Monday, April 16, 2012
On the Use of Medication in Sleep and Psychotherapy
There is a recent piece in the NY TIMES (“Pills’ Risk Complicate Long Wait For Sleep,” March 13, 2012, Science section) that states that those taking sleep medication on a regular basis are nearly five times as likely as non-users to die over a period of two and a half years. Now why is that? Before I answer, let me say that in my life and in my practice I find that at least half the people I come into contact with have trouble falling asleep or sleeping more than an hour or two without waking up. So many of us cannot sleep, and sadly that includes doctors and surgeons who really need their sleep, not to mention airline pilots. The article states that there were 60 million prescriptions for sleeping pills last year in America.
Of course, those who need sleeping pills are already in trouble, usually suffering from anxiety disorders and/or deep depression. And these people may already be on daytime pills for a variety of psychiatric disorders. So why no sleep? I think that lifetime sleep patterns are established in the womb and at birth and just after. A carrying mother who is highly anxious or depressed may interrupt the fetal sleep patterns. It dislocates how we sleep thereafter in the same way that trauma while we are being carried produces lifetime patterns of behavior or symptoms such as headaches. It is also the time when our hormone, neurotransmitter, and neuromodulator output all begins, so that traumas during this period can change the setpoints of so many neurochemicals that affect sleep. Just not enough serotonin can do it, as well as alterations in dopamine. The system may be imprinted with too high a level of vigilance hormones that work against sleep. Or there may be compromised gating functions that prevent us from blocking low-level imprints.
But let us not concentrate only on sleep because any serious anxiety imprint that the carrying mother suffers means the baby suffers too. And that means overloading the gating system early on. The result is that when we try to cede high-level cortical alerting functions in order to reach down deeper in sleep levels, the pain is there waiting and prevents any rest. This is usually the result of serious neglect and trauma while we are living in the womb. And so because the gating system is weak we cannot block enough of the pain in order to get some rest. And we take pills in order to quiet the onrush of pain. And those pills work on pain centers; some work directly on the vigilance centers of the brain stem such as the locus coeruleus. They do what they are supposed to do: quiet the agitation.
The faulty gating system already means serious pain when the gating system was being organized, sometime around the midpoint of pregnancy. An anxious or depressed mother can overtax the baby in the womb; too much input from the mother, so much so that the inchoate gating system becomes defective. And later in life when we try to sleep our minds are racing, racing because the first line is in a hyper state. Why hyper? Because there is danger from the imprinted deep first-line feelings, and so the system must stay alert against the feelings. So long as that imprint of a turbulent agitation remains in place sleep will always be a problem. That imprint has no doubt already lowered the effectiveness of the gating system, making sleep problems unavoidable. So of course we take pills to try to make the physiologic function be normal; those pills are an attempt to normalize the system, to establish a brain system that can shut down when necessary. So they are life-saving and life-threatening. In the daytime we see this in the anxious patient who is go-go-go all of the time, unable to sit still and relax. Sleep problems are only an extension of the daytime behavior. It is still the same person, night and day. He may also exhibit impulsive behavior during the day, as an expression of impaired gating. It isn’t that we have sleep problems at night but are perfect during the day. It is the same system misbehaving at night: on the go when one shouldn’t be, night and day. Same imprints driving it all.
Taking sleep pills is, of course, life-endangering. But here is what an expert, the president of the American Academy of Sleep Medicine, says: “If someone comes to me on a sleeping pill, usually my tactic is to try to take them off it.” Without looking into its biological necessity? Maybe one needs it to equalize the psychic economy. It is clearly what the system needs to go on functioning. Today the experts believe that it is safer to take non-benzodiazepine sedatives than benzodiazepines or barbiturates. Not sure. Maybe, although it is still suppressing the pain, just by a different method. How about discussing the pain, what it is and how to get rid of it? Why is it always a given that we must suppress? Why don’t we express? Assuming we know what we are dealing with, that is. Ah, that is the problem—not enough knowledge about what is behind sleeplessness. It is, after all, a big leap from womb-life to not being able to sleep last night. I could never have figured it out without observing patients who have sleep problems relive first-line feelings and begin to sleep peacefully at last. We see the great inner agitation during the primal, and then see the drops in blood pressure and heart rate and later, reports of sound sleep. One piece of advice: when there is that stab of some feeling upon arising in the morning, instead of running from it, lie back and let it sweep over you. It often helps, and you will eventually understand why that problem is there in the first place.
