Saturday, April 13, 2013
Is There a Science of Psychotherapy?
If we have to ask professionals, I guess not. Here is what the president of the Society for Psychotherapy Research has to say: “There is strong evidence for many…..approaches.” Now what does that mean? That many approaches are all valid? That they are scientific? How could that be? You mean that there are many sciences in psychotherapy, all valid? Are there many different sciences in physics, in biology? There may be some difference of opinion but certainly not different sciences. I mean is there gravity or not? Are there many ways to make electricity?
Let me go back to my internship in a major Freudian clinic (Hacker Psychiatric Clinic). There was no science in what we did. We all had different Freudian interpretations of patients….was he Id dominant? Was his superego too strong? Was there evidence of his childhood sexuality? And on and on. No science, only guesswork and imagination. And there was imagination at work as our staff spun incredible theories to explain the patient’s behavior. There was certainly no science to guide us in how to proceed in psychotherapy.
I think that there cannot be many valid approaches to psychotherapy; either there is a scientific approach or there isn’t. I now must offer our approach which I think is science at work. We can predict what happens to patients and what level of conscious they are on. We can predict the demarche of the therapy, how it should proceed, and what steps we should take. We understand immediately when a symptom such as high blood pressure or a migraine appears. Above all, we know when a therapist makes a mistake. Our staff can look at a tape, and we always tape patients, and know when something went wrong. Why? Because there is a precision to what we do that allows no margin to go off and do something else.
Yes there is leeway in terms of the therapist and his perceptions but not in terms of what the patient needs. It is never doing “what we feel comfortable with,” as I learned in my internship. We have a clear understanding of anxiety and panic (see my piece in the World Congress of Psychiatry http://www.activitas.org/index.php/nervosa/article/view/146/183), as well as what causes paranoia and what to do about it. We don’t have to guess about what generates depression because we have a theory to guide us and decades of experience to tell us what works and why.
So in those many approaches that they claim to be valid there may be ten different explanations of paranoia, not one, most of which do not concord with brain science. Will it help to talk her out of her paranoia? Not quite. Since it is not an attitude; it is an imprint with a history and a biochemical foundation, not just a cognitive misstep. Without a comprehension of the levels of consciousness I cannot imagine how to construct a valid psychotherapy. Because in the brain and its evolution there are distinct levels of consciousness with different identities and different symptoms. For example, colitis has a specific origin and gets its start very early in evolution. That symptom can tell us where in the brain it is located and originates, and what we can do to treat it. When a patient needs drugs we know what to use (in conjunction with medical advice). We know that serious mental symptoms require deep brain blockers because we understand that bizarre symptoms require deep access. We also know that any scientific therapy must ultimately access deep brain engraved memories.
We know that in gestation there are already imprints and repression that may be compounded into terrible depression later on. We do not have to concoct hypotheses stemming from Freudian days about anger turned inward. We learn from the unconscious of each patient, and from there, build a theory that helps explain it; we simply observe and listen. It is all there, just waiting to be discovered. It is not us that holds the truth; it is always the patient.
So how can ten different therapies all be valid? It can be affirmed precisely because there is no science that they follow. Therefore anything can work. If a neurosis is built on sequestered pain, how could we do anything else but access and address that pain? We may disagree as to what to do about it but not of the pain itself, which we have seen thousands of times over forty seven years of Primal.
And of course we would not rely on medication as treatment when we do not want to push down the pain anymore, but rather to let it out; to express it at last. Yes, if we do not admit to the stored pain and imprints then anything goes.
Further, when we do acknowledge the existence of pain, we need to understand that we cannot travel deep too soon. We know now that there is a valence to each pain; only so much that can be experienced at any time. To deny that and over-reach the boundaries endangers the patient and her mental stability. Yes there are times when the pain is hurtful but we understand that each little bit experienced is so much less pain driving us. And that is why we see so much less stress hormones in our patients; as if to underline that feeling pain relieves our neurotic burden.
So to me, there cannot be any number of therapies all valid; there can be many therapies all invalid, but they can claim validity if they change the criteria for improvement. If they rely only on psychologic criteria, “ I feel much better;” but no matter what she says, the biologic measurements tell another story. So yes we can claim validity when we leave biology out of the equation. But it is a pseudo state, and we don’t want to get pseudo well, do we?
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.