As time goes on and I learn more about the human condition, I have decided to share some of my thoughts on what we are all about. I will publish my reflections on this blog, hopefully to enlarge our understanding of what makes us human. Art Janov
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Monday, November 26, 2012
There are several ways to know about how long we will live. First, if you drink and smoke a lot it won’t be very long. If you do a genetic test you will get an idea, but also a very good way is to measure your telomeres. These are the ends of the chromosomes which, if you expect to lead a long life the telomeres need to be long. The shorter they are the shorter the life, in general. And the real question is what is their function and why do they get shorter and therefore shorten our lives.
Lifelong stress will shorten your telomeres, which shorten under stress or adversity. Telomeres form the ends of the chromosome that shorten under chronic financial problems, long-term care of a loved one, emotional neglect and being unloved, including getting divorced, or suffering chronic anxiety. It is one way that anxiety kills. It is that chronic stress indicates a system-wide problem that is expressed in telomere length. The key ingredient for this is long-term stress resulting from more rapid DNA replication. And the key ingredient, then, is imprinted stress that causes rapid DNA turnover; generally the earlier it begins the more deleterious it is because unavoidable stress is deadly. Living in the womb is about as helpless as we get.
Of course what stress does is ramp up levels of cortisol, the stress hormone that work in see-saw fashion with telomere length. The higher the cortisol the shorter telomeres will be, in the long run. When we couple higher cortisol, shorter telomeres together with higher body temperature and elevated blood pressure we have an index of a shorter life. Fortunately, there is something we can do about it since we do lower vitals after one year of our therapy; body temp is on average one degree less and blood pressure in hypertensives are 24 points lower. We have not as yet done telomere studies.
There have been studies on healthy adults who started in life in an institution; they had radically lower telomere lengths. (see Nature. Vol 490. Oct 11, 2012). More important, mothers who underwent severe stress while they were carrying (death of loved one) had offspring with lower than average telomeres. I have not seen studies on telomere length in those with adverse gestational lives but we plan to do it. Particularly, we want to study imprinted stress that continues in our system long after the very early trauma. We must never neglect the imprint; it is the way we engrave experience in the total system. A person can claim that he had a wonderful childhood but if his telomere length is shorter than average we need to examine him more carefully. When we have shorter telomeres we can expect that the person will be more vulnerable to such diseases as diabetes and heart problems. The shorter length individuals are much more likely to develop cancer, by the way. And dementia is another great likelihood. Can you die from neurosis? (chronic imprinted stress). Absolutely. Can you suffer from premature serious illness? Yes, Yes. Can we avoid it? Yes, yes. Take out the pain. It’s the pain, my friends. Take it out and there will be far less smoking, drinking and drug taking, and therefore, longer telomeres. It is the telomere that are shouting out the pain in their own way, We need to listen. And we need to talk back to them in their own language—physiology. And we need to say, hang on, friend, we will take your pain away, even if you do not know it is there.
Tuesday, November 20, 2012
As I have pointed out, the brain develops into three different systems. I call them the first, second and third lines. The first is brain stem and parts of the archaic limbic system, the second is basically limbic system, including the amygdala, hippocampus and other structures such as the anterior caudate nucleus. Each of these structures (including the striatum) contribute to our general feeling capacity. They are connected to the top level prefrontal cortex to help us be aware of our feelings; this is the area of insights. And they are evolved out of the brainstem that provides the energy and gravity of feelings. The first line is silent and wordless. It grunts, exhibits rage, terror and great physical reactions that are never expressed in words; that is why we need higher levels to provide those words when necessary. But less us not believe that the cognitive level by itself can make any changes--insights. It misses out on the serious sensations that exist on the deepest brain levels.
So we have a basic primitive ineffable level, a higher emotional one and finally, a verbal one. All together they form a fully feeling experience. When we relive events from our childhood there is generally all levels involved.