Review of "Beyond Belief"
This thought-provoking and important book shows how people are drawn toward dangerous beliefs.
“Belief can manifest itself in world-changing ways—and did, in some of history’s ugliest moments, from the rise of Adolf Hitler to the Jonestown mass suicide in 1979. Arthur Janov, a renowned psychologist who penned The Primal Scream, fearlessly tackles the subject of why and how strong believers willingly embrace even the most deranged leaders.
Beyond Belief begins with a lucid explanation of belief systems that, writes Janov, “are maps, something to help us navigate through life more effectively.” While belief systems are not presented as inherently bad, the author concentrates not just on why people adopt belief systems, but why “alienated individuals” in particular seek out “belief systems on the fringes.” The result is a book that is both illuminating and sobering. It explores, for example, how a strongly-held belief can lead radical Islamist jihadists to murder others in suicide acts. Janov writes, “I believe if people had more love in this life, they would not be so anxious to end it in favor of some imaginary existence.”
One of the most compelling aspects of Beyond Belief is the author’s liberal use of case studies, most of which are related in the first person by individuals whose lives were dramatically affected by their involvement in cults. These stories offer an exceptional perspective on the manner in which belief systems can take hold and shape one’s experiences. Joan’s tale, for instance, both engaging and disturbing, describes what it was like to join the Hare Krishnas. Even though she left the sect, observing that participants “are stunted in spiritual awareness,” Joan considers returning someday because “there’s a certain protection there.”
Janov’s great insight into cultish leaders is particularly interesting; he believes such people have had childhoods in which they were “rejected and unloved,” because “only unloved people want to become the wise man or woman (although it is usually male) imparting words of wisdom to others.” This is just one reason why Beyond Belief is such a thought-provoking, important book.”
Barry Silverstein, Freelance Writer
Quotes for "Life Before Birth"
“Life Before Birth is a thrilling journey of discovery, a real joy to read. Janov writes like no one else on the human mind—engaging, brilliant, passionate, and honest.
He is the best writer today on what makes us human—he shows us how the mind works, how it goes wrong, and how to put it right . . . He presents a brand-new approach to dealing with depression, emotional pain, anxiety, and addiction.”
Paul Thompson, PhD, Professor of Neurology, UCLA School of Medicine
Art Janov, one of the pioneers of fetal and early infant experiences and future mental health issues, offers a robust vision of how the earliest traumas of life can percolate through the brains, minds and lives of individuals. He focuses on both the shifting tides of brain emotional systems and the life-long consequences that can result, as well as the novel interventions, and clinical understanding, that need to be implemented in order to bring about the brain-mind changes that can restore affective equanimity. The transitions from feelings of persistent affective turmoil to psychological wholeness, requires both an understanding of the brain changes and a therapist that can work with the affective mind at primary-process levels. Life Before Birth, is a manifesto that provides a robust argument for increasing attention to the neuro-mental lives of fetuses and infants, and the widespread ramifications on mental health if we do not. Without an accurate developmental history of troubled minds, coordinated with a recognition of the primal emotional powers of the lowest ancestral regions of the human brain, therapists will be lost in their attempt to restore psychological balance.
Jaak Panksepp, Ph.D.
Bailey Endowed Chair of Animal Well Being Science
Washington State University
Dr. Janov’s essential insight—that our earliest experiences strongly influence later well being—is no longer in doubt. Thanks to advances in neuroscience, immunology, and epigenetics, we can now see some of the mechanisms of action at the heart of these developmental processes. His long-held belief that the brain, human development, and psychological well being need to studied in the context of evolution—from the brainstem up—now lies at the heart of the integration of neuroscience and psychotherapy.
