To my bloggers:
To my bloggers:
On Oct 17, my piece on Epigenetics and Methylation will appear in the World Congress of Psychiatry. As of that date, I will also publish it on my blog as a series over a month or two, as it is 80 pages long. It is the most important article I have ever written and I hope it will change the science of psychotherapy; this is, begin to turn it into a real science. So hang and shortly you will have it.
Saturday, January 30, 2010
There is something we must immediately add to the theoretical mix: epigenetics; how very early events in the womb and at birth can alter the genetic unfolding. One genotype, a single genetic predisposition, can give rise to many phenotypes depending on what happens to those genes during gestation. So what we might imagine is genetic, is genetic-plus what happens to us in the womb. I was so surprised early on in my therapy when long-term patients reported that their wisdom teeth descended. Now I understand it better; the genetic unraveling toward its destination was deferred due to repression.
In the early nineteenth century, a French scientist named Jean Baptiste Lamarck decided that we acquired characteristics from experiences that our parents underwent. Russian communists applied this to agriculture but, no matter, it was a widely discredited theory … until recently. Now this avowed Marxist position may have been resurrected a bit. There is a new field called epigenetics that states pretty much what Lamarck believed. So what is the evidence? And what exactly is it? What Lamarck said was that individuals acquire characteristics as a result of their environment, and now, these characteristics can be passed on to the offspring.
Much of the work in epigenetics has to do with diet; a mother’s diet influences the offspring’s physiology. Epigenetics has to do with how genes are regulated and influenced by the experience of the baby. I believe it has more to do with the fetus who resides in the womb; that his experience is influenced forevermore by the mother’s diet but also by her moods.
Has the genetic switch been delayed or was it premature? This can happen without making a radical change in the gene itself but rather in how it is expressed, whether it is shut off or on. What we are discussing is how a mother’s interaction with her environment can pass this on to her offspring. I think we need to understand that a fetus in the womb is always trying to adapt to his environment and that his genes will evolve and be expressed depending on that adaptation. For example, a mother who is very unhappy from her own childhood pain, and who has depleted much of her serotonin supplies cannot fulfill the young fetal need for his own serotonin supplies. (His own supply does not kick-in until somewhere around the half-way mark). He may well grow up deficient in inhibitory or repressive capacity and be an anxiety/impulsive case forevermore; this can evolve into attention deficit in his youth. This will happen when the fetal set-points are readjusted because of events during womb-life. There may be a continued inability to have a cohesive cognitive ability; to focus and concentrate. I think it is important that all this occurs while the fetal brain is rapidly developing and needs proper input to evolve normally. An anxious mother is so agitated that the neuronal input into the baby she is carrying is so extreme that he cannot adapt and integrate this input. Thereafter, this is the kind of person who cannot accept too much stimulation because the internal input is so great that anything from the outside, such as two term papers due immediately, can be overwhelming.
To get an idea of how early all this may begin, there is a study by the University of Miami School of Medicine that states that: “A review on (maternal) prenatal depression effects on the fetus and newborn suggests that fetal activity is elevated, growth is delayed, low birth weight common.”  It begins a lot earlier than we previously thought. As if to underscore this position, there is a study from Scientific American Mind, (Fetal Recall. January 2010)that is seeking out when consciousness actually begins. And they are quoted as stating that it begins in the womb. They introduced sharp sounds to the pregnant mother (a honking device placed on her abdomen). As they did it the fetus reacted significantly. But after a time the fetus stopped responding to it (Squirming. Heart rate stopped speeding up). He became habituated, got used to it, and it remained, therefore, as only a memory. He “learned” that the noise was no longer dangerous. And the memory endured.
Newborns of a depressed mother show a profile that mimics the mother’s prenatal state, including her physiologic state; this includes higher stress hormone levels, lower levels of dopamine and serotonin, and greater right frontal brain activity. What I think this means is that the right/feeling brain is forced to be hyperactive to deal with emotional push. It is, after all, the right prefrontal brain (orbitofrontal area) that maintains a history of our feelings and has a more internal focus. To summarize: Higher resting levels of stress hormones in the carrying mother can already have an effect on the later life of the offspring. It already presages the constant need for tranquilizers because the early imprint has lowered levels permanently. Then with even minor setbacks later on, the resonance factor can compound the pain level so that taking painkillers is a matter of urgency.
The concept of epigenetics has import for diagnosis. For example, one of my patients was told that she had a genetic vulnerability, very much like her mother had. It led to a diagnosis of a “very serious autoimmune disease.” If it were seriously genetic, as the doctors believed, then any chance to change her state would be close to nil. What this does is prevent us from seeing or investigating beyond the inheritance to factors that may have been equally important; what happened to the baby while being carried? Further, if there were something that altered the immune state while in gestation, perhaps one can relive and connect to it, thus affecting that imprint. Thus, it may be as a result of an experiencerather than inheritance that is ultimately significant. This patient did relive her traumatic birth, and, perhaps, that helped her make some progress against the disease. This happens, again, because in reliving, it is possible to gather up associated feelings and sensations that lie even below the later trauma but which may be related to it through frequency resonance. Reliving later events will usually bring up the earlier events and feelings that it resonates (triggers off) with. Earlier imprints will be re-represented on higher levels as the brain develops. Even though we are reliving something at the age of sixteen we are also dealing with the earlier part of the related feeling. That is why there is hope when we relive; we can attack imprints during gestational life. So when a feeling event brings up severe anxiety with it, it can mean that we are basically dealing with preverbal events where and when anxiety/terror is installed. The importance of differentiating between genetics and epigenetics is that we may be dealing with a reversible disease, not one that is inherited and cannot change. And indeed this is already being tested. In a paper by M. Szyf, (Dept. of Psychiatry, McGill University, Quebec. “The Epigenetic Impact of Early Life Adversity.” He reported on the reversibility of the epigenomes in animals. Using chemical agents they were able to reverse the changes caused by epigenetic events. This has great import for disease today; for certainly there may be genetic factors which only become manifest when certain traumas occur, but even after they occur we may be able to go back and change it. Hence reverse disease. Terribly important.
