Monday, November 18, 2013
The Mystery Known as Depression, Part 4/12
4. WHAT IS DEPRESSION?
Throughout the ages, writers and thinkers have come up with poetic sobriquets to describe depression. Hippocrates called it the "black bile." Susan Sontag famously dubbed it "melancholy minus its charms." For Flaubert, it was simply “the eternal ‘what’s the use?’ ” And in his book The Noonday Demon, Andrew Solomon says “depression is grief out of proportion to circumstance.” (Solomon, 2002) Today, this ancient malady is poised to become the second leading cause of disability through the remainder of this decade, according to a report from the World Health Organization titled “The Global Burden of Disease.” (World Health Organization, 2004) By any name, depression has clearly become a plague among us. From a public health standpoint alone, it behooves us to understand precisely what it is and how to treat it humanely.
People often say they “feel” depressed, but depression is not a feeling. It is a defense against feeling,– against an accumulation of imprinted pain. As such, it is a protective device to keep us unconscious, or rather, to keep the unconscious from becoming conscious. It holds down, via its handmaiden repression, all of the catastrophic feelings and sensations from womb-life, infancy and childhood that, if unleashed from their safe, subconscious stronghold, would threaten the integrity of our conscious awareness. It is the ultimate survival strategy.
Depression is a system-wide state of repression that blankets many feelings. It is the history of the body’s traumatic experience exerting its force. And ultimately, it is the state of repression elevated to a higher level. For this reason, the depressive is chronically awash in suffering because he/she cannot feel those specific, early feelings. The organism seems to say, "Better to feel numb than feel what lies below and go crazy." Thus, the labored movements, feeling flat and unemotional, the lack of energy, and so on; all the feelings adumbrated by my patients at the beginning of my discussion. Any expression – anger, for example – can temporarily ease depression because it lifts repression a bit. But depression is certainly not, as Freud believed, anger turned inward. (Freud, 2005)
A normal person is rarely depressed; he has no backlog of feelings lying unresolved inside. He is open to feel and does not repress unpleasantness. He will be sad when it is appropriate. But sadness is a “now” event, a real feeling related to real situations. Depression is a “then” feeling, unrelated to now. If the young child could feel each and every original imprint, he would not be depressed in his life. The depressive, on the other hand, is stuck in time. He is stuck back in his past whether he is conscious of it or not, so that everything he does is a symbolic portrayal of that past. This means that we are all open to sadness when our defenses give way. To suddenly be out of work, left alone or excluded by one’s friends is most distressing, but depression is quite another matter. We should feel distressed, despairing, unhappy, sad; these are normal reactions. Not so with depression, which has as its kernel a deep hopelessness and helplessness. This is a basic imprint from long ago that can be triggered when one of those adversities occur. This imprint is often set down either during gestation or at birth when there was no escape from the traumatic input, such as a massive dose of anesthetics given to the mother during delivery which, as we shall see, effectively shuts down the baby as well. It is often this hopelessness that is triggered when seemingly not-so-serious events happen and depression occurs.
Feeling down and discouraged in response to losing a job, or breaking up with a mate, or after the death of a loved one, is different from a chronic, interminable depression. The former may be what is commonly known as "grieving" or "bereavement" which lasts for some weeks or a few months. The person has a normal response: gloominess, sadness, crying, feeling terrible, which stops after a time. What happens is that the person is reacting with real feelings. "Sad," for example, is a feeling; depression is not. Depression happens when you don't feel the real feelings. Those feelings agitate the deep brain levels and activate the imprint. The depressive feels all that; the imprint on the move toward conscious/awareness. It never makes it, however, as repression intercedes. But a deep despair and resignation set in, and a feeling of defeat and wanting to give up; and above all, that gloom and doom that is the hallmark of so many depressions. That is the original, precise, imprinted feeling that is trying to push its way into consciousness; it colors and dominates the present. We see the depths of the imprint in a syndrome known as endogenous depression, something that appears without apparent warning, leaving us helplessly deep into its maw. It has been labeled endogenous because until now we did not know where it came from or why. It is so deep that it seems to come from nowhere, but that nowhere/somewhere is deep in the brain.
When external defenses fail or are under attack, what the depressive experiences is the repression, not the feelings themselves. He feels the pressure against those feelings pushing down into his system. That pressure produces effortful speech and movement and total exhaustion so that the depressive has little energy and moves about in slow motion; “my feet are stuck in cement,” as one patient put it. In short he feels the weight of the repression, the ineffable force of keeping feelings down. He does not feel the feelings themselves. Once he does, the depression can begin to lift.
In depression there is the feeling of "heaviness," a lack of energy, which can be so great that even getting out of bed seems like a monumental chore. It makes everything a Herculean job, so that normal tasks such as talking or raising one's arm can become a great effort, even chewing on solid food. There is little or no energy left for enjoyment, pleasure, sexual drive, or any drive, for that matter, other than the wish to find a way to end the suffering.
So the depressive goes to a therapist for help; he/she usually has to be coaxed into it. What he/she gets is encouragement and hope that the therapist will make it all better – someone who will perform magic. He/she wants to be “pulled out” of her state; a symbolic feeling that was there when the original event – birth trauma – was taking place. Someone literally pulling his/her out, breathing life into him/her. The patient’s passivity requires an active, assertive therapist. The therapist becomes his/ her “friend” because he/she has rarely ventured out to make friends. And he/she will willingly take orders and obey his directions. But he/she has to offer hope and encouragement to combat that loss of hope deep down.
Give a depressive a new outlet – a new job, a party or a chance to go shopping – and all of the inner-directed pressure now pours out in manic activity. He will literally “throw himself” into his work. He will be “happy” for those moments when his work will make him happy. What has really happened is that he has found an outlet to release the primal force. Here we see the basis for bipolar or manic-depression. Not a different disease but a different kind of template – hopeless depths followed by manic energy. When repression fails, manic activity sets in. The imprint reflects the same cyclic event that occurred at birth. The person was stuck in what I call the trough and was blocked, then with great effort made it out. The template – down and then up – is played out in the cycle of giving up and trying manically to finish. It is the same energy source but a different way of handling it. So we can see that some of us shut down early in life and, lacking outlets, we become “dead,” globally and emotionally shut down. Others shut down and “act” alive. If being the “happy clown” pleases one’s parents, then the act will continue. Among the professional comedians I have treated this was never truer. I am treating a depressive now whose mother was chronically ill; he became funny to try to cheer her up. Though it never worked for long, it became a habitual pattern. His need? A happy mother who could love him. Take away the chances to please and the lurking sadness will begin to ascend. If one was disliked, suppressed, and rejected at every turn, then deadness and depression will be reinforced. How we develop depends on later life circumstance: Were the parents loving? Were they not tyrannical? Could they allow free expression? If there were free expression and lots of touch, then the imprint will be kept at bay because it was not compounded, but it will never go away until relived and connected.
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.