Grounded in these two principles, Dr. Janov continues to explore the lifelong impact of prenatal, birth, and early experiences on our brains and minds. Simultaneously “old school” and revolutionary, he synthesizes traditional psychodynamic theories with cutting-edge science while consistently highlighting the limitations of a strict, “top-down” talking cure. Whether or not you agree with his philosophical assumptions, therapeutic practices, or theoretical conclusions, I promise you an interesting and thought-provoking journey.
Lou Cozolino, PsyD, Professor of Psychology, Pepperdine University
In Life Before Birth Dr. Arthur Janov illuminates the sources of much that happens during life after birth. Lucidly, the pioneer of primal therapy provides the scientific rationale for treatments that take us through our original, non-verbal memories—to essential depths of experience that the superficial cognitive-behavioral modalities currently in fashion cannot possibly touch, let alone transform.
Gabor Maté MD, author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
An expansive analysis! This book attempts to explain the impact of critical developmental windows in the past, implores us to improve the lives of pregnant women in the present, and has implications for understanding our children, ourselves, and our collective future. I’m not sure whether primal therapy works or not, but it certainly deserves systematic testing in well-designed, assessor-blinded, randomized controlled clinical trials.
K.J.S. Anand, MBBS, D. Phil, FAACP, FCCM, FRCPCH, Professor of Pediatrics, Anesthesiology, Anatomy & Neurobiology, Senior Scholar, Center for Excellence in Faith and Health, Methodist Le Bonheur Healthcare System
A baby's brain grows more while in the womb than at any time in a child's life. Life Before Birth: The Hidden Script That Rules Our Lives is a valuable guide to creating healthier babies and offers insight into healing our early primal wounds. Dr. Janov integrates the most recent scientific research about prenatal development with the psychobiological reality that these early experiences do cast a long shadow over our entire lifespan. With a wealth of experience and a history of successful psychotherapeutic treatment, Dr. Janov is well positioned to speak with clarity and precision on a topic that remains critically important.
Paula Thomson, PsyD, Associate Professor, California State University, Northridge & Professor Emeritus, York University
"I am enthralled.
Dr. Janov has crafted a compelling and prophetic opus that could rightly dictate
PhD thesis topics for decades to come. Devoid of any "New Age" pseudoscience,
this work never strays from scientific orthodoxy and yet is perfectly accessible and
downright fascinating to any lay person interested in the mysteries of the human psyche."
Dr. Bernard Park, MD, MPH
His new book “Life Before Birth: The Hidden Script that Rules Our Lives” shows that primal therapy, the lower-brain therapeutic method popularized in the 1970’s international bestseller “Primal Scream” and his early work with John Lennon, may help alleviate depression and anxiety disorders, normalize blood pressure and serotonin levels, and improve the functioning of the immune system.
One of the book’s most intriguing theories is that fetal imprinting, an evolutionary strategy to prepare children to cope with life, establishes a permanent set-point in a child's physiology. Baby's born to mothers highly anxious during pregnancy, whether from war, natural disasters, failed marriages, or other stressful life conditions, may thus be prone to mental illness and brain dysfunction later in life. Early traumatic events such as low oxygen at birth, painkillers and antidepressants administered to the mother during pregnancy, poor maternal nutrition, and a lack of parental affection in the first years of life may compound the effect.
In making the case for a brand-new, unified field theory of psychotherapy, Dr. Janov weaves together the evolutionary theories of Jean Baptiste Larmarck, the fetal development studies of Vivette Glover and K.J.S. Anand, and fascinating new research by the psychiatrist Elissa Epel suggesting that telomeres—a region of repetitive DNA critical in predicting life expectancy—may be significantly altered during pregnancy.
After explaining how hormonal and neurologic processes in the womb provide a blueprint for later mental illness and disease, Dr. Janov charts a revolutionary new course for psychotherapy. He provides a sharp critique of cognitive behavioral therapy, psychoanalysis, and other popular “talk therapy” models for treating addiction and mental illness, which he argues do not reach the limbic system and brainstem, where the effects of early trauma are registered in the nervous system.
“Life Before Birth: The Hidden Script that Rules Our Lives” is scheduled to be published by NTI Upstream in October 2011, and has tremendous implications for the future of modern psychology, pediatrics, pregnancy, and women’s health.