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.
Monday, July 30, 2012
There is more and more evidence that brain tissue at the extreme anterior (front) part of the prefrontal cortex is responsible for integration of emotional states. Work of a Yale team, Patricia Goldman-Rakic and Pasco Rakic, focused on the corpus callosum (the bridge between right and left brains), in which they developed a model of symmetry in the brain. Cells in the corpus callosum are marked so as to attach to mirror image cells on both sides of the brain. There may be either a certain resonating frequency that helps each side recognize each other or there may be a chemical affinity that allows cells on one side to join up—connect—with cells on the other side. Connected memory may exist when lower level imprints resonate with the same frequencies higher up in the brain. When the prefontal cortex and sub-cortex meet, there seems to be a pattern of recognition; it’s kind of like finding a soul mate. More possibly, the lower level imprints rise to seek out their other half higher in the nervous system. Once joined, they form an integrated, unified circuit.
In an excellent book by David Darling called Equations of Eternity (Hyperion Press, 1993), the author discusses how nerve cells and more specifically axons behave. “Different groups of axons must be able to recognize different signposts, or else most axons in the nervous system would grow in the same place. Evolution has sited many different receptor molecules on the surface of nerve cell, each of which will stick to only one specific molecule.” The result is that nerve cells have a guide that directs them toward connection with other cells. All that is required for connection is that other nerve cells have matching receptor molecules. The cells are able to ignore all other non-matching nerve cells.
Darling goes on to point out that these cells go on to establish a “skeletal nervous system upon which all subsequent fibers can build.” This is one way that each new level of consciousness elaborates on previous levels. Thus axons grow from the lower level brain tissue to its proper target. Darling states that these cells “know” when they have arrived at connection because the receptors on axons are found only on the correct target nerve cell. He continues: “By unfolding stages, the brain organizes and interconnects itself.” Even in the womb, he believes, the brain is preparing itself for when it comes into daylight. I will quote further because what he states in a neuro-philosophic way dovetails precisely with our clinical observations: “Already, the individual has recapitulated, while in the womb, the physical evolution of all life on earth. Now it is racing through the stages by which life evolved mentally.” The stages are “from mindlessness to shadowy awareness to consciousness of the world, to consciousness of self.” Each new level is an elaboration of the previous lower level until we arrive at full consciousness. Critical here is the concept of connection; the merging together of related neural networks.
Without lower level connection to higher levels, we are only considering the late developing cortical brain and not the brain as a whole. He points out that in our personal evolution, the brain is racing through the stages of all of human history. In Primal Therapy we race through the stages in reverse. Only it is not a race; it is more like a crawl. No one can make a connection (insight) for us; it must come out of a feeling, and it must do so in slow orderly fashion. When the patient has the connection, we know it is time. When the insight is forced by a therapist, it usually is not the time—organically; it defies evolution—ideas come after feelings, not before. What Darling points out is that truth is an “unbroken reality”. Neurosis manages to fragment that reality (disconnection). Feeling therapy reestablishes that total reality. There is a unity of nature that happens only with connection. Neuro-psychologic laws do exist. It is up to us to find them.
Let us sum up some of the key points up to now. Early events even before birth are imprinted throughout the system and largely onto the right brain. These events can occur before there is a functioning left pre-frontal cortex to make sense out of them. And by the time we do have that portion of the cerebral cortex the pain on the right, severe because it involves matters of life and death at birth and before, is repressed and results in a disconnection between the two sides, and from lower to higher brain centers. Moreover, the connecting links are not as yet matured. This process is called repression or gating or, as it is often called in the scientific literature, dissociation. The right brain, then, becomes the repository of the unconscious. Becoming conscious means reconnecting the pain to conscious-awareness. Connection means awareness even when the event has no words or scenes. We can be aware of a lack of oxygen during birth or of the agony of being twisted around due to breech presentation. That awareness is every bit as crucial as an awareness of events at the age of six even though there are no words to explain it. Sensing the pain is awareness. It doesn’t need words.
Connection cannot be achieved when the connecting cable (corpus callosum) has been impaired or thinned out due to early trauma. Once the event has been dissociated, the right lower brain areas have a “mind of their own”. That is, the energy of the pain innervates the heart and key organs and begins the ever-so-subtle damage so that years later there is a serious illness and no one seem to know where it comes from. Suddenly the person develops high blood pressure or heart palpitations, or worse, a stroke. Because the origin is so remote, one could never dream that it was due to a birth trauma. The treating doctor says, “Have you been under stress lately?” “Not that I know of.”
