Friday, August 30, 2013
On Catatonia and the Freeze Response
We have a patient coming into therapy who has been diagnosed by an English clinic as catatonic. She freezes up and it can last 8 hours where she cannot move or react. She has no feelings during the episode, just numb. She has stayed in the clinic for eight months while they tried everything they could including art therapy and few booga-booga varieties of nonsense. Why am I mad while I am writing this? Because it is criminal what happened to her. They had no idea what was wrong so they tried a potpourri of all the things that the usual addiction clinic tries. And with the same result: nada.
So let’s look at what it really is: first it needs to be triggered. We are not triggering catatonic; what is triggered is first-line terror, and what happens is one of two responses, both originating in the hypothalamus. The first is attack and aggressive; fighting off menace. The second is the freeze, becoming paralyzed with terror where moving is life endangering; the mother on serious drugs or tranquilizers, for example. Here is where using up oxygen becomes life endangering; the whole system has learned that freezing is the first primal response against danger. And in the first instance where danger lurked it worked. The carried baby may have been reacting to heavy drug overdose or drinking. So some of us, depending on the nature of the early trauma and genetic tendencies admixed with epigenetic effects, find the inexplicable reaction of no reaction as effective. We see this so clearly during the trauma at birth where the baby heavily anesthetized has to withhold breathing deeply to conserve oxygen. These are the later breath holders.
I have seen and helped catatonics at the mental hospital where I worked; most suffered from what is known as “waxy flexibility.” We put their arm up in the air and it stays there. We twist their hands in a certain direction and it remains in that position. They cannot manage any voluntary action. At the time no one, including me, knew what it was. Now we know. And I shall explain it.
Let’s go back to our three levels of conscious; the first line is basically brainstem and ancient part of the limbic system—the amygdala. This is our most ancient brain that has its beginnings millions of years ago. It is a mass of impulses but no feelings; here is where the primitive parts of the hypothalamus exert their dominance. And depending on many factors determines whether there will be either anxiety reaction with aggressive responses (the sympath); or whether there will be anxiety responses held in immediate check as bodily reactions freeze (in the parasympath). These response tendencies get stamped in and engraved so that it directs our characteristic reactions thereafter. The parasympathetic nervous system activates the freeze response everywhere in the system, not just in behavior. Think of the frightened reactions of a deer or rabbit. So something in the human triggers off fear, which then may resonate with first line terror which provokes the parasympathetic system into action—freeze. “Freeze” is a reaction to something that really happened, not a chance or whimsical caprice.
An example: some years ago I was napping in the backseat of the car. The driver looked back to make sure I was comfortable. By the time she looked back to the road she was in a culvert heading for a major steel signpost. She froze. I reached over grabbed the steering wheel and guided us back on the road and to safety. The imprinted reaction governs our life forevermore. My basic tendency was sympathetic but with a lot of parasympathetic reactions as well. The “freezer” usually has low blood pressure and low body temp; she is in the constant conservation of energy mode. She is not a self starter and needs constant direction and guidance. One has to “breathe life” in them to get them going. And why? Because something could have happened during womb-life or birth that diminished oxygen to dangerously low levels. They go on acting as if the imprint is now— current. They go on in a passive mode; go on as if they had no more energy to fight.
Freeze and paralysis is a reaction to anxiety and terror, remember. It doesn’t happen without reason. It is the alarm system that signals the response; we must suss out what the danger is that provoked that alarm reaction. Then we can treat it. And what is the danger? Nothing external; something internal…..sensations (of suffocation) or feelings (something closing in). When the patient who is coming into our therapy gets provoked she goes into the freeze—catatonic response first, for an hour or five. Then slowly as the defense weakens and body lets go of its tension/defense she develops an anxiety state. This is what the freeze response is defending against….not enough oxygen, which produces terror. Then after more time, she seems to be flooded with feelings which causes great frustration. But she doesn’t know what is flooding her. It is now a mélange of feelings liberated. So it is literally the freeze response we see where the person cannot move or speak because she is locked into the deep, brainstem imprint where there is no emotion, nor speech. Her nervous system is moving up the chain of pain, up to higher levels of brain function.
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.