There is the memory by the third line, then we add the emotion to it in therapy and then allow the punch of the feeling to join in. When we relive events before birth, during gestation, it is a first line experience where there are no words or even tears. When we read a speech too often we lack the emotional level; it remains dry, cognitive and intellectual.
When are born we have most of the brain neurons we will ever need, except for some limbic brain cells that go on developing throughout our lives. Early on the brain is developing networks and circuits where different brain structures are connected to each other. But lack of love and trauma during early childhood seriously affects how the brain develops and what networks there are. The feeling system will recruit aspects of the limbic system into a feeling network. Except when there is little emotion in the environment, when the parents are two stones who do not react much. It affects the brain development of the child. The emotions become stunted. The cognitive level may go on developing but it leaves the emotional level behind. We get brainy people who don’t feel much.
We know from much research that neglect in the first months of life on earth adversely affects brain development; there are later learning problems and relating difficulties. But picture the traumas before birth during gestation; imagine the kind of long lasting damage there will be. This is the kind of damage that affects physical systems, the precursor to heart problems later in life and cancer. Why so? Because the newly forming heart cells (and other cells) are being affected by a mother who is anxious and/or depressed, weakening the baby’s circulatory system. First line damage equals first line reactions. This damage may not be apparent for decades but the beginning vulnerability is already there. It has changed the way that neurons develop and differentiate. There is now a sort of detour going on. And more, there is suppression of those traumas automatically so that each trauma evokes its own repression, and here we may have the beginnings of later cancer. This means that first line repression is heavy and deleterious.
Speaking of cancer, I am hoping to carry out some research to follow up on something we did decades ago. We did a double blind study of Natural Killer (NK) cells which are part of the immune system charged with watching out for newly developing cancer cells in order to kill them. After one year of our therapy there is a significant increase in NK cells. What I want to do with a research team is pierce the tumor take out key cells, multiply them a lot and then re-infuse those extracted cells back into the person’s system slowly over time. If I am not mistaken those infused cells will kill only the tumor cells and nothing else. This will be a lot more efficient than chemo therapy and will only destroy cancer cells, leaving the healthy ones alone. And because NK cells are genetically designed to go wherever there are the bad cells it will be less dangerous and far more effective. All we need right now is the money to do it.
When I discuss the idea of detour it may be exactly what happens in the brain, for there is a migration of neurons from the brain stem up. And when there is trauma those neurons may well take a different route in their development (see the work of Bruce Perry in Texas). This migration is foremost in the earliest months in the womb so that a mother’s smoking or pill-popping alters the migration and brain evolution. One way this happens is that we are born with a certain gene pool but how these genes evolved is due to epigenetics, events impacting genetic development. This determines how the nerve cells evolve, how dense the dendrites are and how they connect with other nerve cells. Dendrites accept the messages from other nerve cells. When they are sparse or less dense we don’t get the full message. A carrying mother’s smoking can alter the baby’s oxygen supply for life. That means breathing problems later on.
So we have an ordered evolution of brain cells from the stem cell area on upward. And each new system appears on a fixed time-line. These systems occur in order so that we can’t speak at 3 months. Brainstem functions include digestion, breathing and blood circulation. If later on there are symptoms in these areas, we need to look at first line events. Did the mother smoke heavily in the first 4 months of pregnancy? If so, there are likely to be serious developmental problems including evidence of mental illness later on. These primitive neurons are there long before the cortical neurons exist, both in evolutionary times and in personal ones. And during gestation and the first months of life on earth they are the most sensitive to environment impacts.
This is no more than saying that there are critical windows when the system is the most sensitive. Not being touched at age ten is not going to have the impact if there is no touch right after birth. What this means is that the critical period for the first line is far more malleable than later critical periods. And its impact the greatest, which is why we always need to include this period in any of our studies, and especially in our therapy of patients. This first line is the epoch of longest lasting effects and of the greatest impact in terms of our evolution and brain development. This has been emphasized in a study by Cornell University (Nov, 21, 2007. “Trauma Earlier in Life May Affect Response to Stress Years Later”). During womb-life there is a new organizing framework which determines how the person faces life later on. The brain is “settling in.” And it imprints this frame of reference to guide our lives.