I use the term “crucible” when referring to the womb because it encompasses various elements, molecules, and organ systems. It is broadly systemic. It forms and directs later development. The prototype sets the tone or the stage for what comes later. A twin I saw was left in the womb after his twin sister was pulled out. They had no idea he was in there (this was decades ago). He waited a long time and death threatened. Later his parents never offered any love or touch. He felt he waited for that as well, something that never came. The urgency of that wait was based on the life-and-death struggle in the womb (the crucible). That gave the trauma its force later on. He was sent away to boarding school at age six and waited years to come home to family. The family rarely, if ever, visited the school. As an adult any waiting was excruciating. One night he was going to make love to his girlfriend, but first she had to go to the bathroom. The inordinate wait put him back into old feelings (he was waiting for love—literally), and he lost his erection and could not get it back. The wait triggered off waiting for his parents to come and take him home from school, and then set off the prototype of waiting to be born.
The original reaction during the prototype was that he could do nothing to help himself (weak and helpless=impotent). There was an imprinted lower stratum of helplessness and hopelessness from that time on. When the early pain was provoked, the precise early reaction was also set in motion. It is not simply that the pain of the trauma is stimulated all the way down the chain of pain, but also the whole panoply of reactions with it. They are an integrated whole.
Friday, July 20, 2012
Once feelings are blocked from conscious-awareness, any belief system can fill the bill. No matter how outlandish the belief, it will be adopted if it serves to symbolically fulfill old needs. The trajectory of the belief system begins deep in the brainstem and in ancient parts of the limbic system where devastating imprints are stored. The pressure/energy moves upward to cortical centers and forward to the orbitofrontal cortex (“OBFC”).
The right OBFC is doing its best to contain the pressure, but some of it escapes and travels to its ultimate destiny—the left prefrontal area. But because the need/feeling is partially blocked, the actual context of the pain cannot be connected. The result is a vague pressure from the feelings on the left side. It then concocts ideas about those needs/pains—God will watch over and protect me. These ideas are the wrappings for the pain that provide symbolic fulfillment. That is why the exact nature of the need/pain is not known. But if we strip away the covering, the pain mounts to the surface immediately. The symbolism slips in before the pain can become conscious. Its function is defense, and that is why it can be “far out”. It is dealing with a mysterious internal reality without even knowing what that internal reality is. The deeper and more powerful the pain/need, the more abstract and abstruse the ideation and belief. The ideas may be crazy, but the feelings are not. If the ideas are challenged, the person will continue to defend them with one rationale after another—all to keep reality at bay.
A study by a team of researchers from a number of universities, including Princeton and Harvard, found that faith in a placebo changed the brain’s neural activity, specifically altering the activity of those circuits that process pain and diminish its intensity (Wager, et al., 2004). Another team found that just thinking you are receiving treatment is enough to make you feel better (Zubieta et al., 2005). When subjects were given pills that were neutral but told they were painkillers, there were changes in the brain exactly as though they had received real painkillers, and a significant increase in the secretion of endorphins—the morphine-like pain-killing chemical in our brains. That is why patients in conventional insight therapy feel better and imagine they have made improvement. The fact is they do feel better. The effect is neurobiological. And that is why almost any therapy is addicting. It is identical to going to a doctor for a shot of morphine (endorphin is an analogue of morphine). The wonderful thing about this is that the injection is painless and done without benefit of a needle. A kind, attentive look by a therapist and there are squirts of morphine secreted in the brain. Implicit is that the doctor is going to make you feel better, and of course you do. We think the therapy did it but, in fact, the thought of what the therapy can do is what accomplished it. In contrast, what we offer in our therapy is pain, not as end in itself, but as a necessity for getting well.
Placebos work on the same areas of the brain that process pain. Many of the same areas of the brain that respond to pain also respond to mere expectations of pain, and expectations of less pain (how the therapy is going to help you) yield as much relief as less pain—the effect is neurobiological and real (Meissner, et al., 2011). In other words, how we respond to pain depends in great part on what we believe about it. So in a cognitive therapy that alters how one perceives pain there is bound to be a lessened response to it. Thus one can quell the pain of childhood by adopting a different perspective.
Placebo reactions are a good example of denial. Through someone else’s ideas, we can be so removed from ourselves that we completely deny an agonizing experience. That is not only the case with cognitive therapy; it mirrors how some of us grew up, in a kind of cognitive milieu. We were denying pain and getting on with life. Denying agony is not the same as being out of it. There is believing…believing in healing…and then there is real healing.
What we see again and again is how beliefs can diminish the experience of pain. When someone gives up drugs or alcohol and adopts new beliefs, his brain accommodates just as if he were still on drugs.
According to a 1990 Gallup survey of 1,200 American adults, one in four believed in ghosts. One in six had communicated with someone deceased, and one in four said they could communicate telepathically (through their mind). One in ten claimed to have seen a ghost or been in the presence of one. One in seven said they had seen a UFO. One in four believed in astrology, and fifty percent believed in extrasensory perception. In a 2005 Harris poll only twenty two percent of Americans believed that we evolved from earlier species. Fifty four percent thought that we did not evolve from earlier species. Forty eight percent believed that Darwin’s theory of evolution was not correct. Two thirds of the population polled believed that human beings were created by God.
