Thursday, March 31, 2011
This is the first of a series of four articles I wrote on EMDR therapy.
I believe that, grosso modo, I have outlined the basic tenets of EMDR therapy. I will begin with Van der Kolk’s work first. What I think he is onto is many of the basic tenets of primal therapy but in a less organized fashion. For example, he states rightly that for trauma to be resolved there has to be a high level of arousal since the trauma was stored under conditions of that level of arousal. He emphasizes that traditional therapy focuses on reducing arousal either through the use of tranquilizers or in attempting the calm the patient’s arousal level, also known as anxiety. The question is can his therapy produce the same arousal? Bereft of reliving the trauma I don’t think so.
We control every session in terms of vital signs. During a reliving of the early trauma, and that means pre-birth and birth, which is not in the parlance of EMDR therapists, we see body temperatures climb three degrees (F) in minutes; systolic blood pressure over 200 and heart rate exceptionally high, as well. We have done salivary cortisol studies (stress hormone) on before and after therapy with reduction in levels after one year of therapy; plus four separate brainwave studies where we found, inter alia, changes in the power distribution between left and right hemispheres, which is what Kolk wants to achieve.
We have done several EEG studies on hemispheric laterality. Early in our therapy there is a change in the right hemisphere amplitude. Long term changes, on the contrary, affect the left hemisphere. In an eighteenth month follow-up of fifteen patients there was a statistically significant increase of left hemisphere activation. More important, increased left temporal activation was significantly correlated with the patient’s improvement. (As measured by blind ratings by therapists) What the researchers concluded was that there was an overall greater harmony of the two brain hemispheres. Another conclusion was that with a slight shift in power to the left side there was better control of own’s feelings and impulses.
Some conclusions of our EEG laterality studies: 'Several studies have been done on hemispheric amplitude asymmetry in primal patients. This author (Hoffman, E.) found that primal therapy initially affected the right hemisphere the most, while long-term changes primarily showed up on the left side, in an 18 months follow-up study of 15 primal patients at the New York Primal Institute, a statistically significant increase of relative left hemisphere activation was found for the anterior temporal areas. Increased left temporal activation was significantly correlated with the patients' improvement in therapy as rated blindly by their therapist.
In a recent long-term EEC brain-mapping study at the LA Primal Center a similar significant increase of left temporal activation was found in a group of patients after therapy. In most patents, following one year of therapy, alpha amplitudes were nearly symmetrical in the right and the left temporal] lobes.
Neuropsychologist Rhawn Joseph writes:
"Thus. the left and nght halves of the brain and the mind can, in fact, be influenced and overwhelmed by these limbic unconscious forces simultaneously, independently. These impulses can be transmitted “first through the unconscious mental system maintained by the right brain to be acted on because the limbic system maintains rich interconnection with both halves of the brain.... Whereas these impulses are almost complete; they are foreign to the language-dependent conscious mind, and the left half of the brain. The right brain, being more involved in emotional functioning, is able to discern and recognize these limbica!ly induced feeling states and desires for what they are."
Thus, higher amplitudes in the right hemisphere, as we see in most normals, may indicate that this side of the brain is closer to and more integrated with feelings originating deeper in the brain. If upshooting Primal Pain interferes with left hemisphere functioning we may expect mental disturbance of a psychotic dimension accompanied by larger amplitudes on the left side. This is exactly what several studies have shown. Our hypothesis was that both hemispheres can be differentially influenced by deep unconscious, limbic/
brainstem forces. The right side is more attuned to deep-lying stored feelings. Remember, it is this side that develops earlier and is more responsive to very early emotional imprints. We have found that intrusions of painful imprints impact the right side more than the left. When there is long-term stored trauma the right side of the brain is called upon for the heavier work; it is activated during recall and reliving. It then shifts some of the burden to the left side for control and integration, hence the enhanced harmony. When someone is awash in old pain and cannot integrate there is a right side dominance.
In my book, “The Biology of Love,” I discuss arousal levels and their importance. The point of all this is that Dr. Kolk is on the right track but it is doubtful that any therapy other than a complete neurophysiologic reliving can accomplish that. Secondly, every reliving of a certain trauma, such as being left alone for days after birth (perhaps due to the illness of the mother) produces the same vital signs as the session before. It is one way of many that we can verify the veracity of the reliving. It is accompanied by a later developed, articulated feeling of hopelessness. In these cases the vital signs drop significantly. One can feel hopeless long before one has the cortical wherewithal to articulate it.
Monday, March 28, 2011
May I respectfully suggest that most of the current problems in psychotherapy today lie in the inability to differentiate between awareness and consciousness; thus, the cognitivists and insight therapist believe that if the patient is aware she will make progress. And I suggest that awareness has little to do with progress unless you are happy to get well from the neck up and leave the body behind.