What new research is showing is that those young children who are abused, neglected or otherwise unloved have smaller brains than those who grew up loved. This implies all kinds of associated problems from learning to relating. We and our brains need others; we need attention and love and caring. And we need it during the greatest epoch of our critical window—the first line. That is when there are irreversible imprints with widespread effects. Our lives are in danger when we are unloved; when the mother is heavily depressed or drinks. Institutional children do die when there is no love in the first years of life. So instead of children not being allowed to speak at dinner there must be lively conversations all of the time. They need information and stimulation. They need food for the brain. So just imagine what damage happens to children who are unloved as children, and before that when the critical window is wide open during first line before birth. If we can see the damage done to young children in institutions can we imagine what goes on earlier in the womb when we cannot see the damage? The earlier the damage the more irreversible it becomes. Luckily we have a therapy that goes deep and undoes some of the damage. But with no first line therapy there will never be a cure, not if we ignore the crucial critical window where so much impact exists. There has been an attachment theory around for more than fifty years, but consider the attachment between the baby and the carrying mother where her every mood is transmitted directly to the fetus. When she is anxious so is her baby; when she is depressed so is her baby. And as the pain mounts from womb-life on there will be a greater tendency to shut off the right feeling brain and flee to the left where there is no direct pain.
All I am reiterating is that there is information and research to show that the earlier the impact on the brain the more damaging and long lasting the effects. We must never ignore this period if we want to help our patients.
Friday, November 16, 2012
I am not against statistical research. It is essential. But too often research studies are a stand-alone phenomenon; true unto themselves but unrelated to a larger picture and other key phenomena. They are not plugged into a bigger frame of reference. And that is my quarrel with constant statistical studies, especially in Psychology. Let me give you an example. There is a new study that states: serotonin promotes patience. The idea is that animals can wait longer for reward once given serotonin. And, not surprisingly, the animals failed the test after being given something to stop serotonin production. Ok . We have the results, but the “WHY” we don’t have. Their conclusion: these findings suggest that activation of serotonin neurons is required for waiting for delayed reward. OK fine. Our clinical experience shows that the more activated the top level neo-cortex, the less impulses break through to force impulsive behavior. It is one way we know that serotonin is an inhibitory chemical. We know that very early neglect and trauma require the production of more serotonin. We now know that a dog can be more patient with injected serotonin. A frame of reference would inform us that high level cortical functioning can be recruited to shut down feelings and make us feel better and be patient; that general inhibition can lead to patience.
And that serotonin can shut down feelings and impulses. And when we do that we increase the ability to wait. My birth trauma patients are often impulse-ridden.
I don’t want to drown the fish but here is one more example: almost 20% of patients with coronary heart disease suffer from major depression. Another 20% have some symptoms of depression. Again, Why? The problem with statistical studies is that we get statistical truths; and in the usual research we get correlations; this correlates with that, etc. What we don’t get are causes of disease. Correlations never do that, and indeed in our field of Psychiatry and Psychology we are looked at negatively because we offer causes or at least generating sources. Scientists are too often content to do stand-alone research. And too often it is the left brain that is content with statistical studies because it requires little further imagination. We don’t have to engage in pesky thoughts beyond what we see and measure. We don’t have to posit implications. It is one reason we do not get beyond Freud and/or cognitive therapy. Is is why we have rigid, inflexible, dry results. And scientists seem to prefer it that way; equating dryness with science.
These are interesting studies(above) but they lack a frame of reference, which is what I require, “a truth beyond the facts”. A frame of reference is essential in order to make sense of our results. For that we need experience with patients; to see how theory and research studies merge with clinical observations—the proof in the eating. It is the frame of reference that can tie two disparate studies together and provide broader implications. It is indeed a truth beyond the facts; that truth requires a frame of reference. It seems that it is right brain that supplies the frame of reference, the meaning and implications of our studies, while the left brain deals with point by point statistics. We need both in our therapy and our theory. It is why statistical results are rarely enough, yet psychologic science is stuck there and why so little has changed in therapy over the decades.