The number and kind of belief systems is limitless. So long as beliefs are not anchored in oneself and in one's feelings, they can take off and encompass all sorts of delusional notions. The prefrontal cortex when separated from other aspects of memory (the disconnection) can soar into the delusional stratosphere without boundary. This applies to the most intelligent of us, including scientists who, disciplined in their own fields, once disconnected from their feelings, can believe in the most irrational of philosophies and psychotherapies, approaches that have not one ounce of proof about them. Once unhinged from feelings, anything is possible, and intelligence has nothing to do with it. Normally, the left brain harbors the critical faculties that can evaluate beliefs and test their reality. But now it is overwhelmed in dealing with right brain forces and cannot put its critical faculties to work.
Dr. Martin Teicher, a brain specialist at Harvard University, confirms a strong connection between trauma and brain impairment: “Severe early stress and maltreatment produces a cascade of events (that) alter brain development” (Teicher, et al., 2002), one result of which is “attenuated development of the left neocortex, hippocampus and amygdala” and their interconnections. A major consequence of the deprivation of love early in life is weakened communication between lower centers of the brain and higher control areas, and thus a disconnection between deep feelings on the one hand, and one’s “conscious” reality of thoughts and beliefs and behavior on the other, which may be shaped by the former without the person ever knowing what “drives” her.
It is easy to become entangled in a mesh of thoughts that bind us, the more labyrinthine the better—hence the attraction of insight therapy. One is now a captive of those beliefs, and he enters into his slavery willingly, because this slavery is also an important defense. If fascism were ever to come to America, it would no doubt come by popular vote, not by autocratic edict. We would slip into unquestioning obedience to the leader gladly for it would relieve us of having to think for ourselves. He would protect us from the evil “out there”. I am reminded of those who dive for sharks in steel cages. They have no freedom of movement but it is a fact that the sharks cannot get to them. Their steel cage is their defense and their prison. Chemical prisons are just as strong as those steel ones. They allow for few alternatives in behavior. Beliefs are the psychic equivalent of repression. We can rechannel the flow but we will not change the volcanic activity. We can cap the explosion with ideas, but there is always a danger of another eruption; sometimes it is in the form of a seizure, other times it is found in being seized by a sudden realization—finding God and being born again.
One patient during a session began to get into an incest sequence. Halfway through horrific pain, he sat up and screamed, “I am saved!” He saw the hand of God reaching down to protect him. From what? Himself. His experience and feelings. He was saved by the idea of God, unless we really believe that someone up there was listening and really did reach down. The idea intruded itself into his awareness in order to stop the agony. He became aware to avoid full consciousness. The idea took the place of the pain. He could go no further into his archives of suffering. He came out of the feeling with a jolt. He came out of his past and into his present; that present defended him against his history. There was a sudden, abrupt shift from his right brain to his left, from internal focus to the external. And the pain did it all by itself; no willpower was involved. Instead of saying, “There is an automatic governor in my system that won’t let me feel too much pain,” he believed that there was divine intervention that stopped him from suffering. God became interchangeable with serotonin.
Meissner, K., Bingel, U., Colloca, L., Wager, T.D., Watson, A. and Flaten, M.A. (2011) The Placebo Effect: Advances from Different Methodological Approaches. Journal of Neuroscience 31(45):16117-16124
Teicher, M.H., Andersen, S.L., Polcari, A., Anderson, C.M., Navalta, C.P. (2002) Developmental neurobiology of childhood stress and trauma. Psychiatr Clin North Am. 25(2):397-426, vii-viii.
Wager, T.D., Rilling, J.K., Smith, E.E., Sokolik, A., Casey, K.L., Davidson, R.J., Kosslyn, S.M., Rose, R.M. and Cohen, J.D. (2004) Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain. Science 303(5661):1162-1167
Zubieta, J., Bueller, J.A., Jackson, L.R., Scott, D.J., Xu, Y., Koeppe, R.A., Nichols, T.E. and Stohler, C.S. (2005) Placebo Effects Mediated by Endogenous Opioid Activity on Opioid Receptors. Journal of Neuroscience, 25(34):7754 –7762
Monday, July 16, 2012
Connection has neurologic roots. The Swedish neuroscientist, David Ingvar, using a CAT scan of the brain, found that a perception of pain involved both sides of the prefrontal area working in tandem. When emotional pain is repressed, I would assume the right side is more involved. As I’ve pointed out elsewhere, the right amygdala tends to swell when there is feeling (Primal Healing, 2006). Thus, disconnected pain is more active on the right side than the left.