Researchers at Karolinska Medical Center, Sweden, have found that cesarean births can result in increased allergies, diabetes and leukemia risk. Mikael Norman states: “Our theory is that altered birth conditions could cause a genetic imprint in the immunecells that could play a role in later life.” Their work, as is that of others, indicates that stress around birth affects the genes. The assumption is that the fetus is not prepared for an “unnatural” birth. It is different from a vaginal birth where the stress gradually builds and can be adapted to.
There are experiments with pregnant primates. As a result of stress during pregnancy there is an adverse effect on the hippocampus (dealing with memory). It seems to shrink. And, as I have mentioned elsewhere, one has to wonder if this kind of stressful gestation can play a role in later Alzheimer’s. There is new evidence on this point: a study by Brigham Young University found that the size of the hippocampus was reduced when trauma occurred. (Neuroscience, Aug. 2009. See also, “Trauma, PTSD, Followed by Reduction of The Brain Involved with Memory.” Science Daily, Aug 27, 2008). It took a long time to discover this because there was no immediate damage; only after a long period did the damage show up. More importantly, again, there is no taking into account the unobserved trauma in the womb and at birth which, in my opinion, does permanent damage to the memory centers. It is not just an assumption; there is new research to demonstrate this: in a paper (reported in Science News, Jan. 4, 2010. “Acute Stress Leaves Epigenetic Marks on the Hippocapus), there is more and more evidence of this. A single trauma in rats can produce changes in their brains, and these changes are reflected in the memory centers such as the hippocampus. The changes that occur can also affect whether or not our genes are turned on or off. It is so difficult to differentiate between nature and nurture as causes because they are so intertwined as we mature.
A corollary of this is that as stress increases so does the mother’s level of cortisol. That, in turn, affects the brain structures. The investigators indicated: “If there is anything we all agree on it’s that the fetus is incredibly vulnerable and fragile, and that even subtle perturbations in the mother’s mood can have measureable effects on the fetus that last for years.” One additional finding. Stress while being carried, later lowers IQ, as well as anxiety, ADD and depression.
The thalamo-cortical circuits are finally established very late in gestation (thalamus to cortex and back). When amygdala-cortical circuits are in place it is then possible to have a mental appreciation of the pain we are in. It is before thalamic and amygdaloid circuits are mature that we can experience pain without acknowledging it. Thus pain can be laid down in a completely unconscious way, and most certainly there are no words to clarify or explain it. Can one imagine getting a patient to explain a gestational trauma? But he can describe a sensation of butterflies in the stomach, pressure on the chest and a churning sensation in the belly. We call it amorphous anxiety but these are part of the overall experience of fear and terror while we are being carried. Each is a fragment of a gestalt experience.
There was a study reported in the British journal, Nature. They noted that when the baby is under threat the amygdala signals to the prefrontal cortex triggering the expression of that fear in behavior. The cortex becomes the “decider.” What the investigators did was to train mice with a tone accompanied with a shock. When that was administered there was commensurate brain activity in the prefrontal area of the mice. But when the amygdala was surgically removed there was no longer any prefrontal activity; it could no longer signal fear to the top level. The same is true when we drug that structure or tranquilize it; it diminishes the force that mounts in the prefrontal area. We see from this research why so many of us have trouble sleeping; either falling asleep or staying asleep. And why some individuals cannot get into feeling. Lower level imprints voyaging or meandering upwards and forwards keep the person from traveling to a lower level of brain function. It literally jolts the person who has lain down for a few minutes trying to relax, into a hypervigilant state. There is too much going in that deeper level to permit entry. Lower level imprints are stimulating the frontal thinking/ruminating neurons to get busy. Thus in quieting the lower levels there is a sense of calm in the thinking area. A false sense, I might add. But the person reports feeling calmer. So much for subjective reports.
So when can a fetus feel pain? A better question might be: when can it signify pain? After the circuits are in place. Neuroscientist J.K.S. Anand explains this when he placed a needle/probe into a fetus (for amniocentesus). The fetus grimaced in pain and its stress hormone levels rose dramatically. The baby suffered; not only that but from our point of view, that suffering can be coded and registered in the memory system, thereafter lying in storage waiting its chance for connection. And this is what we in feeling therapy are about—connection.
There are some serious diseases out there that have been considered only in the domain of inheritance; muscular dystrophy is one of many. Perhaps the cures for these afflictions have been slow in coming because our emphasis has been on inherited factors rather than experience. If we don’t look at gestation as critical, our diagnoses are bound to be skewed.
