Saturday, February 9, 2013

Where Do Anxiety and Panic Attacks Come From?


For years I have been discussing limbic fear versus brainstem terror; that is, as we go deeper in the brain the responses become  more exaggerated; mild hopelessness becomes suicidal hopelessness, fear becomes terror, anger becomes rage, and on.  The responses become more primitive as they emanate from a brain that is more primitive; older  and pre-human.  Those deep responses go way back in time to when they were the reigning animal reactions extant.  That brain is still alive inside of us and it provides all of the responses that existed millions of years ago.  In some respects we are still that alligator or shark with no pity or remorse, just instinct.  Those primitive animals are pre-emotion before caring and concern existed;  they do allow us to murder.  They also permit panic attacks.  And where do those attacks come from?  Ah.....They seem to come from a brain where panic is life-saving.  Where rapid and ferocious responses meant survival.    And where someone overwhelmed by his brainstem can  react exactly like the alligator does....and kill. He is acting out of his brainstem.

The panic victim feels threatened but  he doesn't know what he is afraid of.  Or, believe it or not, that he is  even afraid; it sometimes doesn't feel like fear; it is some unknown feeling that seems so alien.  I know what he is afraid  of..... Whatever  lies  in his brainstem.  Oh my, what  might that be?  That is the rub as  my friend old Willie (Shakespeare) noted.  When I was in graduate school I learned about antecedent-consequent reactions.  All it meant was that if there is a response something caused it.  Well in rage and terror something causes it; and it is not ordinary reactions; they are primitive in the full meaning of the term.  So far we have not known what that meant.  Stay with  me  now as it starts  to get interesting.

  What is clear in  my writing is that there are three brains in our head, (The Triune Brain), but we have ignored the first one, that I call "first-line."  In the first line  lies all of those primitive reactions; when there is trauma at birth or during gestation, long before we have an an intact emotional brain, our reactions are coded and  stored down on the first  line, the brainstem and the ancient parts of the limbic system.  When we suffer great trauma during those early times the gating system weakens and we have "leaky gates".  The trauma causes us to use up major supplies of repressive chemicals, such  as serotonin, that impairs the proper functioning of the repressive gates.....our defense system.  Not only does trauma use up serotonin; it damages parts of the brain that produce it, as well as dopamine and epinephrine.  This is especially true of smoking mothers, in my experience.

    We are less defended, so when we arrive at age thirty with  a panic attack it is such a mystery.  No longer, we can now understand its provenance.  It comes out of a remote nervous system, so remote  as to be constantly ignored, yet it is responsible for so much of our aberrant behavior.  Who would dream that inside us  lies all those primitive instincts that  can surge forth when our defenses weaken?  And up comes terror from a carrying mother who smoked and  drank  and who was effectively killing or damaging the baby from diminished oxygen.  That and many other configurations conspire to inculcate terror  in the baby that is imprinted  and sealed in  as a (Primal) memory.  When there is a panic attack or rage attack we must look to that brain for understanding and cure.  It is only with that brain that we can find  causes  and answers. And the cure involves reliving, as I have explained at length in my books and blog articles.  If  you all are interested I will go over it again but I think 2 blog articles ago I discussed in How to  Make a Cure.    Now comes the fascinating part:

Some recent research by Justin Feinstein at the University of Iowa City (Nature Neuroscience 2013), did a study with those who had a damaged  amygdala, the hub of the emotional system.  They did not have normal fear responses.  But if oxygen supplies were lowered and carbon dioxide supplies were increased, mimicking  suffocation (increasing acidity of the blood) there were panic attacks.  Where in the world  did those attacks come from?  Certainly not from the usual emotional structures.  They believe it includes the brainstem!  Because the lowering of oxygen supplies and adding carbon dioxide provoked the lower structures to sense the danger and reacted  appropriately.  Very much like what happens to a fetus when the mother smokes during pregnancy and produces those same effects.  What  all this means is what  I have been writing about for decades; fear and terror  are  two different reactions involving different brain structures emanating from structures million of years  apart in evolution.  However the emotional reactions have some similarities which allows resonance; that is, enough fear can travel  down in the brain  and trigger off those primitive panic/terror responses that I call first-line. It is not ordinary fear; it means a life-endangering cause and that come from our time in the womb and at birth.  In the  experimental patients, it meant and means  terror  of dying; that is what it feels like  to the sufferer because that is exactly what it is.  In the memory he is dying and the fear it evokes has a reason; a reason that is knowable. and therefore explains the reaction....and once known can lead to understanding about first-line and  a  cure.  If all this is ignored there will  never be a  cure,  no matter what the technique  use  to treat it.

