Saturday, August 8, 2015
On the Difference Between Abreaction and Feeling (Part 5/9)
Connection Is the Key
So how do we guard against abreaction and produce genuine feelings? There are two important factors at play. First, the patient must arrive at a particular feeling/pain/need untrammeled by other feelings, which are often compounded by a history of unrelenting pain from childhood trauma and neglect. That is, the therapist must be acutely aware of the leitmotif in the session – which feelings are critical and which are peripheral. It takes much experience to know how to do it because often, there is a tendency to conflate feelings and go off on the wrong tangent. If the wrong feeling is addressed, we get abreaction. For example, if a patient is in a feeling and suddenly starts gagging and coughing as a result of first-line intrusion, the therapist should steer him back to the original feeling because the intrusion is a diversion, and that diversion itself is the abreaction. Or if the patient comes in bitching about his wife – “she is just suffocating me with her demands” – and then he begins gagging, we know that the origin of his complaints is deep in the brain, likely the part of the brainstem concerned with breathing. We do not push the patient into the birth trauma unless he is far along in therapy and ready for such an experience. Otherwise, he is steered back into the original feeling, to explore why he feels suffocated. It is indeed a thin line to know which level the patient is on and what level he can access without unbearable pain.
The same is true of a patient who comes in crying on the third line and never goes beneath it, to older pains. That too is abreaction. He is discharging deeper feelings on a higher level of brain function, unable or unwilling to take it back further and deeper. The result is not a full feeling; rather it becomes a chronic discharge of the energy of the feeling with no final resolution. For example, a patient may come in and cry only about a film he just saw, but never connect it to his own life and his past experience. He is stuck on the third line, and abreacting. Screaming and yelling in and of itself always remains a simple discharge. Feeling ultimately means an experience in context. The problem is that yelling, crying and screaming with no context still feels good and can form a groove of relief.
This is where it gets tricky because there are levels of contexts: the ideas (top level), the emotional experiences (limbic system) and the infantile (brainstem) level. The contexts deepen as the patient is able to go deeper in his therapy. A complete primal experience means encompassing all three levels of brain function involved in a single feeling. That comes later in therapy when access allows the patient to travel to the beginnings of experience and of life. He is then allowed to complete the cycle of feeling and obtain resolution. In this kind of primal the patient feels the entire crucible of his behavior and symptoms. It is no longer a mystery, so long as we allow evolution to do its job. It is too tempting sometimes for a therapist to push the patient into something very dramatic so as to show his so-called skill.
So we need to know on what line or level the patient is operating on, so that we help him and us to focus. This avoids a mélange of levels that also prevents proper connection. We see this with patients who wander over several feelings and disparate subjects during a single, scattershot session. Nearly always, the patient’s wandering over many subjects means there is a mélange of great underlying pain pushing him from one place to another. Needless to say, this is the patient who often suffers attention deficit for the same reason: too strong a primal force, preventing focus.
Feelings must be felt on all levels but in an orderly sequence, not all at once. The therapist must get the patient back on track so the natural feeling can be allowed to unfold in tune with the natural resonance that links the levels of feeling together neurologically. Once the patient is on the right track, resonance will take its course, leading the patient naturally deeper and more remote over time. In abreaction, it’s often the therapist that is leading the patient in the wrong direction, creating all manner of bad outcomes.
The idea is to remain in the feeling zone, the only zone where connection can take place. Outside of the Primal Zone, no integration is possible. This is why it helps for the therapist to have at least a modicum of brain science at his disposal. In some cases, for example, we know that the use of tranquilizers can help get the patient into the zone for a time. This is not in lieu of therapy but as an aid to it.
Now why is the wrong feeling addressed? Because when a therapist has unresolved feelings of her own she will tend to drive the patient where she needs to go. Or worse, she will avoid feelings of the patient that she is not ready for. As for example, anger. If the therapist is terrified of hostility, she will shut it down in the patient. She won’t let the patient go near it, and the feeling will remain unresolved. If the therapist cannot be criticized, she will dodge any blame and try to make any error the patient’s fault instead of hers. This is the most widespread of problems with therapists. Above all, we want to avoid confining the patient to his ideational cortex to the neglect of feeling. In other words, we want to avoid precisely the predominant therapeutic approach in contemporary psychotherapy, which is Cognitive Behavioral. The cognitivists really do believe it’s all in your head, that changing thoughts can change behavior. To me, Ideas signify something “disembodied.” When a therapist lives in the world of ideas there won’t be much feeling there; one reason is that feelings seem secondary to them. Ideas, they agree, are paramount and have value.