There is a study by a Canadian group from the Douglas Mental Health University that found when child abuse exists there is a change in a gene (NR3C1) that affects how the child will deal with abuse. That gene was much lower in abuse victims who eventually took their lives. It would seem that childhood abuse had changed the structure of the gene so that it was less active. And these changes endured throughout their lives. It changed the way the whole stress apparatus functioned (the HPA). McGowan implies that the changes are stable and that they alter the gene’s activity leading to later illness and suicidal tendencies. When that gene is ineffective it cannot produce the kind of alerting, galvanizing chemicals that help one fight through things (glucocorticoid hormones). So the body behaves as though it were constantly under stress when there is none apparent. It is reacting to the imprint. What this research group believes is that mothers can affect the fate of their children even before they are born. The epigenetic changes could force the children to be depressed and suicidal later on. It will look like genetics but it will be more than that.
And to make matters worse, there is a study that indicates that a mother who is been stressed before she gets pregnant can also affect the life of her offspring. This was a rat study by the Israeli M. Lesham. Those rats who underwent stress before pregnancy had offspring who were hyperactive. The females displayed symptoms of anxiety and were generally more nervous. In general a nervous mother is not providing a good soil for having children. We then say she is just like her mother. It is inherited. No it is not. It is what that mother does to her baby just by who she is.
Every day there is new information and research on this subject. A new study by Alberto Bucay of the Research Center, Halabe and Darwich, Mexico, is now suggesting that when parents are happy it can change the germ cells (egg and sperm) that will affect the offspring. He writes in Bioscience Hypotheses, reported in Science News, that parent’s psychology and emotional state before conception can affect the child’s genes. For now this proposal is mostly polemical but it is intriguing. It is for all these reasons that epigenetics will soon be a very important area of study, something that did not exist when I was coming up in psychology.
 I discuss research into anise later on.
 Infant Behavior Development. July 29, 2006. Pgs. 445-455. “Prenatal Depression Effects on the Fetus and Newborn.”
 Healthday News. July 09
 Vivette Glover. Imperial College, London. Royal Society Summer Science Exhibition. July 9, 2009
 See:“Stress During Pregnancy May Lower Baby’s IQ” British research. Reported in the Globe. Canada Zosia Bielski.
 “Neuro-developmental Changes of Fetal Pain.” Semin. Perinatol. 2007,
Oct 31,(5) 275-82.
 Nov. 18, 1999
 Science Daily. May 13, 2009. “Trauma Experienced by a Mother Even Before Pregnancy Will Influence Her Offspring’s Behavior.”
 “Can Happiness be Inherited?” May 14, 2009
Saturday, January 16, 2010
Unfortunately, a good deal of intrauterine trauma is registered in the right brain. It then becomes a vain task to use the later developing left frontal brain to gain access to it. They are two universes apart, and, as I explained earlier, they speak two different languages.
At the start of therapy the patient rarely retrieves memories of high life-and-death valence. The laws of evolution often will not permit it; that is, repression does the job for which it was intended. It allows only manageable fear at first. We have found a way to access the depths of the unconscious in an orderly, methodical fashion so that the patient is not overwhelmed by pain. Man is a microcosm of the universe; therefore what man is, is a clue to the universe. And we certainly learn about the evolution of the brain by observing patients in our therapy.
A study of 3-day-old baby rabbits, deprived of oxygen, found radically lower precursors (building blocks) to serotonin (5-HT). And they did not recover from this deficit. If we found these rabbits later on and offered them Prozac (serotonin enhancer) I am sure they would literally jump at the chance (pun intended). There are many animal studies that show how oxygen deprivation at birth lowers the set-points of serotonin. The research is now endless, almost always with the same conclusions: early trauma, including pre-birth trauma, alters serotonin and other neurotransmitter levels in the brain.
When a fetus develops normally the inhibitory/serotonin cells also develop in orderly fashion. But trauma to the carrying mother (a husband leaves the home) interferes with that process. Later on when the baby, now adult, suffers panic and anxiety attacks that appear out of the blue we can perhaps understand the origins. We see it in newborns whose bodies express it in restlessness. They are often non-cuddly babies.
One reason for the evolution of the left frontal cortex was to produce a brain system that could distance itself from the other areas of the nervous system where painful feelings lie—a way of not being overwhelmed by what lay below so that we can get on with life and deal with daily problems. It is a brain system that can uncouple itself from massive, damaging input. It is the human part of us that can do it; it can disengage from that lizard in our head with our brain above water, no longer communicating together. Another important reason for the evolution of the left hemisphere is that the left frontal cortex evolved with the use of tools. It is the left frontal area that is involved in precise tool use, as for example, hammering a nail. Precision has become the domain of the left frontal area. If we are looking for a good surgeon we should find one that is left-brain dominant. We can be assured that she will be precise. If we want a therapist who can feel and sense things we may want a right-brain dominant individual; but of course, someone with a balanced brain is always the ne plus ultra.
Are we actually born with not enough serotonin in our systems? Yes, but it is not genetic; we are born with it but not born with it. Think of it this way: We take drugs that boost serotonin (Prozac, Zoloft, etc.), levels to help repress anxiety and pain. Does that mean that anxiety is due to low levels of serotonin? Isn’t that like asking if headaches occur due to low levels of aspirin? Not really. Because serotonin is a natural product, something we produce internally; and it can be low. We are indeed born with low serotonin levels due to epigenetics where a mother’s anxiety and low serotonin levels herself cannot help the fetus out with donating any supplies. So the fetus is in pain. Because basic need was not fulfilled, for example, the need for safety, e.g., to feel safe and untroubled. A child who lives with a rageful parent never feels that kind of safety and can never really relax. The world becomes a dangerous place for him, and when the pain is compounded by a stark, sterile, unloving home there could be the development of delusions, “They are after me and want to hurt me.” This all comes from a feeling that there is no safety anywhere, no one to turn to for help and soothing. Danger lurks, not just from the outside but also from the inside; it is a danger that is hard to escape.