    It is interesting that suffocation has such a great terror reaction associated with it.  And not so oddly in the panic attack there is often a feeling of suffocation, cannot catch one's breath, the heart beating so fast that it is about to jump out of the chest.  And these breathing problems are again brainstem originated (included the medulla of the brainstem).  It is all an ensemble of reactions originating deep down that later on set the stage for many kinds of pulmonary problems, asthma, shallow breathing and other malfunctions.  One other part of this reaction is that there may be a certain vulnerability for the suffocation feeling during birth; that is, if a mother smoked during pregnancy there is already a groundwork for the suffocation feeling at birth.  It  becomes  compounded, the anesthesia at birth in the mother and the background of a smoking mother.    We must keep in mind that this is all an imprint from the beginning of life that will affect so many parts of us including constant nightmares........again where one cannot catch one's breath; a nightmare of being in a dark room with no air or someone putting a pillow on our head.  It is fine to treat the nightmare, even to drug or medicate it but we cannot medicate an imprint; that remains to go on causing damage.  So nightmares, panic attacks, breathing problems pulmonary dysfunction are all part of an ensemble, a gestalt, if you will that must be considered as one problem, not many many problems.  Yes, there are many, many symptoms each must be treated until.....until we go to the generating source where it is all  treated at once and permanently.  What we must understand is that the physiology memory comes up intact with the whole panoply of feelings.  There is often too much terror to feel it all at once and integrate it.  That is why it needs to be revisited time and again.  So how does the patient know where it comes from?  Often not at first but after many relivings it becomes comprehensible. Clearly it is so remote an experience that it can be experienced but not immediately understood for what it is.  It is the same when reliving a gestational trauma.  We can experience it long before we understand it, and experiencing it is crucial for integration.  Non-verbal experiences can be relived and experienced on their own terms and in their own way; they can be integrated, nevertheless.  Let me explain further:

There are times when a patient can remember when his dog died, being hit by a car.  What  needed to be experienced and expressed was the repressed emotional aspect of the experience.  The pain needs to be unleashed and finally felt. It is the same with preverbal pains.  They need to be unleashed from their biologic constraints and fully experienced.  They then are integrated and become part of us.  That is the essence of a Primal.  We don’t have to know exactly where  it comes from because the fetus did not.  But he experienced it and repressed the pain.  It needs liberating.  It is what we do.

To reiterate:  because it is now established that lowered oxygen levels in the fetus creates panic in him, it should be clear that a carrying mother who smokes is damaging the baby severely.  Can he really feel terror?  I recommend to you the work of K. Anand.  He did an amniocentesis on fetuses and found as the probe invaded fetal space all of his stress hormones rose; he also grimaced and show signs of distress. He felt pain and terror.

    We have successfully  treated panic attacks (they are anxiety attacks, and they are terror attacks) and rage because we address the first line.  It is not a mystery; it just belongs to an ancient brain system that we have ignored for too long.  If we want to help those in danger of acting out in rage  and to help those who suffer panic we must travel to millions of years of phylogenetic history, deep in the brain  to find our answers.

19 comments:

  1. I would suspect that claustrophobia is also part of this. The panic that goes with that. I used to be claustrophobic until a couple of years ago. I still think I am at a subconcious level. When I was a teenager I was mucking about and I climbed down a narrow cloth bag that was sealed at the end. When I got to the end I went quite crazy with panic. I was more terrifed than I had ever felt. Quite obviously this was a birth trauma repeated. I managed to get out with what seemed to be a superhuman effort. I can really relate to this piece. What is strange is that having read your books and felt real terror and panic and all pervading bodily pain which caused me to be able to hardly walk I no longer get claustrophobic in confined spaces. Perhaps I would in another cloth bag but I do think a certain amount of intergration took place.

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  2. Ah, panic attacks. A subject close to my heart. Unfortunately. Those familiar, most terrible experiences you can imagine. A couple of comments though: although primitive reactions like rage and panic have the same origin, most people with panic disorder aren't violent or aggressive in my experience. The feeling of losing control, and losing your mind, and the fear that you might do something violent is very familiar to me, but I have never done anything violent. My experience is that people with panic disorder tend to hate and fear violence... I'm actually sort of semi-pacifistic myself. The feelings of rage that one might experience during a panic attack are all the more disturbing because of this. Point number two: my mom didn't smoke or drink when pregnant. But I'm pretty damn sure she experienced stress, though. Well, you know this well, I assume. A mother doesn't have to drink or smoke when pregnant... stress during pregnancy and lack of oxygen during birth (which I happen to know I experienced) can be enough. In a perfect world these wouldn't be critical periods but...

