Sunday, May 17, 2009

On Psychosis

Is psychosis a different malady from neurosis? Is it treatable? Curable? What causes it? Heredity? Epigenetics or just plain bad experience?

I wrote this recently about how we manufacture inhibitory/repressive chemicals such as serotonin.

“What is very important for us to realize was that a mouse fetus does not make her own serotonin until the third trimester. It seems like the mother supplies what is needed until the baby can take over. But when the mother is low on supplies, she cannot fulfill what the developing baby lacks. Therefore, the baby carries around a load of pain. Now if we apply that to humans, there seems to be a time in gestation when pain or noxious stimuli impinge, but we are not yet able to produce our own gating chemicals—ungated pain. This residue will continue and may lead to bouts of anxiety later on in life. It becomes free-floating fear or terror. This is not due to heredity but rather to experience in the womb. This is why we should never neglect womb-life when addressing neurosis.

Part of our in utero life, therefore, takes on hurt at a time when our system can do nothing about it. Nevertheless, it affects all later development. At thirty we may suffer from panic attacks that began its life in the very early months of our mother’s pregnancy. It is pristine and free-floating, ready to spring forth whenever we are vulnerable. No talk therapy can make a dent in it. It leaves us fragile for a lifetime so that any insult in infancy and childhood weakens us all the more.

It seems to me that there may be a genetic component to psychosis but equally if not more important is epigenetics; what happened very early on in gestation. My guess is that the earlier the trauma (mother smoking, drinking, high anxiety state or depression) the more we have the makings for psychosis. For the reasons cited above; the fetus takes on hurt before he can do anything about it. Worse, this alteration in the first months of gestation alters the set-points permanently so that the person is forever low in inhibition or repression. Of course, as an adult he will need the very chemicals he lacked in the womb; inter alia serotonin. And the heavy duty drugs we use on psychotics are enhancers of serotonin. Why? Because early trauma depressed its output and made the body think that was normal. Of course the body doesn’t think in words, but it does in chemicals. And that communication begins with the advent of the secretion of key chemicals while in the womb. It is just an accident that effective pills simply make up for what is missing in the person’s system? What pills do is supply the missing link, help out our physiology and try, therefore, to reestablish normality. So sometimes the mentally ill feels normal again. That is no surprise since we are artificially normalizing the person’s physiology. In Primal Therapy we normalize in the normal way; that is, we reestablish setpoints. That is why after one year of our therapy there are normal levels of serotonin.

What is the hallmark of psychosis? Usually it is hallucinations and delusions. Delusions are a later development than hallucinations. They indicate a more organized cerebral/thinking apparatus. But both manifestations are provoked by upsurging very, very early pain; usually there is no content to this pain other than pure agony.

Can they be treated? We have done so with some success but in-house therapy is needed. Otherwise there is too much stress out there for the mentally ill to adapt. There is evidence that when the psychotic hears voices there is an activation of the brain system where those voices originate. For delusions; there is usually the notion that someone “out there” is out to hurt him. The pain/hurt is already inside, and it is now rationalize as being out there. But the brain is reacting to the hurt. Since the person has no idea where that hurt comes from and how early it occurred, he has no choice but to project it out there: “They are plotting to hurt me.”

There are many ways to go crazy. The body does it with cancer, a cellular out-of-control event. The brain does it with ideas, but it is always the same pain they are dealing with. Psychosis merely means that the normal defense mechanisms do not work. The brain is stretched into wild and unreal ideas because there is no other way to get a handle on the pain. As we add pain killers to the psychotic the delusions lessen. Clearly, they are associated with pain. The great question is where does it come from? I think I know, but we will let research help out here.


  1. I recently found out that my Granny "smoked like a chimney" throughout all her pregnancies. Both my mother and her sister had severe psychotic episodes and two siblings died shortly after birth. What an impact this might have had!

  2. Good morning Dr Janov,

    I have several questions about psychosis : does it mean that an healthy human being even in an highly stressful environnement (war, mental harassment etc) isn't going to become psychotic even for a short time? that is if you have no inner pain to control i.e that your serotonin level is right you won't react the same way?(become psychotic or depressed). Or is it that a healthy human being won't let himself get caught in that kind of "trap" and will know how to protect oneself...?