We professionals are never going to convince this person that there is no danger. There is, but the doctor cannot see it; only the patient can feel it and know what it is. What is troubling is that the person is convinced that the danger is outside.
I explained in other works how one of my patients during gestation was involved in an auto accident during her eighth month. Her mother was pinned against the steering wheel and had the fright of her life as the car turned over twice. A chronically anxious mother can produce the same effect. The child seemed anxious, nervous and distracted and remained so throughout her life. She suffered a continuous low level of anxiety throughout her life making her unable to deal with the simplest task. She could not handle any additional pressure. One obvious reason was that the mother remained anxious all through her pregnancy, downloading it into the baby. The baby then had a substrate of anxiety herself. When father was menacing with a strong, loud voice she tended to overreact and be especially fearful (hence, obedient). Overreacting means reacting to different epochs of early life, to different kinds of trauma and lack of love, or to layers of the same feeling compounded over time.
So she is not just reacting to the current situation but she is reacting also to the past trauma, as well. It is how parents take our “no” away. We dare not disobey because we are so fearful from the start. So a healthy baby would shake her head and say to her parents “I don’t want to eat this,” whereas the child who spent his life in an anxiety-filled womb wouldn’t dare say “no;” the dreaded consequences, triggering off the birth and gestational traumas would be overwhelming. Without a theory that takes into account gestational life we will be at a loss to help patients. The kind of person I am describing is someone who cannot refuse an invitation or who cannot discipline a child. She cannot say “no,” in the same way that the parent could not, as a child, say no to her father.
If we have normal levels of serotonin we could repress on our own and there would be no anxiety or panic attacks. Low serotonin means inadequate repression. Thus, those riddled with impulses, homicidal and suicidal, are typically low in this neuro-chemical. It means loss of control. Anxiety starts its life as pure terror barely held back by the gating system. It gets transformed later on to phobias or to free-floating fear. We are able to dampen it with a variety of defenses but it is never less forceful than originally. Let me state that again. Pure primal terror never changes; it is defended against, filtered and softened but it never changes its internal effects. It is biologic. It is kept in place for reasons of survival. But it uses up supplies of inhibitory neurotransmitters. And the suffering may be exacerbated.
The problem seems to be that from just after conception to adulthood some of us utilize more serotonin than we manufacture. Animals, who were shocked while rendered helpless had far lower serotonin levels. What is diabolic is that traumas during womb-life not only cause us to use huge supplies of serotonin but they can compromise the inhibitory/repressive system so that we cannot make enough. The set-point is then very low. Don’t forget that it takes almost half of our womb-life before we can make our own serotonin.
Consciousness is the end of anxiety. Consciousness means connection to what is driving us. Disconnected feelings are what drive us constantly to keep busy. Their energy is found in the form of ulcers or irritable bowel, in phobias and the inability to focus and concentrate. They are the ubiquitous danger, shaping a parallel self—a personality of defenses and the avoidance of pain; a self stuck in history forever. In effect, there is a parallel self, the unreal front; and the real self, the one that feels and hurts. Thus, there are parallel universes that make up the human condition; one that feels and suffers, the other that puts on a good front. The latter, the front, is what most psychotherapy deals with: the psychology of appearances versus essences; the psychology of phenotypes instead of genotypes. It is navigating in the wrong universe. I propose that we navigate in the right epoch with the right tools and the right brain?
I have come to believe that a general theory, made of many hypotheses is essential for guiding patients to their pain. It should contain some philosophy, some neurology, some psychology, and, above all, a strong sense of humanity. Suppose we were like the very early explorers (and current professionals) who did not know there was a down under? Their explorations were random, without maps, a hit-or-miss proposition. We need to know that there is a proper destination, and we need to know how to get there; to be cartographers of all the elements of mind, not just the thinking mind. If physicians and therapists don’t know about “down under,” they will not solve panic and anxiety attacks, depression, suicidal tendencies, high blood pressure, sex problems, nightmares, and hormone deficiencies, to say nothing of heart attacks and other catastrophic diseases. To continue the metaphor, when we stay in the verbal neighborhood, we are never going to learn a foreign language--the language of sensations and feelings—the language of no words. Even though these lower levels talk to us continuously, we have never learned to talk to them. We haven’t learned their language because their language is ancient, developing long before the newer verbal language we have today. We are trying to get one level of the brain to do the work of another level, and it simply cannot. We use words to control anxiety when it has nothing to do with words. With each unblocking of feeling in our therapy there is an incremental increase in consciousness, and one is less driven by unknown, unconscious forces. Our goal is to widen and expand consciousness and narrow the gap.