It is as though there is a secret underground in the brain where messages are passed back and forth, but on the side that should be aware there is no recognition of them. So the right side “tells” the left side, sotto voce, “Look, I can’t take any more criticism. It means I am not loved.” And the left side says, “OK. I’ll defend you against having to feel so bad. Just don’t tell me too much. Anyway, I’ll twist the criticism by the other person, and make them wrong.” And the left side jumps in immediately and automatically as soon as there is a hint of criticism. “Don’t worry, my right-wing friend, I’ll keep those feelings of feeling unloved and criticized under control even though you haven’t told me what they are.” So the left side acts out the feeling; the act-out is unconscious because the right side feeling is not connected. The left is not yet consciously-aware.
We see this clearly in split-brain surgery (the surgical split of the left and right brains) where the surgeon will feed input into the right brain, but because of the lack of inter-hemispheric connection, the left is forced to rationalize a feeling it doesn’t even recognize. The doctor will feed something funny to the right side while the left laughs and concocts a strange explanation for his laughter: “That white coat you are wearing is very funny.” The fact that the left frontal area doesn’t recognize the feeling doesn’t stop it from manufacturing all sorts of rationales. In brief, the right side input is forcing it to create rationales, as it does in both meditation and neurosis where the disconnection is enhanced. Studies show that in practiced meditators there is a thickening of the nerve tissue in the prefrontal cortex (Lazar, et al., 2005). What this means to me is that meditation is essentially enlisting the thinking/intellectual area to help in repression. The subjective feeling may be relaxation but in actuality it is the result of effective repression. In other words, meditation is a defensive operation to keep feelings down. That is why taking a patient’s word is not always the best way to measure progress in psychotherapy.
When someone says, “You are wrong about this,” or, “You made a mistake there,” the left brain quickly says, “Yes, but the reason I did that was....” The feeling is, “If I’m wrong I won’t be loved by my parents. I must defend.” It is defending against the feelings on the right. “If I’m wrong I will feel useless, like a nothing, not deserving of anything. Not worth being loved.” That feeling of being unloved, I must underline, is already there! The trigger in the present lights it up and swirls the feelings again. One rationalizes because one cannot stand one more bit of criticism and the terrible feeling that it sets off. The left accommodates and does the defending without even knowing why.
Neurosis, in many respects, is a split-brain state. The essence of neurosis seems to be to concoct rationales for one’s behavior, which is driven by unrecognized forces. That is why one cannot penetrate elaborate rationales and explanations for other’s behavior. “Why should I give up drink when it always makes me feel warm and cozy?” said an acquaintance. He had no recognition of the constant tension he suffered. So long as feelings are hidden and repressed, the defenses must remain intact. When the insight/cognitive therapist attacks this defense, trying to dissuade the person from her ideas, it is a vain cause; he has neglected the split-brain effect, which tends to be literal.
Rush Limbaugh, the radio commentator, admits to taking strong painkillers over many years. His ideational brain and rather strange philosophies are anchored to feelings he’s not aware of. There’s no more use in talking him out of those feelings than it would be to try and change his whole history. It isn’t just that he has “unreal ideas,” it’s that his disconnected system forces him to both quell his pain on the physical level with drugs and to dampen his pain with a philosophy that may be at odds with his feelings.
In any effective therapy, it is the connection between the deep right limbic to orbitofrontal areas that will resolve so many of our problems, from anxiety, which is pain leaking through a faulty gating system, to depression, which is pain butting up against rigid, unyielding gates. Why? Because many of our later problems derive from experiences in the lower right areas that never make it to higher level connections. Rather, they continually do their damage on lower levels; chronic high blood pressure is one of many examples. Feelings of hopelessness in depression markedly raise a person’s likelihood of suffering a stroke. Bruce Jonas and Michael Mussolino report that depression is equivalent to suffering from high blood pressure, in terms of risk of stroke (Jonas & Mussolino, 2000). I have found that depression is often accompanied by deviations in blood pressure. They form an ensemble.
Preverbal pains are sequestered like an unwanted guest that we keep in the garage where we store undesirable items we’d rather not look at. What does get through is a vague sense of discomfort and malaise—the suffering part. The undesirable is knocking at the gates (almost literally) saying, “Can’t I come in from the cold and join you?” The system, however, keeps the gates high, implying, “Sorry, but I can’t tolerate all you’ve got to say. Let’s wait for a better day.”