By contrast, a full, feeling experience in the Primal sense means that that we are not confined to the neocortical level where ideas and intellect live. What we are after is to hook up the primitive, lower levels of the brain with higher levels so that there is a proper connection. This means that the historical need/feeling/pain has been fully experienced with all of our being.
And how do we know when a real feeling has taken place? We can verify it, physiologically. Before and after every session, we systematically measure vital signs of each patient. During a real Primal, we expect to the vital signs move pretty much together – up at the start and back down towards the end of a session. Over months there is a constant normalization of vital signs so that the blood pressure, heart rate and body temp get reset to the normal range after some months of therapy. Over time, there is also a significant drop in cortisol levels and enhanced natural killer cells. (See my book “Primal Healing” for further discussion.) Measurable metabolic changes also include a permanent one-degree lowering of body temperature; since body temperature is a key factor in our longevity and the work of our bodies, it is an important index. In addition, our research found that after one year of our therapy there were systematic changes in brain function toward a more harmonized cerebral system. It all means that we are getting to the pain and undoing repression.
That is not the case with abreaction. In a feeling without context, which is an abreaction, there is never this kind of organized, coordinated movement of vital functions. Instead, a random discharge of energy from the feeling/pain will produce a sporadic, disorganized movement of vital signs. There is no harmony to the system. Thus, when vital signs do not reflect integration, we can be sure that connection never took place. By these measures, “thinking” that we feel and actually having a real feeling are neurologic worlds apart.
By definition, abreaction lacks connection, which is the sine qua non of Primal Therapy. Without connection there is neither healing nor cure. So, clearly it is crucial. If there is no connection to solidify the feeling there is no progress. So what is connection, after all? It means that while the patient is feeling and reliving she is connecting to the pain/fear/terror. Bit by bit as she relives and feels she is making a connection to something buried away for perhaps years. Connection means feeling something in context, comprising each different level or aspect of the feeling until the patient arrives where it all began. That is eventually where patients need to go. But a random scream or cry will not take you there. At each level, the feeling must connect with its context, which is different as we descend down the chain of pain. Each brain level contributes its specialty: ideas, feelings or instincts.
On the other hand, abreaction is just a release of the energy of feeling without meaning and out of context. There is a great gap between reliving and relieving, and this is the mistake so-called mock therapists make all of the time. The mistake is easy to make because, again, abreaction looks like feeling but it is not. It should be noted that the patient is not deliberately faking a feeling. Abreaction can be a real feeling, but it is out of sequence, and therefore it is not curative because it does not allow for proper connection across all three levels in a natural, orderly way. The patient is pushed into the tributary feeling because the pain of the main feeling is too great. This heavy painful feeling does in therapy what it does in everyday life; it keeps us from focus and concentration. It pushes us away from the central feeling. So abreaction is going through the motions of feeling without its depth and history. And it requires that the person perform the sidetrack feeling over and over again—relieving not reliving.
So again, connection means liberation of feelings in context. There are those who scream and writhe and cry out of context, as in an exercise. They make no profound change, but when the patient slowly descends to deep levels over time and reacts to the stimuli and events on that level with the neurological capabilities of that era, there is progress.
The goal of our therapy is to retrieve memory, not only of the scene or the place but also of the feelings belonging to them; that is what has been repressed and held in storage, the pain and terror. When we primal, we are reaching deep down physiologically to a part of our history that has been sequestered for decades and will not give up its secrets easily. Sometimes, the patient is not yet ready for the experience so it remains a mystery, until the time is right. When patients finally experience those feelings in their totality, including physiological aspects, they become integrated. The neurotic split is healed and the person is no longer at war with himself. Now we can use the term “holistic.” The patient has become whole in every sense of the word. His feelings are integrated into awareness and into his neurophysiology.
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.