  3. I suggest a correction from "It is just an accident....?" to Is it jsut an accident....?"

  4. Hi Dr.Janov this is emanuel (from Germany..) unemployed sales person..) some 20 yesrs ago my "psychotic" friend -I would prefer the notion the victim(nt only!!) of a lifelong history of fist line intrusion into his third line .which led him to proclaim he`s Jesus ( crucified he was in those weeks and treatment !! therafter .. And now my point after he got a t r a n q i l i z e r ! he suffered almost immediately a decompenation /as the white clothed gentlemen (?) like to denote it .My guess is this the second line was calmed ,so that the first line pains had better access to his thus flooded third line ...? Yours cincerely emanuel

  5. Yann, Psychosis is the last ditch stand of the neocortex to defend itself against trespassers and intrusions of feelings. Healthy people could have a transient delusion but it is usually unlikely. I was in the war, seven battles, and felt that I was cracking at the end, vomiting continuously, but no delusions. art janov
    Very very early pain is the culprit plus parental compounding with neglect and lack of love.

  6. Pbef: You need to give me the context. art janov

  7. Dr Janov,
    thank you for your answer. I understand that some people are born psychotic (traumatic events during womb life)and unloving parents but I was thinking about people who become psychotic between their teenage years and before 25/30. It means that those people have been able to deal with their life till they become overloaded with first line intrusions?
    Is it always because of drugs usage (Ecstasy or other)or is there another possible explanation?

  8. Dr Janov.

    Don't reply if this is a personal question, but I am curious about your wartime experience.

    Can you outline it? Do you feel that you've 'primalled' it all out of your system?

  9. Yann: I am no expert in all this. There are many research studies on psychosis and it seems to me that the hormonal turmoil going on in late adolescence is a major contributor. But because we take far fewer psychotics than neurotics I am not on sure ground. I think, basically, it is when the first and second line become the third line that we have the makings of psychosis. dr. janov

  10. Hello Dr. Janov,

    what do you think is the difference between full blown "psychotics" and people who have some psychotic symptoms (hearing voices, paranoid thoughts) associated with their illness? For example, psychotic symptoms during mania (my brother has been diagnosed with bipolar disorder, and he sometimes hears voices and gets paranoid).

    Err... I hope the question makes sense.

  11. AnttiJ: Sorry but it would be unethical of me to presume to understand this case. We need far more information to diagnose this. dr. janov

  12. Andy: Someone is writing my bio but I was in seven battles in the pacific aboard a battleship where I was a machine gunner. art janov

  13. Sorry, I can't resist talking about myself again. It's not because I'm totally's because I like to talk about stuff that I know is real (coming from personal experience).

    When I was five I experienced a couple of psychotic episodes. One time I saw long black worms sliding down the walls and they all slid under my pillow. I knew they were hiding there. I cried out for mum. It was always very hard to cry out because I felt like I would wake the demons. My mum came into the room and I told her there were worms under my pillow. She lifted my pillow and I saw the worms. She swept all the worms away with her hand (she was pretending ofcourse). When she was sweeping the worms, I actually saw the worms vanishing with each sweep of her hand.

    Around the same time, I also became delusional. I believed I was living in a world of dinosaurs, and my brother and two sisters and parents were not real. I thought they were just in my imagination. I was terrified that one day I would wake up and see all the dinosaurs around me. This delusion happened only during one night. It began as soon as the lights were turned off. I was wide awake. I resolved the horrific feeling by convincing myself that I will be able to continue living in my imagination. I told myself "It doesn't really matter if nobody is real. I will stay here forever so the dinosaurs can't get me. I can be happy even if nothing is real" (this was an incredibly difficult thing for me to accept, and was by far my worst childhood experience, involving deep terror).
    I never thought about it again after that night.

    My point is: I have never experienced psychosis since then, so I believe psychosis is not strictly reserved for the "psychotics". I think psychosis is probably just an extreme case of neurosis. With enough pain or toxin....a biased belief becomes a completely unrealistic belief.

    I am not an expert either but I don't think it is unethical to give an uneducated opinion. Maybe someone out there can shed some light on the subject.

  14. Richard. There is a difference between transient hallucinations and delusions and a psychotic state. One happens to someone who for the moment is overwhelmed with pain or input. The other is when defenses breakdown completely and the lower levels reside in the higher ones. The pain pervades conscious/awareness and makes us believe it is real because in some respects it is real to the person. It is just a slight shift in context. Someone is out to hurt him but it is a long ago and actually happened. Because the early imprint is now to the fore the person takes it as real. There is not enough critical capacity to differentiate real from the unreal. art janov

  15. Emma: See how important all this information is? dr. janov

  16. Emanuel Sounds right but it is risky to make diagnoses without more information. dr janov


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.