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  3. I suppose the other questions is:

    Why do the smoking Mothers smoke?

    Perhaps repressing early trauma experiences of their own as they subconciously start to remember how they were Mothered so they can also Mother. After all tobacco is a first rate first line repressor I understand. Therefore while the cigarette may act as a repressor the trauma is still there also having an effect on the unborn child.

    Also what happened to these very same Mothers before the discovery of tobacco?

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  4. Hi,

    Thanks, really helpful and clear. Particularly about how the foetus cannot 'know' what's happening to her / him and so when re-living the patient cannot necessarily 'know' either.

    So the centre and the therapists are trained to help people 'recognise' the true sensations and feelings for what they are (after the re-living) and that is part of the 'integration process'. From my own experience it is becoming obvious that I could go around and around in abreaction without the supervision of a trained therapist in a three week intensive.

    I can see that the 1st line pushes the 2nd and the 2nd pushes the 3rd. I can see there can be a direct 'short circuit' from 1st to 3rd and consequently I am in a labyrinth beyond my own comprehension without proper supervision.

    Also, if patients have to return to the centre for further treatment then I suspect it would be to help them descend further. Two separate but related attempts to deal with two different but related brains.

    Consequently I have realised that it may well be better for me to get to the centre for 1 month (a lot easier to plan and less expensive and disruptive of my life in UK) and then plan to return a year later.

    Paul G.

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    1. Paul: Look forward to seeing you. We also do follow up with Skype. art

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  5. "But if oxygen supplies were lowered and carbon dioxide supplies were increased, mimicking suffocation (increasing acidity of the blood) there were panic attacks."

    Also amazing as I had read about acidification of the blood via anxiety. I have an aunt who I adored as a small boy. A beautiful gorgeous creature who I now understand to be someone who has suffered from great anxiety throughout her life. She has produced children with many emotional and mental problems. She has Osteoporosis and has to take calcium tablets. My understanding is that as the blood acidifies so the body releases calcium from the bones to nuetralise it. Thus another problem of old age starts early in life. I also find that I tend to get cramps etc and these are aleviated by taking calcium. I gather that calcium etc can help control anxiety. I wonder how that works?

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    Replies
    1. Planespotter: Why not find out? art

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    2. hi planespotter,

      our digestive system is a part of a our feeling system.

      it's surface is enormous and full of different cells
      that recognize, digest, metabolise, integrate,
      eliminate.. and who knows what else... for our survival.
      even our eyes are part of it.

      food is a part of our environment and digestive tract
      is actually externally oriented "tube".
      it is not so hard to conclude that it is affected by
      our moods and/or imprints AND vice versa.

      if you feel a Ca pill can help you balance your emotional state - great!

      i prefer a balanced DIET. but it's a messy subject (.

      i hope your therapy will help you choose what is good for
      YOU.

























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  6. Sometimes I think, I have acted out a great deal of my life as a panic victim; especially when I was younger. Now, it gets supressed/repressed a lot. Many of us would like to fix the mechanisms in us that distract us from positive productivity; living a "successful life." A panic victim could also be a victim of ADD; which is too bad. To me, I believe, unfortunately, that panic victims cause their own problems. Can only hope through reading what Dr. Janov has to say, that one can "get better." I do believe that Dr. Janov really knows. Thanks Art.
    Coastbeach7

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    1. Coastbeach7: de nada il y a pas de quoi. art

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  7. My pal Art,

    The cognitive dream world is like sleep... unreal about its content... neocortex has taken over our lives. Our real lives behind suffering in the limbic system... a hellish suffering as "given" the evolutionary process as a "task" to defend life at any price... against otherwise an obvious "doom"... the consciousness of a possible change!