So, let’s define things: awareness involves the last evolved neurologic system, the neocortex where ideas, beliefs and perceptions lie. Consciousness involves the three levels of consciousness, the three key brain systems working in harmony and fluidity. Consciousness involves all of us and particularly our history. Awareness is ahistoric and since we are historic beings we cannot hope to get well if we leave our past behind; if we ignore our history and what happened to us from our life in the womb onward.
When we rely on awareness we are dealing with a thin sliver of brain function, disconnected from physiologic processes which areprimal the motor for how and what we think. Thinking and beliefs (which is what we are asked to do in cognitive therapy, believe the therapy and therapist) are ultimately malleable and change with the wind; not so with lower brain processes which involved survival, and should not be so malleable. When we rely on awareness we are avoiding our life blood, our feelings; that is what makes us feeling human beings.
Why is feeling so important? When we speak of “quality of life,” we are dealing with feeling. So we have one brain, the left, that is fragmented and the other that sees the whole. To become whole we must manage to recruit the fragments of our lives into a complete picture; for that we need both brains hemispheres working in harmony. That is one definition of consciousness and its differentiation from awareness. In therapy we see how this works when after a feeling, the patient will begin a litany of, “That’s why I did this and why I did that.” The fragmented behavior begins to make total sense. It has a gestalt context—consciousness out of unconsciousness.
The Problem with Left Brain-Centered Psychotherapy:
Unfortunately, we tend to glorify left brain awareness to the neglect of the right feeling brain. We expect the left brain to fight our battles, particularly, the internal enemies. We do this without taking into account that left-brain development came into being much later in evolutionary history than the right brain, and in each of our individual lives, in part as a means of disengaging us from the other side. One kind of brain tissue cannot do the work of another. The left brain developed different abilities to avoid a redundancy between left and right. The left brain’s activity helps soothe and calm us. It allowed and continues to allow us to defend against feelings that were too much to bear. We use the left hemisphere to rationalize a hurt or insult so it won’t create so much pain. Or at the mercy of needs of which we may be only dimly aware, the left brain can superimpose all kinds of needs onto a romantic object and imagine her to be wonderful, only to be disappointed two years down the line because it didn’t see reality. It didn’t listen to the right because communication was either reduced or non-existent. When perception is detached from need and feeling, we misperceive. For instance, if we need a strong protector, we will overlook the other person’s weaknesses and ignore his flaws. We "see" protection where it may not exist, or we get protection accompanied by total domination.
It is difficult to know what is real about humans if we take words alone as a sign of reality.
The left frontal area is also where we conjure up or embrace beliefs(*). Insights given by a therapist are ultimately beliefs to soothe and ease pain. So of course the therapy patient feels better after a session. She has knocked down painful feelings; that is one of the key roles of the top level neocortex—suppress feelings. Indeed, the words of a therapist, no matter whether right or wrong, can be soothing to our agonies. It is not only the content of what the therapist says, but just his words offered in soothing tones. Oddly enough, that tone affects the right brain, not the left. The content of the insight remains in the left. We can be fooled into thinking that the content of an insight is what makes us feel better, but in reality it is the reassuring tone, all along. It dampens right side pain, the pain of a father who never cared, was never soft, and whose tone was unrelentingly harsh. The therapist’s presence says, “I’m here now. It’s going to be all right.” Just being in his office can make us feel better. In other words, the left side allows us to be partially oblivious to ourselves. This is particularly egregious when it comes to psychotherapy, which traditionally has been left brain focused for over 100 years.
It is now apparent, due to an abundance of new research, that psychotherapy must address the right brain and consider how to affect right-left brain connections—as this is the way feelings become integrated. Psychotherapy must work to help not only ourmental state but our entire neuro-physiologic system. This is the difference between dealing with words (left brain) and the use of images, scenes, and feelings (right brain). The former is what occurs when we “reflect” on our past, while genuine emotional retrieval, which is what is needed for integration and genuine healing, requires access to the right brain feeling structures. Once again we see that it is not possible to use ideas and thinking processes, which literally came along millions of years later in brain development to affect what is lower in the brain, and developed millions earlier.
(*) The right frontal area is as involved as the left, although the contributions to the ideas are different. The right will tend to “like” grander ideas.