Take migraine. We have had success in treating it. One research study found that oxygen therapy helped alleviate its suffering. It was stand/alone research. Our own frame of reference after seeing dozens of migraine patients over the years, indicates serious oxygen lack during the birth process, usually due to massive anesthesia given the birthing mother. It causes a serious oxygen decrease in the baby who struggles for air. One result of this oxygen loss is the precursor for migraine—constriction of blood vessels to struggle with the loss of oxygen. And what is one treatment for it? Oxygen. And treating dozens of those migraine people led us to a breadth of data to provide a frame of reference. I didn’t have to concoct a theory; I had to observe closely and note what I saw. I rather doubt that anyone could come up with our hypothesis with statistics alone. At least now after almost one hundred years of headache research I still have not seen possible causes mentioned.
What is lacking? A frame of reference. We really can’t come up with a frame of reference with a one-off study. We need a good deal of information. With each patient we gather more evidence, and we modify our theory accordingly. Our patients are our research subjects. We are now correlating our vital sign results. We will soon know how and when blood pressure and body temperature change with feelings. Our results are found in our patients; they have the answers.
Our clinical work has found depression to be a forerunner for later heart disease because of deep repression involved in both. And from our clinical knowledge of how early repression sets in. When in our work we extirpate pain out of the system we alleviate depression and possibly prevent heart attacks.
It's not that we are depressed and also then we have heart disease; it is that deep suppression of early pain, often begun in our womb-life, activates heart cells and affects later heart function. That is, constant repression is involved in depression and heart disease. Seeing the whole person allows us to develop a frame of reference that statistics usually cannot do. Both heart disease and depression emanate from the person and begins most often during life in the womb. No theory of womb-life-- no understanding of its role in heart disease. So if we treat heart disease by stand-alone methods, leaving the imprints out of the matter, we are possibly ensuring another attack. This is one reason that in therapy with serious disease if we do not address the generating sources, the imprint, there is a constant danger of recidivism. And yet if we add imagination/frame of reference to our results we are often looked at as unscientific because we have gone beyond the facts. This is a dilemma because too often getting ahead of the facts can indeed be dangerous and unscientific. Look at our pal Freud, he posited childhood sexuality out of his own unconscious, nary a fact in sight.
The danger is that a largely left brain scientist (a right brain scientist is too often an oxymoron) cannot objectively supply an untrammeled frame of reference. Our brain research indicated a more equalized brain in patients after one year of our therapy. What this means to me is a more objective one; a brain that will follow facts and produce a relevant meaning, not fabricating theories out of the unconscious.
Thursday, November 8, 2012
What they do is explain to us how psychosis happens. New research informs us about the brain structures involved, but what it does is simply pin down in the brain something we have seen for years clinically; both help to clarify psychedelic effects. It is not that brain research is more scientific; rather, it offers the cerebral corollary for what happens clinically.
The research is by Drs. Carhart-Harris and David Nutt, using MRI’s to pinpoint what goes on after a subject is given a small dose of psilocybin. (See http://www.beckleyfoundation.org or/and http://www.huffingtonpost.com) There was reduction in those areas of the brain that, inter alia, control feelings and their rise into the top level cognitive cortex. It also seems to unhinge parts of the limbic system, including the anterior cingulate cortex. Basically it allows lower level imprints to rise unabated into the thinking area; and from there, because as someone said, it is like trying to drink from a fire hose, there is an inundation and flooding. The brain regions dealing with constricting conscious/awareness give way and we get exactly, not approximately, what happens in psychosis. The difference is that in psychosis there is a slow accretion of imprinted pain that finally damages the gating system and feelings rise and flood the thinking cortex; exactly what happens much quicker with psychedelics. The gates are open in either case; the pain is the same. Nothing changes except the time to takes to damage the gates and allowing flooding.