Each month of our personal fetal evolution and our infancy (ontogeny) seems to represent millions of years of human development (phylogeny). In this sense, in our therapeutic sessions, ontogeny recapitulates phylogeny. What we can do now is go back to our beginnings, and through reliving we can find what happened during our birth. Further, we can discover how that event affected our lives. We can get to the beginning of our survival strategies, and each step means getting back more of ourselves. Think of it: we can discover how and when our neurosis began, if indeed, there was a significant trauma early on. (Remember the auto accident by the carrying mother?) Otherwise, there is the slow accretion of pain week after week, year after year, until one day we wake up and discover that we are miserable. We fight assiduously against the liberation of the unconscious when that alone spells emotional freedom. We need to get “emotional.”
We have the power to make an atavistic leap into our past and unlock the unconscious. We can peer down into millions of years of evolution by traveling back in our personal development. We can see how when feelings are too strong, how ideas and beliefs jump into the fray. We can see the origin of anxiety in our system as we feel the primordial terror. Anxiety is not a normal feeling. There are those who claim it is necessary to drive us and get things done. That is true if we are neurotic. We are not normally born anxious.
What most of medicine and psychotherapy involves today is the treatment of fragments of a human being, pieces of an original memory that has lost its connection to the whole. So we have coughing spells, frequent colds, anxiety and phobias, seizures, migraines, all pieces of an original imprint. We then treat the varied offshoots from a central imprint rather than the imprint itself; treatment then becomes interminable. What we get is a fragment of progress—a change in aspects of an early experience. We treat the phobias, the high blood pressure and the palpitations, sometimes all with the same drug. Because it is all of a piece, aspects of the same early experience. We have several different doctors really treating the same problem. Inadvertently, we are treating the central experience even though we may not be aware of it. What we want to avoid is a false or deceptive sense of health in our patients. We will have that false sense when we do not have good access to our inner life and to our feelings.
Feeling isn’t just another psychological approach. It is a sine qua non for mental health.
Thursday, January 7, 2010
Living with hypercritical parents can be the soil for this feeling, and of course, the sense of catastrophe also emanates from from the early non-verbal event at birth, perhaps, where the baby sensed that to make a mistake could be fatal. There is lingering feeling that, “I cannot be wrong or make a mistake.” And the inability to be wrong is present in so many of us. This kind of person does not know how to react in crises. It is not a reasoned response that is required but a physiologic/feeling one. Defending against the possibility of a mistake begins with that very early feeling/sensation where doing the wrong thing, being wrong, could have been fatal. Defenses sealed in the feeling which then lingers and can make the person a “know it all.” Someone who cannot be wrong.
When a fetus develops normally the inhibitory/serotonin cells also develop in orderly fashion. But trauma to the carrying mother (a husband leaves the home) interferes with that process. Later on when the baby, now adult, suffers panic and anxiety attacks that appear out of the blue we can perhaps understand the origins. We see it in newborns whose bodies express it in restlessness and afflictions such as colic. They are often non-cuddly babies.
One reason for the evolution of the left frontal cortex was to produce a brain system that could distance itself from the other areas of the nervous system where painful feelings lie—a way of not being overwhelmed by what lay below so that we can get on with life and deal with daily problems. The prefrontal area is a brain system that can uncouple itself from massive, damaging input. It is the human part of us that can do it; it can disengage from that lizard in our head with our brain above water. It is a system that can bolster defenses and keep us out of inordinate pain. Another important reason for the evolution of the left hemisphere is that the left frontal cortex evolved with the use of tools. It is the left frontal area that is involved in precise tool use, as for example, hammering a nail. Precision has become the domain of the left frontal area. If we are looking for a good surgeon we should find one that is left-brain dominant. We can be assured that she will be precise. If we want a therapist who can feel and sense things we may want a right-brain dominant individual; but of course, someone with a balanced brain is always the ne plus ultra.
The anxious patient is giving us her early generating source on a platter. The key feeling is right behind the anxiety, which is a sort of an avatar ushering in some catastrophic feeling. The fore-runner of doom. How do we know that? Because when a patient begins the session with feelings of gloom and doom, and is miserable, we often know what feeling is coming. And from what level. If we listen carefully we will know where to go in the patient’s past. The feeling is there. We need to understand its significance. We can begin serious therapy while the patient is suffering because she is very close to the feeling and its origin. Acute anxiety means in itself that the generating source of it is very close to consciousness. And as I note elsewhere, the closer the person is to her feelings the more anxious she becomes; it is telling in almost mathematical precision how close to conscious/awareness the feeling is.
We see the defense at work in studying the brains of our patients. As feelings surge forth there are higher vital signs and a mounting amplitude of the brainwaves (how many neurons are recruited to defend against feelings). As connection is made the amplitude drops precipitously. It would seem that one aspect of brainwave amplitude is in the construction of defenses. At a certain point when defenses are lower the connection is being made and the brain can relax. No, we do not use too much of our brains; we use too much of our nerve cells when we must defend against feeling.
Since to be conscious is to be free of anxiety we are already half-way there. There is not much difference between an anxious patient and one who develops anxiety during the session. In both cases the feeling is approaching. With the patient, she only gets anxious as she gets near the feeling. Then we can see a full-blown anxiety attack; just before fully experiencing the feeling the patient whispers, “I am going to die!” Generally, the anxious patient has chronically leaky gates so that part of the feeling is seeping through at all times. Both are propitious for the therapy so long as the anxiety is not terribly overwhelming; meaning that the patient needs to be brought into the primal/feeling zone. It is not helpful in conventional therapy because they attempt to suppress, not express. Quite different processes and goals. If feelings are erupting it is clearly better to let them out in some methodical way than to continuously push them back. It hasn’t been done because since Freud’s admonition that the unconscious is a dangerous place. It is the flip side of the old religious tenet that says we are inhabited by dark demons and must hold them down. Those demons to the layman were evil spirits. To the psychologist they may be negative feelings. The same thing; some mysterious force at work. The mental health professional often cannot accept what it really is because in his theory there is no room for deep-lying memories that constantly direct our lives. And he has not the techniques to travel deeply to the antipodes of the mind.