Sunday, March 20, 2011
I remember years ago I saw a TV interview show with a woman lawyer who was famous for wearing extra large hats. And the interviewer asked her to justify it. She said, "I wear them because I like them." And I thought wow! that was a reason?! I never heard that before because in Jewish life everything has to be explained and justified, and then you grow up and become an analyst so you can go on explaining. ay ay ay. and there I learned that if you liked something it was all the justification you need. Your feelings can justify things. What a discovery. If you grow up where kids are given orders and never asked their feelings they grow up unaware there are such things as feelings. If everything is cut and dried, "did you pick up the cleaning?," then feelings do not enter your universe of discourse. So I had to learn from television something I should have learned as a child when someone might have said, "How do feel about dinner. Do you like fish tonight?" Then and there you are inculcated that feelings count. Or, "I don't feel like taking out the garbage." It is usually met with anger as any dissidence is, but suppose someone said, "Why not? You know it is important for all of us." A dialogue instead of military orders. Some believe all that stuff and enter the army where they can receive and obey more orders; being told when to sleep, when to get up and when to eat. Military intelligence has got to be an oxymoron. Would any free and liberated emotional person want to do that? Does he love the idea of wanting to kill so much that he gives up his freedom? After all, it is the job of the military ultimately to kill. Yes protect too, but to kill if protection fails.
Children learn about feelings if parents know about them and listen to them in themselves. If they are prompted to seek out what the children are feeling. "I am not tired right now. Can I stay up another hour?"
What do you say? "You go to bed right now." Would you do that to a friend. a wife? Children are not another species. They are human beings like us. When parents wonder if you should do this or that to a child--should I pick them up if they cry,? they should know that you do not need to answer that question by asking someone. Your feelings should tell you that someone in pain should be comforted. That is not too difficult a question. Why do we think that children are not part of us? That they should under go some different kind of regime. Of course, any feeling person would pick up a child who falls. And she should cry; she is hurt.
I learned in my analyst days not to empathize with suicide cases and heavy depressives; not coddle them and reinforce their depression. Then I learned to act human with them; and I teach my interns, "When in doubt act human. Act like you are having coffee in a shop and show the kind of courtesy and empathy you would drinking coffee." If they get caught in technique they might forget that. And above all, follow their feelings, like their parents did not. Patients need that; they need a human there, not a dry interviewer and insight giver. Patients will pay the price for the insights by listening attentively, but a little hug might also help and above all, kindness. Yes, our therapy takes years to learn because the techniques are complex and a good deal of neurology enters into it, but human and humaneness are central. Everyone who comes to us had that lacking in their lives. We cannot love neurosis away but a little loving, reassurance and holding out some hope is also important; it brings down the pain level so that some of it can be felt. Patients never need to be busted or criticized. They have that in spades.
Monday, March 14, 2011
So I saw a video lecture by Robert Sapolsky the neurobiologist at Stanford University about depression. Whenever anyone gets outside their field to lecture I get worried. Even when I discuss neurology you are far better off listening to someone like Sapolsky. So what does the bearded doctor say? That depression is like diabetes and is a biologic disease.
Well all diseases are biologic in the end since they effect the physiologic system. The question is, is it biologic in origin? If you don’t see what I see every day then yes you can make that mistake. But if you see patients going back in time to preverbal days to relive origins of depression then you know it is NOT a biologic disease in origin. That confusion between origins and results; making the results the cause is a very common mistake in psychology and neurology. I promise not to discuss neurology anymore if neurologists will lay off psychology. Just because a professor has a doctorate in finance doesn’t mean he can lecture in psychology. We are all smart in little ways.
So what are the hallmarks of depression?
1. a feeling of hopelessness and helplessness
2. no energy. Everything is a great effort.
3. A big dark hole that one cannot crawl out of.
4. Everything is in slow motion, labored movements and shallow breathing
5. What’s the point of it all?
6. An emotional numbness
7. No joy in anything
8. No able to talk or express oneself
9. Nothing to live for
10. Extreme fatigue
11. Nothing to live for
12. Cannot concentrate
13. Wish to die
14. Lack of sexual interest
15. Total despair
I could go on. But you all fill in the blanks. Is all that caused by our biology? Watch out for cause and effect. Now the catch: all that is also what one feels during the trauma of birth; and indeed when patients relive these events they lessen their depression. All that the depressives feel had their precise beginnings during womblife and at birth.
Why? What can a fetus do when the mother smokes continuously? What can the poor guy do when the mother takes painkillers and tranquilizers every few hours. He is helpless and hopeless; there is nothing he can do. No escape. Death is near as the little system goes into alarm mode. That may be later translated into wanting to die because it is the only way to stop the pain. It is a big dark hole that he cannot climb out of. He cannot talk or scream or show his pain; no one to listen, no one to hear. No one cares. Of course there is extreme fatigue; think of the effort it takes to get born when the newborn is drugged out of his mind. There are labored movements as he can barely move at all. And on and on. You can read The Janov Solution for the long version of this discussion. But there is a cause and if you have no idea about the imprint, even though all new information supports it; and if you have no idea about how early those imprints are laid down, then of course you will confuse cause and effect and lecture about how depression is a biologic disease just like diabetes (Sapolsky’s idea). In a strange way, it is not so far off the mark. Because diabetes too is biologic but it may well be that early experience sets off this disease, as well.