And what happens when there is flooding? The cortex is exigently pressed into service to cover over the rising feelings with whatever ideas and imagination the person/brain can concoct. They have a bizarre quality to them because they arise not out of specific feelings but from an amalgam of them. The “fire hose” is spritzing everywhere. And the brain is forced to use its latest developing structure, the neo-cortex, to join the fray. I repeat: this is no different from lifelong lack of love and trauma that puts cracks in the defense system (including lowering serotonin supplies), which then ultimately gives way. When it (defense) does not give way but only weakens we get ADD attention deficits where the gates are leaky and cannot properly contain the upsurge. The feelings rise and are scattered but do not produce full-blown psychosis. But they prevent careful and sedulous attention to each task; there are too many tasks, too much input that breaks up focus and concentration. The brain is forced to pay attention to multiple inputs (leaky gates), and cannot do it. In this way we could say that ADD is the forerunner, the harbinger, of a psychosis to come. This only means that the gates are leaky and will not withstand further trauma input. The beginning signs of a collapsing defense system can be delusions; this happens often with lifelong use of marijuana which gnaws away at defenses. All this means according the study cited above is that the areas of the brain that control memory retrieval are faulty and do not function well. What some drugs including psychedelics do is facilitate the retrieval of memory; the problem is with these drugs, there is too much retrieval all at once and the top level cannot integrate it. And when there are leaky gates brought on by drugs you get continued and long lasting sleep problems as rising feelings agitate without cease. The feelings rise to just-below-cortical levels so that the top level is constantly stimulated, and falling into sleep becomes impossible. Sometimes a lone feeling may come up such as feeling unsafe throughout childhood. Occasionally the person can focus on one thing to alleviate the agitation……"if I try the door knob twenty times a day I will feel safe". Often there is no awareness of the role of the obsession; the person simply feels better if she can try the door knobs. The ritual alleviates latent anxiety.
This is the difference between what seems like pure statistical science and clinical science. Clinically, we see the relationship among disparate phenomena; we understand why this happens and that does not. We are not bound exclusively by the "facts". That is, we have a frame of reference in which to place the facts. This frame of reference is truth beyond facts; it gives meaning to the facts and broadens our understand of what it all means. This does not mean that we do not use brain science to further our understanding, but that seeing all this in action explains so much and takes us beyond pure statistics. As I said many times; we are after biologic truths, not simply statistical data. It is data with imagination that we need.
Saturday, November 3, 2012
Sometimes the three levels of consciousness are sitting right before us for all to see. I read an article today on Alzheimers Disease. It seems the victim can still do all of the feeling chores: affection, getting a new boy or girlfriend, cuddle up to a doll, take walks with a new friend, cry, kiss, pet animals, and so on. It means that they can lead a feeling life even when they do not know who they are or where they belong. They can do all this without an effective (and affective) third line prefrontal cortex. They are effectively decorticates. And yet they can love and feel loved.
Now look at the higher level professor, with a super functioning neocortex, someone who wrote a book on the PROOF OF HEAVEN. He is an M.D. and it is recommended reading by a Ph.D. It is about consciousness after death. Here the neocortex is used to keep him unconscious. The blurb for this book is that he is “living proof of an afterlife.” Or, as I might describe it, ” living proof of nonsense.” Unless we believe that we can have experience without a functioning brain.
What it seems to be is last in first out: the last to develop, our prefrontal cortex is the first to go as we grow older. But we can still have a life even when that happens; it is called a feeling life. We cannot do math but we can be overjoyed when someone brings us a teddy bear. We become the child again who does not as yet have a functioning cortex. Or in the case above, they can do math but have lost their child in the process. Choose what you prefer: an unfeeling mental giant, or a feeling child. Who is the more alive? And if you choose the feeling child you won’t have to read books about experiencing the after life.
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.