Wednesday, December 15, 2010
More on Attention Deficit Disorder
I would let this go, except that last night there was a one hour special on PBS about ADD, with four major specialists in the subject. The diagnoses they came up with is what I think is the problem with the whole field of psychotherapy, psychology and psychiatry.
Not once in the hour did I hear what the origins of ADD might be and why it occurs. Most of the time, it was spelling out how to cope with it. So we also might add how to deal with phobias, obsessions, migraines, high blood pressure and on and on. It is tantamount to saying that the illnesses stay but how we deal with them changes. It is all about our attitude. So you still have the allergies and you avoid this and that to cope with your allergy. Or you have a chaotic mind, try to avoid clutter.
The first point they made is that diagnosis is essential. And they list ten things that make you an ADDer. You need to be impulsive, not able to focus and concentrate, unable to pay attention, hyperactive, unable to sit still (I am adding here), low self esteem, learning disorders, can’t listen, needs to talk constantly, cannot wait, no long-term goals, lose temper easily, act without thinking, very impatient, a bad memory, an underachiever, etc. I added here some from a list of the Brown Scale for ADD. It pretty well covers it. But you have to be suffering from this for six months or more, they claim.
What the experts concluded was that a diagnosis was critical. Once you are aware, they claim, you are half-way there, because you know what to do; which includes: making future plans, making your environment work for you, find a calm partner and a job that suits you, making an effort not to lose patience, and above all, they claim that the therapy for this is success. Once you have a success you can build on it. And you will have a higher self-esteem and won’t be an underachiever.
So let me see: you tell the doctor that you are impulsive, impatient, cannot wait, cannot concentrate nor sit still, and she says to you that you have ADD. Ok there is the diagnosis, now what? She has told you what you just told her in more simple terms. Have we made progress? Is that what a diagnosis is? Saying things in esoteric language? The doctors have then many suggestions: don’t do too many chores at once, stay in a calm environment, jog to work off tension but do not over-talk. Don’t work amid chaos. I say to the doctor that I cannot stand crowded restaurants and he tells me to avoid them. And he adds “do not take so many risks in your life”, yet he adds it is the risk takers who invent and innovate and tend to be more creative. Now I am confused.
Not once did I hear in one hour the word, why? Where does it come from and what I can I do about it. What is the generating source of all that? So now you will read my opinion about it. It is an educated opinion since I have treated many cases. What happens is that cognitive/behavioral approaches have taken hold so that the psychiatric diagnostic manual indicates all these behaviors, and it is assumed that to treat it all, we need to change behaviors, hence, behavioral therapy.
Let’s go back to womb-life; there is a good deal of evidence that a mother’s hyperactivity, the drugs she takes, such as cocaine can leave an imprint or a residue that affects the offspring for a lifetime. If the mother is “hyper” the child may also be. Just that can set up a child who is revved up from the start. An Israeli study found that the children of holocaust survivors, very anxious people gave birth to anxious children. At first they thought it was because the parents told horrible stories to the children but then they discovered that the anxiety came down through the genetic chain; that is, it was descended from the mother’s physiology—epigenetics. (Laura Spinney, 2,Dec. 2010. Internet) Then there is the trauma of birth and infancy where the child may be left for days without warm cuddling. And then harsh parents who fill the child with feelings of rejection and abandonment. All this sets up imprints down low in the neuraxis. This is then transmitted to higher centers (as they develop and evolve) where the child is filled with input from inside that frazzles his brain; that feeds constant and varied input to the neo-cortex, no different from listening to ten people at once all talking at you. Except...,except that this information is constant from inside not outside. It competes with stimuli from outside but it all gets to be too much. It is paying attention to too much input which is normal, not an aberration. The disease, if it exists at all, is stimulating information that floods the cortex with electrical input just the same as being flooded with shock therapy.
Of course, he is hyperactive, he is being prodded all of the time from below so that any new input is overwhelming and he starts to crumble. He cannot manage complex instructions; you go to the right two blocks and then one block to the left and then go straight to the roundabout and then………we have already lost him because the internal input is crowding out the information. And of course, he cannot sit still because there is information that needs connection and resolution, the integration. That cannot happen so long as he has no access to his early imprinted memories. The information is constantly climbing upwards and forwards for that connection so that the system can function better.
And then he cannot get down to things, quickly start a paper, a project or an article because there is so much going on in his brain for him to focus on just one thing. So others get impatient because he did not turn in his paper on time. He was so busy, doing this or that, as his moods dictate because he is being twisted and turned here and there internally with little cerebral control.