You see that once you believe that, then there are only physiologic therapies such as drugs that you believe in. You eschew psychologic explanations and therapy. Worse, you no longer look for causes because, you see, you already know it is BIOLOGIC. Dr. Drew of television fame for treatment of addiction calls all this a brain disease. Of course, there are brain effects but what is the cause? Life experience, for the most part. But if you never see those experiences, hidden as they are during womblife and birth, then you have no choice but to believe it is all brain disease. But when my patients relive birth and then we see fingerprints coming up on both legs immediately afterward we know about the imprint and its enduring nature. Or when they relive anoxia at birth and then lessen their addiction we see the connection. But if you do not have the means to observe all that your conclusions will be faulty. And you will be led to believe that addiction is a brain disease.
Depression is by and large a parasympathetic reaction. I suggest reading my books for a full discussion of this but the depressive is stuck at the time when he was in the trough trying to get born; all to no avail as drugs rushed in to block his efforts, or he was strangled on the cord, or he had unavoidable trauma during womblife that left a mark on him. The system goes into parasympathetic excess or passivity in order to survive, and that survival mode, parasympathetic, endures for a lifetime. We are stuck way back there and we don’t know it. I know it and my patients know it. And now you know it. We all know it. Ahhh.
There is a study from the Mayo clinic that seems to conclude that forgiveness is good for you. They say that holding a grudge can adversely affect your heart and your nervous system. This ought to give great comfort to the religious among us because the bible states the same thing.
And, not so oddly, many psychotherapeutic systems believe in forgiveness, as well. The research shows that if you hold a grudge it raises yourblood pressure and heart rate. When subjects imagined forgiving the person they felt more relaxed. But of course the first step for them is to acknowledge the pain. Step number 2, is to find a new way to think about it. Finally, begin to experience emotional relief. It all sounds pretty straightforward. Except! This is no different from cognitive therapy, which also asks patients to think in new ways about the hurt. What it is actually doing is rerouting the hurt from the right frontal area to the left prefrontal; and guess what? The left, when busy concocting ideas and rationales, actually suppresses the structures in the limbic/feeling area so that the person feels more comfortable. But it never really touches the pain. And, as many animal experiments show, when you tranquilize with a pill or shot the animal seems relaxed. But when you measure the deep physiology there is a raging inferno going on. There is no magic to all this. If we don’t address history there can never be a real cure.
Monday, March 7, 2011
The title seems like an oxymoron but what I mean is that each of us marries our need. We marry what we feel we need. Let me put this way; because of a lack of love early in our lives we are left with unfulfilled need. That need bubbles us later in life and becomes an idea of what we need. It often isn’t even an idea; it is just an automatic behavior that directs toward fulfillment of an old need. A man may idealize almost every woman he meets, and then as time goes on he begins to see who she really is. Then divorce, as is so often the case. She is at first wonderful then someone with faults, and then someone who is terrible. All because he never saw reality, in the first place.
This is the paradigm for so many divorces and breakups. We need fulfillment so badly that we see it everywhere. And later in life we see it nowhere. And it is that screen or filter that we put up automatically when we meet someone new. We don’t see them; we see ourselves. We see what we need. We don’t exactly see who we need, mother, because if we did we would be rolling around the floor in pain begging for love, which is what my patients do. Then they are bereft of their illusions and can finally marry someone who suits them, who is who she is and not some fantasy creation. We finally see reality and that is such a relief and avoids so much strife later on. All those bitter recriminations because the person wasn’t who we thought she was. She had faults and they became more and more evident as the relationship went on.
The woman marries a strong, aggressive man so she can feel protected like she could not with her weak, passive father who let her mother beat up on her. But, alas, he is demanding and driving and sometimes brutal because that is who he really is. And then he could not protect her from himself and his rages and his drinking. She knew he drank a bit but did not really see it because he was her “protector.” Or the woman who married a weak man who would not be a threat as her angry father was. Then reality sets in; he wants her to work and earn the living. He is so passive with the children. He won’t fight for her when there is a problem, and on and on. Disappointment set in but it shouldn’t be there because that was the deal at the outset. “You be soft and unaggressive so I won’t feel threatening and overwhelmed (by daddy), and I will be the forward aggressive one fighting for both of us.” And if we look at the faults of our partner we will see our need; we will see our history and what deep feelings we have. We will finally see ourselves.
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.