The more we learn about personal evolution the more we understand about evolution of our internal universe. As I noted, inside the human brain we can find remnants of our fish and reptilian ancestors. What this means is that what we are is built on the most successful adaptations of what we were. When our patients go back to the most primitive brains in their reliving, we see those ancient brains at work. And,I might add, there are never any words in those first-line relivings (Primals). There cannot be because it would mean not a true reliving (there were no words when it happened). No real reliving and therefore no getting better.
The power of anxiety explains much about the power of the imprint. And we note that anxious individuals are forced to keep busy so that they are never left still long enough to fully feel the anxiety. It is absorbed in the constant phone calls, moving here and there. Phone calls are telling because the original anxiety may have been just after birth when there was no one to hold and caress the baby, no real contact. The feeling behind the anxiety may be feelings of total isolation and alienation. Also a feeling of abandonment. Phone calls reconnects the person constantly. The act-out is, “I need contact to show that I am not alone.” And above all, he doesn’t have to feel that abandoned feeling he suffered just after birth or in the first months of infancy. He stays on the phone for a long time because he is staving off the feeling of no contact. He cannot judge that he may be on the phone too long with someone because he is acting-out old feelings that drive him to talk; he has found an outlet for his feelings.
On my desk is a scientific paper on how early life affects adulthood (Max Planck Institute, Germany, 8 November, 2009. Published online in Nature Neuroscience, by Chris Murgatroyed and nine other authors). What they have shown rather conclusively is that very life events can induce long-lasting changes in the brain, physiology and behavior. Early life stress can cause over-secretion of the stress hormone, cortisol, which effects changes in memory and coping mechanisms. (For those scientifically bent, there is a detailed explanation of methylation in the article, explaining long-duration effects). In their study of mice they found that periodic infant-mother separation just after birth was a major cause of anxiety. And in humans the earlier the separation the more lethal.
I have discussed anxiety and the levels of the unconscious in several of my previous works (see Primal Healing or The Biology of Love). A first- line imprint requires a first line response, that is, reactions that heavily involved the brainstem and limbic system. The brainstem is involved in high blood pressure, palpitations, and shortness of breath—the silent killers. It houses many of our instincts, our terror and furor, and our basic, primitive needs. It is and always will be, wordless, unless we think that salamanders can speak. It contains the secrets of our birth and of our lives before birth in the womb. If we want to know what kind of birth we had, it will tell us in its own way. It will be precise and unmistakable. Its wonderful quality is that it cannot and will not lie. If we claim not to be afraid, but down deep there is unabated terror, there is no argument.
A chronic symptom of palpitations is testimony to the possibility of an old imprint lying deep in the nervous system. It is a fragment of a central memory where a rapid heart beat was called for; one aspect of an anxiety state. So one goes to a specialist for heart problems; another for high blood pressure; another for migraine, when they are all part of a single imprint, which, when relived normalizes all reactions. There is a reason for high blood pressure. Too often the reason is so arcane as to be disbelieved. But it is there. Either genetic or more likely an imprint while we lived our womb-life (epigenetic). The specialist, a necessity, offers medication to lower the blood pressure without asking once where it comes from. She has a task to complete, a task to help the patient not suffer. That cause is so mysterious that the question is rarely asked by the treating physician. And, as I often point out, we are not used to delving deep into the brain and its levels of unconscious. We don’t delve because we often do not have the tools. We do now. But still, it takes such a level of abstraction to tie palpitations in the now to an event during our womb-life. Luckily, we don’t have to make that intellectual leap; the patient will do it for us. And when we give the patient the possibility of deep penetration of herself, giving her total freedom of expression we will discover things we never knew existed. And we will learn from the patient and change our theory and therapy accordingly. We will learn from experience instead of creating the same old circumstances and explanations that reinforces our prejudices. And for the patient, too, she will learn from experience, not ideas; not the beliefs of the therapist; i.e., that there is an id or shadow forces that drive us. Rather, there are concrete events in our lives to account for a heart attack or out of control behavior.
Once a patient has access she may relive oxygen deprivation (a smoking mother) during her time in the womb. The patient may have a transient palpitation attack, or the pain of angina which she can now connect to the original threat (perhaps too low oxygen supply). One patient, as I discuss elsewhere, re-experienced being polluted in the womb as her mother smoked constantly. She learned why bars or smog drove her crazy. She could not stand any kind of pollution; it resonated with its original source. She never knew it as pollution originally. It was just a disagreeable sensation. She called it pollution after she grew up. But that early experience of smoke, over and over each day, laid down a permanent stratum of misery that kept her unhappy. And of course until she had access she never knew why. She finally connected.
The feeling makes the connection. Anxiety is a refractory symptom because it is basic to our survival. It should not disappear easily.