So why so little control? Because trauma in late pregnancy can damage or prevent the evolution of prefrontal cortical cells, as well as the cells that carry information from down below via the right to left brains, the corpus callosum. So there is damage or impairment of sorts. They do not have the cerebral equipment to control impulses thereafter. And we know that the prefrontal area works often times to control right subcortical feelings in order to shut them down for a time. When control is weak it is harder to put off an impulse, to wait for later to do something, to reflect and ponder rather than act. But those impulses are the imprints originating deep down in the brainstem centers. The impulses, the same as with the salamander or snake or shark, are there for an evolutionary reason: to strike, attack or flee at the instant when it is necessary--survival. They come out of those primitive brains and are essential, as well, for our survival—needing to swerve to avoid a car accident, for example. Here we do not want to be too reflective. Immediate reaction is called for.
Now think of the snake; he too must act immediately for his survival. It is not an aberration unless the snake brain overtakes the rest of our cerebrum and runs the show. In a way, in ADD he is running the show. What are we fleeing from? Danger. Menace. Feelings that are overwhelming. Pain that is much too much. Suffering that threatens our mental stability. It has to be contained. Think of this when we are dealing with ADD, and believe that a different turn of behavior can solve things. Think of this when we offer advice to “Make your world comfortable to you. Make your world work for you.“ Think of what and whom we are talking to because the salamander brain is doing its best to deal with matters and it isn’t getting much help from the impaired neo-cortex. Remember, then, it is an ancient survival mechanism there for a reason and very necessary in our evolution.
What is behind a lot of this, is anxiety; that is the major prod. It is pure terror engraved down below from traumas in the womb that have been reacted to just in terms of the non-verbal brain system. Or imprints from a bad birth that was life-threatening.
The ADDer is an underachiever because he could never stay with anything long enough to learn it properly. So he becomes a salesman; someone with a gift of gab who runs off at the mouth, running off part of the tension and energy of anxiety. When he recognizes this maybe he suffers from low self esteem, as the project stated. He must know that he cannot succeed because success requires sustained effort; his scattered mind cannot do that. But he may find a job that suits him and that will allow distractability. But do not ask him to be calm and to follow directions because his brain is revolting. To infuse too much input into his brain, even a simple idea, is overwhelming and that is how he feels—overwhelmed. The cortical level is being overwhelmed so he should feel that way. It is all too much. Literally.
I cannot help but feel that current therapy for ADD and most other psychologic afflictions is just “get over it”. One psychiatrist tells his patient that you must first identify the problem and then develop good habits to overcome it.”Do not live in a cluttered environment.” But he needs chaos because it reflects his brain. And as one specialist in ADD said at the end, “I am not interested in making you normal. I just want you to be successful.” The reason he is not interested is that the depth of the problem and its origins seem so mysterious, arcane and recondite that the condition, like Freud’s Id, becomes a given, not to be tampered with; an immutable force, part of genetics—our inherited weakness. All because the field and the populace is not used to considering womb-life and birth experiences as critical in our development. The science is now there; we have only to use it.
In my previous books I have discussed the notion of the parasympath and sympath. These are two different personality types governed by the hypothalamus. The parasympath is the slow, reflective type and the sympath is the hyperactive unflective type who keeps driving and going and doing. This largely is set up during womb-life and at birth; was the end of the birth difficult? Was the newborn shut down by anesthetics given to the mother, or was the end a success because the child struggled and got out successfully? He learned that he could not wait because waiting could have meant death. He wants out! It sets up an inability to wait, impulsivity and a driven brain. The parasympath is much more passive, less driving and less spontaneous. Keep in mind that those experiences happen to a brain that could register, code and store. The memory endures. And it creates a hyperactive system that is largely beyond our control. It goes to where we are weakest and most vulnerable. Trying to go to sleep is a big effort because impulses from down below are activating the mind into constant rumination and won’t let us relax enough to fall asleep. That is, it won’t allow us to go below the top thinking level and into where sleep might happen.
One of my senior therapists who has stayed with doing therapy for years was a classic ADDer. He never went to college because he was sure he could not concentrate enough to do classes. He can now and is on his way to a Ph.D.
I have treated enough of those who have ADD to know what a successful therapy entails and it is not advice, even though that might help a little. It is a deep voyage to the antipodes of the mind to where it all began.
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.