That better day is when we are older, when the critical period is long gone, and we are able to tolerate the previously unacceptable. As adults we have a stable environment, are no longer dependent on neurotic parents, perhaps have love in the present, elements that allow us now to face our childhood. Meanwhile, the brain has done its best to block the feeling, providing detours from the right-limbic information highway heading upwards and leftwards. The blockage is not complete, however, because the feeling drives act-outs. “No one wants me,” becomes trying to get everyone to want her—being helpful, kind, unobtrusive, etc. The feeling becomes transmuted into physical behavior. The energy, which needs connection, has gone to our stomach and created colitis, to our cardiac and vascular system with palpitations or migraines, and to our muscles, making us tense. It may make us act meek and diffident as if no one wants us around. It causes an inability for males to become erect. What we try to do in our therapy is to allow feelings to go straight up the feeling highway to the right orbitofrontal cortex and then to make a left turn to reach their destination.
Connection is always the brain’s prime destination. If we only turn left and never go right, we will never make the connection. I believe the system is always trying for connection, but it gets blocked by gating. Because of the constant push to connect, feelings tend to intrude and disrupt our thinking—hence, the inability to concentrate or focus. Once connected, those diversions will no longer be necessary to drain the energy. The energy always spreads to the weakest link. “Weakest” means a vulnerable area or organ either due to heredity or to damage done earlier in life; a blow to the head in infancy may end up as epilepsy. A history of allergies in the family may result in asthma later on.
Lazar, S.W., Kerr, C.E., Wasserman, R.H., Gray, J.R., Greve, D.N., Treadway, M., McGarvey, M., Quinn, B.T., Dusek, J.A., Benson, H., Rauch, S.L., Moore, C.I. and Fischl, B. (2005) Meditation experience is associated with increased cortical thickness. Neuroreport. 16(17):1893–1897
Jonas, B. S. and Mussolino, M. E. (2000) Symptoms of depression as a prospective risk factor for stroke. Psychosomatic Medicine, 62(4):463-471
Thursday, July 12, 2012
I had an interesting day yesterday. It may seem banal but it wasn’t to me, and I thought it enriched my life. So let me explain.
I was going by my hangout restaurant and the waiter was going home. We stopped to talk. And I asked him about his life; did he want to stay a waiter or not? I never said a word to him before except “can you bring some water, please.” It turns out he was a helicopter pilot who couldn’t find work that paid as much as waiting on tables. And we got to talking about how hard it is in life, how one’’s dreams seem to go by the board; he has children to support, and how they need to save for the kid’s university, etc. I found out about his wife and how she is taking it all, and the possible strife in a marriage that lack of money produces. We only talked for half an hour but I learned so much about him, about life, about the economy and what it does to people. Quite simply I learned.
I went home to mee the man who was fix my dishwasher. I watched him work so I could learn a bit and then because he had an accent I asked him where he was from and why he came to American. He was Russian, from the same town as my parents. He was a saxophone player who could not get work in Russia due to the heavy anti‐ semitism; the same as drove my parents out of Russia early in the last century. I learned about prejudice and why it happened to Russia, and I learned that he had to come to a country where he barely knew the language and where he had to leave music to learn how to repair machines. We talked a bit about the history of his country and why so much hate existed still. But in his account of his life I learned more about my history than my parents ever revealed.
It seems made up but that night my wife had a stereo expert come over. We began to talk about how he got into it and his life. He told me with tears how his previous wife hung herself and why. What her family life was like and what her suicide did to him. He said “I never talk about this but, you asked.” I did and what I found is that nearly everyone needs to talk about themselves. But that day was very interesting and seemed to enrich my life. I learned really about the human condition. I discussed all this with my wife at dinner and it led to a deep discussion of depression and suicide and what causes it. And it lasted an hour with her. My life was so much more interesting, all because I inquired. And it brought me closer to complete strangers who finally could talk about feelings. Hardly anyone in their lives, certainly, not their parents ever inquired about their feelings, and how they got along with other kids, and what they meant to him. What they wanted out of life; it is such a simple but profound question, what do you want out of life? That makes people feel important. Instead of, do you need this wrench? I have rarely met anyone who does not want to talk about her life. It is also a way to deepen friendship, instead of staying on the surface; where we then find things so boring.I get answers because I am interested. Many are not; they are waiting to be asked so that can find a warm head and heart to lean on. Most of those who are neurotics are too full of basic unfulfilled needs to be able to focus on someone else. They first need to have someone interested in them. After they have told about themselves, then they can be interested in others.This is what happens in so many families where parents need interest before they can be interested. And yet those who are interested in life are interesting to others. Above all, we like those who are interested in us. Many parents are content to give orders and not inquire deeply into their child. These parents lead the unexamined life; they treat kids pretty much like they were treated with no intervening reflection on what they are doing. They walk around in their past and never realize it. They are living their history over and over.
You would think after seeing this time and again that there is no free will; we seem to be robots going through life dazed and unconscious. There is no richer life for them.