    Frank

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  8. Dr. Janov,

    Anxiety and panic attacks that’s me.
    As far as I remember back into my childhood I was terrified of the dark.
    When I came in to the USA in 1991 the anxiety remained but the panic attacks lessened - until 2010. After a burglar tried to break into our house at 2:30 am, while we were asleep, the night anxiety is full-blown.
    And the panic attacks are back in full force since my car accident in Sept 2012 and with it a memory - long forgotten.
    My grandfather told me in 1970 that my mother had a motor-bike accident while in the 5th month, pregnant with me. I never gave this story any weight until now – after I read Primal Healing.
    The pain from the accident triggered underlying pain (leaky gates) and in Dec. 2012 my nightly panic attacks became unbearable. Night after night the slightest little noise woke me up. I heard my heart beating in my ears and rushing adrenalin kept me awake for hours. I finally gave in and put myself on 10 mg Prozac. I have no more doubt; I must have a horrible brain stem imprint on top of a complicated birth.
    Sieglinde

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    1. Hallo Sieglinde
      Are you STILL living in America? If so, have you been to the primal centre yet? I can understand the desire to emigrate from a very unhappy childhood and have always had this wish myself but fear it may be too late now! You once blogged me about it, saying I can't run from myself BUT I note you have followed the desire to flee yourself and so am interested to ask you this question.

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    2. Hi Anonymous
      Yes, I live in the US and no I have not been to the Primal Center yet due to the illness of my husband who has Parkinson’s/Shy-Drager syndrome and Amyloidosis and needs 24/7 care.
      I immigrated many years ago to the USA at age 42 (not knowing anybody here) to escape the people who reminded me daily, with their rigid, unfeeling attitude and self-righteousness, of my childhood. The “new world” gave me a chance to breathe and not feel constantly attacked and limited in my thinking and feeling.
      Sieglinde

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  9. could it be that in a session...
    descending from third (outside)
    into second line....
    than the first...
    patient can AVOID panic and slip more naturally into terror, into real context? the same terror that in different, more functionally active third line circumstancies, would appear as panic/anxiety attack.

    i just tend to relate panic/anxiety attack
    with third line still well in function (while eating, driving, stopping doing anything... waking up from sleeping) but unable to grasp where (outside) is the danger??

    maybe even body trembling, urge to piss,
    feeling of going mad
    in this situation is reflecting a messy
    state of consciousness
    - out of this world feeling of
    terrorising confusion!!!!

    "feeling vehicle" could be more efficient,
    more straight to reality?
    bit by bit...


















    maybe

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  10. Art... How can we discover ourselves to be prisoners for what you tell?

    The problem we have around others and not least their leadership is how we let them decide what we shall do because we ourselves are so anguished... so anguished that before our thought of anguished reached us... we blocked it.

    We simply let others decide at us... as we have packed our anxiety so well that we hardly notice that it exists.

    Do we begin to be suspicious... so will that be donated by idiotic comments of how talented others are... everything so that we ourselves can feel some kind of satisfaction... satisfaction by attributing to others being talanted... and without the content for the consequences.

    This is a nuanced everyday "normal" behavior... but now by this reminder... a behavior as even through its hue can provoke thoughts about our own captivity around others.

    Frank

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  11. There is a Swedish song whose text goes like this "over there by the tree I have buried my father in an anonymous urn... that's all that's left of him," these words arouses all my feelings without limit to what is to experience about my dad. There is no suffering left just a lot of memories that I feel... not without tears... they flow in a smooth stream... I love being here... it tells so much. When memories again found its place I will be with them where they once were and still are... I follow in their tracks wherever they lead. On the road... it is very lonely... but tells me everything I need to know about my life.

    Frank

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  12. A patient's experience:

    "In the last 3 years I am doing my therapy pretty steady and it feels like it is a long and painful process of cleaning out my body and my self from an enormous amount of poison .

    I do not know any words that can describe the changes I feel in my total being as a human being. Shortly I want to say that I was dead and now I am alive…that is some thing that I COULD NOT KNOW when I was dead…." What it is to be alive" my body keeps on singing happy songs from every cell of mine even when I am sleeping I feel that song.

    I said I FEEL that song because it is sensations that contain never ending happy data from every cell in my body followed by a sound of joy.

    In the last session I re experienced a turn that I did in my attempted to be born …it was an hour and a half of repeated attempted to turn in the canal while my body felt so squashed that I felt that my shoulders bones almost touching each other. It was a very difficult physical experience, together with an agonizing feeling of emergency and desperation, but when I finished the turn I was so very happy physicaly and emotionally. I was going to live. After I rested for a while I was so happy I just started to laugh and I kept on laughing for a long time. Actually I still am.

    One more thing which I want to express here is that the more I feel my unmet needs from my past the less they seem to be very important in the present.

    Sometimes I wonder where it will stop.

    My thanks ,my hugs to both my therapists, the angels who helped me in my fight to be alive.
    "

    ReplyDelete

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.
Editor