Because the brainstem continues to develop for several months after birth, what happens to us emotionally during the few months of life on earth can affect our heart function, most of our survival mechanisms, and our brain development. It is the first organized response to threat among most animals. It involves breathing difficulties and heart problems. My dog gets anxious when there are fireworks in the neighborhood. She begins to pace and breathe heavily and her heart beat is forceful and pounding, which won’t stop until an hour or more after the fireworks. In humans there is often a very rapid beating of the heart (makes me feel like wanting to “jump out of my skin.”) Unable to uncouple from a runaway sympathetic nervous system, one remains powerless. That’s one good definition of powerlessness; the linchpin of why most efforts for control fail.
Painkillers plus reassuring ideas from a therapist can control anxiety for a limited time. But it is never eradicated. And if we want to see if this hypothesis is true we have only to measure key biological processes during therapy, not the least of which is cortisol. As the patient approaches a first-line feeling the vital signs begin their rapid rise, much higher than we see when a second-line feeling is at hand. This is one way we know about the force and danger of the feeling. It is how we know what feelings to ignore for the moment. We do not want to push the patient into a feeling he is not ready for. If we listen carefully we won’t make that mistake. When we feel that we know best, the patient will suffer.
Sunday, January 3, 2010
The concept of resonance is important in understanding anxiety because situations can resonate within us from language centers to below the level of language where the panic exists. We can be stirred up even when we don’t know with what the outside situation is resonating. Thus, in sex, a nude female body can resonate in a man with an early experience with his mother. She may have been seductive long before the child had any understanding of it. I had one white patient who had a very seductive mother; she French-kissed her son. Later, he could only have girlfriends who were Black or Asiatic—too white a girlfriend would resonate with that early seduction that scared him. Here “White” women resonated with a White mother, something to be avoided. I treated a lesbian woman who was molested sexually by her (white) stepfather. She could only have relationships with Black men. Later, any man resonated with the early stepfather. She switched to sex with woman. It seemed much safer to her. She discovered that when she was with a man in bed she had a chronic low-level apprehension. When she switched to women there was no more problem.
When there is a life-and-death struggle at birth due to lack of oxygen (anoxia), for example, the existing reactive system is activated, but because it cannot fully respond due to the complete load of pain and terror (to feel it completely would be to run a cardiac attack or at least to lose consciousness), it reacts partially within its biologic limits and then puts the excess part of the terror away for good keeping; it houses it until our system is strong enough to feel and resolve it. It lives behind our repressive gates. However, we continually respond to this stored terror with chronically high stress hormone levels, a compromised immune system, misperceptions, strange ideas, nightmares, and chronic malaise and a startle reaction. This high activation level gnaws away at the cardiovascular system so that we fall seriously ill at age 55, even though at the time we seem to be living a normal, relaxed life.
We have done systematic stress hormone cortisol studies with our patients and have found a normalization after one year of therapy. That tells us that the variable, reliving, may well be responsible for the reduction of anxiety. This drop is also associated with a drop in heart rate and blood pressure. The patient also claims to feel better. Biologic measurements are more reliable because they inform us of what the physiology is doing, irrespective of what the person thinks.
Tranquilizers seem to be obligatory to enable someone in pain to function on a daily basis. What is diabolic is that in spite of a loving childhood the person suffers. She may not have been loved on the first-line where good oxygen and nutrients were essential, which were lacking; or there may have been a mother terribly tense over losing her job in the economic crisis. From the baby’s point of view he is unloved; his needs (for calm)are not met. From the mother’s point of view she was doing the best she could and could not help her feelings.
A carrying mother who smokes and drinks is not loving her baby; her needs come first. If she takes drugs such as cocaine she is alterating the physiology of her baby. Male monkey offspring of mothers were given cocaine had poor impulse control and possibly were more likely to take drugs later on. This study went back 15 years to monkey mothers who were given cocaine. Despite the effects from womb-life, too many of us were not loved in obvious ways later in our emotional life when there was no touching or holding.
One of the ways we know where anxiety comes from is the depth and agony of the feeling of terror. There is always the fear of dying because that is what actually happened in the womb or at birth. Fear is second line, organized higher up in the brain. Anxiety is paralyzing because it is how some part of us reacts to terror. When we have chronic over-arching anxiety we are dealing with a mélange of fear and terror overwhelming the defense system; a compounding of a harsh childhood and poor gestational life. Here is resonance. Current apprehension soon turns to anxiety as the feeling triggers off low-level terror. The terror, I remind the reader, is already there. It keeps us from relaxing on the beach, pushing us into constant activity. And we rationalize, “I don’t like the sand.” What we do in the present is usually the reflection of our history. Life becomes a rationale for our imprints. If we have a therapy of current focus we are missing out on all those causes.
In order for some patients to feel the fear and its context we need to tranquilize the terror so that it does not interfere with the feelings the patient has. We offer first-line blockers. In conventional medicine and psychotherapy this is sometimes known as anti-psychotic medication. What is being blocked is the terror that often produces bizarre ideas in the patient. The tranquilized patient will no longer be overwhelmed because we have reduced the overall pain load; she can focus on a single feeling. And there is no longer an overload that caused the generation of all those strange ideas and beliefs. We see here how psychotic ideation develops. Feed in too much pain and the systemic searches for an outlet. Reduce the level of pain and the system calms down and no longer needs the ideas to rationalize what is going on inside. Those strange ideas are like an overflow valve that channels the pain away from consciousness and into awareness. He is hyper-alert.