Sunday, July 8, 2012
Regrettably much of modern day psychotherapy reinforces the split, or disconnection, between the deep primal universe and our thinking frontal cortex. The feelings leaking up from the primal universe are treated by most therapists as aberrations requiring suppression by our thinking minds, the cortex. We now know differently. That universe not only exists and is quantifiable (feelings can be measured along with the level of repression) but is also crucial to our health. The body has a voice, and it tells us if the level of cortisol, our stress hormone, is high, and if serotonin, a brain chemical that suppresses other brain activity, is low; the body can override anything the cortex would have us believe. If there is a discrepancy between what we believe and what physiological tests indicate, we should be suspicious.
One patient began therapy saying that he was coming for intellectual reasons because he believed in our philosophy. Little by little we found that he could not sleep, was agitated constantly, and could not relax. He organized his day so that he always had something to do and some place to go. His vital signs were high—a heart rate of a constant 95 and blood pressure of 160 over 100. He wasn’t seeing us for philosophical reasons. He was ashamed to be “neurotic” like everyone else and could not stand being a “nut case.” This man had what I call “leaky gates.” His inhibitory, repressive system was defective. There are many reasons for that, as we shall see later. One important reason is the birth trauma, which diminishes the frontal inhibitory cortex from proper development. He had trouble controlling his impulses, which surged forward during sleep, waking him up, causing him to ruminate and think about any number of trivial things. His gating system was inadequate for proper sleep.
We have done imipramine binding studies (blind) of blood platelets. (with Open University in Milton Keynes, England). Blood platelets have a high degree of biochemical resemblance to nerve cells, including neurotransmitter uptake and binding sites. We reasoned that we could measure through the blood, by surrogate, the serotonin production in the brain. Imipramine has a role as an antidepressant. It blocks the uptake of serotonin so that more of it remains to help repression. That is why it is important that levels normalized after one year of Primal Therapy. Our informal analysis of a number of patients in Europe found that manic patients were low on binding. It is something we expected, as their frontal control mechanisms were faulty. We assumed that early trauma compromised the development of prefrontal brain tissue.
Within our brain system resides the left frontal cortex, which has a tremendous capacity for self-deception. Once we understand its role in evolution, we should be wary of relying on it for accuracy and truth about internal experience. We can rely on the left frontal cortex for external perception because that is its role, but not for internal understanding. If we want to know about our primal universe of feeling, we must appeal to the right brain and right prefrontal cortex. We can trust the right side; it is the repository of our truth. Unfortunately, it forces the left side to lie and deceive; above all, to lie and deceive the self.
Brain research has shown that if we receive a lack of love early in life, there are fewer key cells to help us think, concentrate, focus, and connect our thoughts with our feelings (see for example Teicher, et al., 2002). Once we understand that hidden feelings drive much of our behavior, we will then understand how important it is to connect our thoughts with our feelings. Without connection, we cannot control the behavior or the physical symptoms that grow from such feelings.
Through conventional psychotherapy, we manage through various insights and drugs to achieve temporarily what should have occurred had we had loving parents very early on. Both drugs and therapy allow us to achieve at least a temporary state of ease through enhancing the effectiveness of the defense system. I submit that cognitive/insight therapy is in effect a tranquilizer and increases left hemisphere repression to the detriment of feeling.
Drugs kill the pain from not being loved early in our lives, making us believe for a time that we were loved, or at least, allow us to think we are doing just fine. Because early love optimizes the amount of repressive chemicals we secrete, when there is an absence of love we have a loss of those chemicals and are rarely comfortable in our skin thereafter. When someone has a traumatic birth, the entire biochemical system is altered, and the body may, for example, produce less alerting, vigilant chemicals, rendering an individual sluggish, passive, and non-aggressive. Such early life experiences are imprinted neurochemically into the brain and influence our lives in adulthood.
The notion of the imprint is key to our work and to an understanding of neurosis. Once an experience is imprinted neurochemically, our neural connections are permanently affected, meaning that it remains within our brain’s system for a lifetime. However, it appears that it is possible to change the imprint through reliving the experience in Primal Therapy. The distress caused by the imprint may be diminished with drugs or alleviated to a degree with conventional psychotherapy, but the imprint is indelible, and ultimately wins out.
The imprint is laid down in every cell of our bodies. It distorts organ function and re-regulates key set-points of hormone and neurochemicals such as serotonin. For it to be changed or eradicated, we need to go back to the moments when it was set down, relive the experience, and normalize the system. There is no act of will, no trying, that will normalize; only reliving the time of deviation will do it, and it will happen all on its own. That is why a depressive can come into a session with a 96-degree body temperature, relive a deep early hopelessness, and leave with a more normal reading. Why? Because the imprinted sensation/feeling no longer holds the deviation in place. That is, deviated readings are a product of the imprint. The body must react to deleterious early events; it doesn’t develop low body temperature capriciously. It is part of an ensemble of reactions throughout the system that keep depression intact. It is all part of the memory. We can fix this reaction (blood pressure, heart rate) or that with vitamins or New Age techniques, but to change the whole cascade of reactions we must address the time of the primal event.
