinting, an evolutionary strategy to prepare children to cope with life, establishes a permanent set-point in a child's physiology. Baby's born to mothers highly anxious during pregnancy, whether from war, natural disasters, failed marriages, or other stressful life conditions, may thus be prone to mental illness and brain dysfunction later in life. Early traumatic events such as low oxygen at birth, painkillers and antidepressants administered to the mother during pregnancy, poor maternal nutrition, and a lack of parental affection in the first years of life may compound the effect.
In making the case for a brand-new, unified field theory of psychotherapy, Dr. Janov weaves together the evolutionary theories of Jean Baptiste Larmarck, the fetal development studies of Vivette Glover and K.J.S. Anand, and fascinating new research by the psychiatrist Elissa Epel suggesting that telomeres—a region of repetitive DNA critical in predicting life expectancy—may be significantly altered during pregnancy.
After explaining how hormonal and neurologic processes in the womb provide a blueprint for later mental illness and disease, Dr. Janov charts a revolutionary new course for psychotherapy. He provides a sharp critique of cognitive behavioral therapy, psychoanalysis, and other popular “talk therapy” models for treating addiction and mental illness, which he argues do not reach the limbic system and brainstem, where the effects of early trauma are registered in the nervous system.
“Life Before Birth: The Hidden Script that Rules Our Lives” is scheduled to be published by NTI Upstream in October 2011, and has tremendous implications for the future of modern psychology, pediatrics, pregnancy, and women’s health.
Editor