Feeling overwhelmed happens when something in present resonates with terror, and the combined force is overwhelming. “It is all too much.” We cannot follow orders because there are a string of orders from the past inside that command us; they take precedence.
What is diabolic about anxiety is that many of us suffer from chronic low levels of anxiety, barely perceptible, acted-out constantly. The person is rarely aware of it yet it drives her to go and do all of the time: cannot read a book without that agitated feeling. Cannot focus for long, cannot listen to a long lecture, cannot listen to the children’s stories and above all that agitation catches up with her at bed-time when she cannot fall asleep. We cannot be a loving parent when we don’t have the patience to listen to our children and their stories. It is not that the parent is bad person or unloving in his intentions, but that he suffers and cannot help himself. He rationalizes that he must keep busy to feed his children. We know otherwise. He has to keep busy to discharge all of that energy. If he cannot he suffers.
The low level anxious person can rarely listen; that takes too much patience and the person can’t wait. This individual cannot listen to complicated instructions (how to assemble this table or how he must turn right at a certain intersection); he bows out and glazes over very quickly. If he is given a chore of what to buy at the supermarket, as soon as it gets to three choices he is gone. “I know she said to buy low-fat but low-fat what?”
Sleep is problematic when the low level mobilization (against the early pain) is now active as the third line diminishes its hold a bit. Don’t forget, the higher-level neo-cortex is often pressed into service to control our lower level feelings. It is an escape hatch. As we need to let go of that top-level control in order to sleep we become more vulnerable. We have to release control. Enter a ruminating mind. A very busy, unceasing mind that cannot stop itself long enough to fall asleep. As we get closer to the deep brain in deep sleep we approach those primal feelings. They agitate and move upward to make the thinking brain work very hard. Even in sleep when we begin to suffer from the uprising of first-line terror the brain rushes in to cap it with a nightmare. The nightmare attempts to encapsulate the feeling so that it never becomes conscious. It is not a willful act, that nightmare. It is a built-in survival mechanism that ensures that our conscious/awareness will not be impaired by overwhelming input. The story in the nightmare does not count for much, but the feeling in it counts a great deal. That feeling can give us a way in; the royal road to the unconscious.
The imprint of a memory is really an ensemble of reactions that is impressed simultaneously into the whole system when there is inordinate danger, a smoking mother, for example. It is a total experience, unlike recall, which is largely mental, meaning a left prefrontal cortex operation. We may not be able to recall an imprint. We can only remember it with our entire system: with our muscles, viscera, and blood system, because all of us was involved in the original experience; therefore, it must be relived with all systems involved originally when it was set down. Not only that, but it must be relived with the same intensity in which it was impressed, which is why it has rarely been seen in conventional or cognitive therapy where the emotional level is rather subdued. A few tears is not exactly deep wailing that we see in our therapy.
Let us not confuse recall with memory. Deep preverbal pains can only be recalled with the entire biologic system. Verbal recall is another animal (literally) altogether. It is systemic, organic, physiologic memory that cures; verbal recall does not. When we suffer high blood pressure, for example, we may be suffering from a lingering residue of an overall trauma very early in our lives--in the womb. The high blood pressure has been stripped from the generating memory and lives its life apart. It is trying to tell us something about where it came from; but alas, we drug it unmercifully so that it never volunteers its origin. Same for heart rate. We are forever putting those memories to sleep.
So there are at least two main avenues to provoke anxiety and repression; one, the meaning of a certain look by the parent, (or any negative reaction of theirs) which means I am not loved nor will I ever be. Two, something is happening that is an immediate threat to my life. In either case there is a disruption in the evolution of the organism.
Originally, suffocation during birth provoked repression to order to keep the system on equilibrium and to keep the baby from dying. Two of my patients were later told by a doctor that they had what seemed like a heart attack at birth. Later on, as the feeling was compounded by additional pain and terror it provoked even more shut down. In both cases there is danger. It will be crippling anxiety and not plain old fear (terror-light) when the lower brain centers are actively involved.
When the resonance travels down the chain of pain and reaches low levels of the neuraxis, terror then appears. It is not something new; not something to try to reach. It is an old friend (or enemy). In fact willfully trying to reach a lower level feeling is an oxymoron; the more we use top level will, the less we can descend to where we have to go. The more we let go of the present the more access we will have. The person in terror will suffer anxiety because the body is preparing for extreme reactions in order to survive. You cannot be slow to react if there is a lion coming toward you.
There is usually the gloom and doom aspect of the anxious feeling, “I feel like I am going to die.” Since no one manufactures a feeling that has no basis in reality, we must seek out origins. If we want to successfully treat any of the so-called psychosomatic (migraine, high blood pressure) symptoms we must find the generating sources. Here the feeling needs to meet its maker, and there is a maker. What happens is that a current situation, giving a speech; through the process of resonance, a mild fear and apprehension has set off the original terror deep down in the brain so that the person is not just sort of fearful, but suffers a full-fledged anxiety attack, feeling she is going to die. The feeling is correct! We don’t understand her reactions because it is just giving a speech to fifteen people. Yet she feels overwhelmed. Or someone is criticized and goes into an anxiety state. Why? Because it can mean, “I am not loved if I make a mistake.” Or “catastrophe happens if I make a wrong move.” And no doubt this person in her childhood was not loved when she made a mistake.
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.