When we address whole man or woman, we get a different set of reactions from when we address a symptom here or there. We don’t want to make the symptom well, we want to make the person well, and the symptom will often take care of itself. That is why in our hypertensives (high blood pressure patients), there is a significant permanent drop in their readings after one year of therapy. We don’t work on symptoms directly, we often know little about the minutiae of a symptom. We know about the human condition that gives rise to symptoms. Specialists often know more and more about less and less, more about one specific reaction (which is very valuable) but that often will not explain its origin and how to get rid of it. Instead they have learned through medication how to control and manage it.
One depressed patient came into sessions chronically fatigued and lacking energy. She relived a birth where the mother was heavily anesthetized; she could not get out no matter how hard she tried. She finally was brought out with forceps. But the fatigue was imprinted as was the lack of energy. She had been diagnosed with chronic fatigue syndrome and treated with various drugs. But the fatigue was a memory--that could only be treated with memory; going back to where it all started and feeling the fatigue in context. Then her vital signs came back to normal as did the energy levels. It didn’t happen after one session, but after many.
Just as conventional psychotherapy ignores the organic disposition of the brain, there is a converse problem in some circles of medicine where health problems are reduced purely to brain function, disallowing any psychological factors. Thus, in the current zeitgeist, an eating disorder such as bulimia exists because of low serotonin levels, a hormone produced by the brain, with many concluding that it is a function of genetics.
The belief that only physical factors matter is demonstrated in an arena of medicine known as biofeedback, which maintains that we can change a mental health problem such as anxiety by temporarily redirecting brainwaves, i.e., by having a patient imagine relaxation and then directing her brainwaves to the alpha range, which some therapists equate with a calm state. But is this sufficient criteria toward determining whether a treatment has been successful or not?
In biofeedback a notion of normality is applied to the patient rather than allowing the system to normalize through a natural evolutionary process of therapy. It is the therapist’s idea of normality. It is taking a piece or fragment of our psyche and treating it as if that were the be-all and end-all of the matter. Imagine that you are hooked up to an EEG machine and that you try through visualization, such as that in biofeedback, to change your brain waves to so-called normal. It is pure mysticism to seriously think that this will overturn the effects of a lifetime with an alcoholic mother and a violent father. Such a therapeutic process is dependent on imagining a normal state, which means thinking your way to health. What one achieves is an illusory state; in short, something that isn’t real or lasting.
To treat a patient successfully it is imperative that we take into account their psychological history, a history that might contain incest, abandonment, and neglect. Most importantly, we must consider an individual’s early physical and psychological development, and examine that critical period from gestation through the first three years of life, which science is just now beginning to recognize has so much to do with problems later in life. It is necessary to look at the person as a whole and consider the patient’s early history, taking into account physiological as well as psychological factors.
I call the gap between feelings-sensations and their psychological counterpart the Janovian Gap. I believe this gap is important in determining how long we live and how early in life we may fall ill with any number of diseases, both physical and psychological.
The only progress in psychotherapy is to become whole again, to retrieve a self that was lost long ago and to recapture feelings that we disconnected from at the start of our lives. Only a therapy based on the experiential, on the development of the individual’s brain, on evolution, can succeed. The patient’s whole system must be considered in such therapies so that the whole system can get well, not just a part of it.
Symptoms are the expression of an imprinted memory—memories of experiences we had in our earliest moments that have been laid down neurochemically within our brain and nervous system. That is what lies in the primal universe—monumental emotions of imprinted memories that have been sequestered in the far reaches of the brain. For a patient to get well, it is necessary to access those memories in a safe way, bring them to conscious-awareness and finally to integrate them. When that happens the individual’s entire system is harmonized, key hormones are normalized, and the system is finally righted. After a connection is made between feeling-sensations and the thinking mind, perceptions are more accurate and a sense of calm and relaxation never before known is finally experienced.
Teicher, M.H., Andersen, S.L., Polcari, A., Anderson, C.M., Navalta, C.P. (2002) Developmental neurobiology of childhood stress and trauma. Psychiatr Clin North Am. 25(2):397-426, vii-viii.
Tuesday, July 3, 2012
As for science, professionals think that science is advanced now with the new machinery we use. We can measure all the way down to a single nerve cell in the brain. What that does is inform us more and more about less and less. We learn the mechanisms in the brain and body but nowhere do we learn how to treat patients. We learn the accompaniment of neurons and neurochemistry to the problem but never the problems itself. And why not? Because that essentially attacks the personality and defenses of the doctor. “I am comfortable doing repression therapy because repression is how I function.” So in EMDR the doctor waves a wand and pushes away the feeling. It is literally magical therapy; and out of 40,000 practitioners in the world no one questions the premise. It is pure booga booga. The analysts are more subtle, they don’t use a wand; they reason feelings away; you feel this because of that, and if you stop thinking this you won’t suffer from that—blah blah. So change your thoughts and you will be better; it is still cognitive/behavior therapy, no matter how it is cloaked—thinking your way to health. And if the patient does by chance fall onto feelings in a session of therapy, the doctor quickly reasons them away. They need to be allowed to sink deeply into the feeling and let it overcome them. This means for the patient and above all, the doctor, losing control a bit and retreating to an unknown past; not as an adult thinking about the past, but as someone totally immersed in it. The past dominates our lives, how could we not become immersed in it in psychotherapy since we already are? We just move one step deeper and discover what we are already immersed in.
We are not inventing; we are discovering. The doctor doesn’t need to explain; our bodies (and the right-side deeper brain) will do it all. Our deep brain will rise to play the music and the prefrontal cortex will provide the lyrics. It is all there. We need someone to conduct the orchestra of feelings. The conductor, as it turns out is our imprints, our engraved traumas, that raise or drop our blood pressure and heart rate. Feelings provide the frame of reference, our raison d’etre. They conduct the symphony of the body. They move up like a volcano that gushes its energy upward and dictates our reactions. The system manages to let just enough through so it can be connected and integrated. That is why we do not need managers in the therapy. Evolution will do it all and channel feelings where they need to go. It is also why we do not need high level doctors to accomplish all this. Yet it helps to know science but only if that science is relevant to the human condition. We do not need to apply behaviorism to neurons, slowing them down or speeding them up until we know why they behave the way they do. So you see that Behaviorism rears is ugly head everywhere. And here we try to treat the neurons instead of the person, making the symptom “better” instead of the person. And with sharp enough techniques we can indeed make those neurons behave, leaving the person in his agony.So neurons behave as we want them to, while there is a raging cauldron of pain down deep inside. It is one more way we extract the person from his feelings. Look at biofeedback. We have an idea of what normal brainwaves look like, and if the patient doesn't have them we will perform voodoo until he does. Never once asking why are those waves so irregular? Ah, for that we need to go very deep.
Now imagine that a stranger (therapist) comes along and explains your unconscious feelings. He has to be wrong because he explains out of his own unconscious not that of the patient. No analysis is necessary; those emerging feelings carry with them all the understanding we need: how this feeling caused that behavior or that symptom. Having a birth Primal will explain why there are migraine headaches. One can feel in a primal session the brain being squeezed of all its energy and oxygen as the anesthetic given to the mother sweeps in to gobble all of the oxygen the baby needs. So there is constriction of blood vessels (to conserve oxygen) followed by vasodilation (to counteract the constriction and stop a stroke) and the forerunner of the migraine. Very few words are necessary. After all, the migraine is not there because of someone’s words; there was an ineffable experience at the base, one that no doubt had no words since it was usually at birth that it started. Yes, now hurtful words can trigger off the template or prototype because of resonance. The hurt descends down the chain of pain to the generating source, all by itself without anyone directing the operation. And it will come up without anyone directing it.
Think of this: we had a patient who felt toxic all of the time. She had “toxic friends” and decided to move to another State which was less toxic. We could offer all sorts of explanations but the system did it itself when she relived a gestation event where the mother was drinking heavily and intoxicating the baby. She felt toxic and projected it everywhere because she never knew where it came from, or even that memories go back that far. I could easily offer hundreds of examples like this (and I have in my book, Imprints).
Above all I don’t have to be smart anymore. I allow the patient to be smart by respecting her and her feelings. I don’t decide from above with all my majesty to change her behavior according to my criteria or values of "healthy or normal". She is not some underling or bad child who comes to me to be corrected or changed. She is my equal whose feelings need respect, who needs to be understood so she can help herself. The end of professionals who see patients weekly for years. _We must avoid giving the patient what she wants; too often warmth, concern and "love." That is what is addicting in psychotherapy. And they go back for years. We give patients what they really need, which is their pain from feeling unloved; a major difference. Then there is no addiction. Meeting their current need indulges patients and gives them what they want but don't need. They have already spent their lives behaving to get something the never existed. We offer independence and self-determination so that they can plan their own lives and don't need outside advice about how to live. We offer liberation from a terrible past so that they can make their own future. That is what is liberating. When a patient goes to a therapist for years she is addicted and that itself needs to be treated. That is, the patient and the doctor need help. They have a mutually operating addiction.
We cannot "love" the patient but we can help her feel unloved from early on so that she is now open to feeling and love at last.
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.