Monday, December 29, 2008

The Dialectics of Hopelessness

I have come to believe that apart from fear and anger the primary key enduring feelings are hopelessness and helplessness. These are two ineffable feelings that are installed long before we have words for them. Yet they drive much of our adult lives; and more, they turn into their opposite, hope and help, and that then drives us. The process by which this happens is neuro-biologic. In the womb there are no behavioral options when the mother is drinking three cups of coffee or four cokes a day; nor when she is hyperexcitable. Her excited state transfers to the baby. The input to the fetus is too much. It is truly hopelessness and he is helpless. All his system can do is deal with the input. Serotonin is summoned but it is often insufficient. The fetus suffers. Then a birth with massive anesthetic that doesn’t allow the fetus to participate in his own exit leaves him with that same feeling. And then to compound it all there are parents who allow the child no freedom and no behavioral options except to obey. Of the epileptics I have seen this has all too often been the case.

So what happens to these feelings? There is a surge of serotonin/endorphins and other neuro-inhibitors that quell the pain. The feelings are dampened but as the child develops some of the energy manages to slip through. So part of the hopeless/helpless feeling traverses vertically to the prefrontal cortex, and also across the corpus callosum to the left frontal area where these painful feelings should be but are too much to acknowledge; so what happens? Hope. And where does that go? Into ideas and, above all, behavior. The hope is embedded into behavior. And it is but a thin sliver that manages to insert itself wherever the possibility of fulfillment exist. If one parent is a bit more human than the other, the hope will go to that parent. If there is no love at all, or if parents inculcate religion into the child, then the hope will go to God who will fulfill all the needs symbolically. There is still the feelings of hopelessness because the fulfillment, so-called, is symbolic.

But it is also more subtle than that. Right now we are treating an obsessive cleaner. She spends hours a day cleaning her house and it never feels right, never feels complete. She only got “love” for helping mother keep a clean house. That is where hopelessness drove the hope. It wasn’t really love, though. Her real needs were not being met—hence the hopelessness. She acted symbolically to get what looked like love. It is biologic; hopelessness drives hope in whatever avenue it takes. When basic needs are not met, it is obligatory and biologic that hopelessness sets in. It does not have to be articulated. Why does hopelessness turn into its opposite? Because hope means survival and hopelessness can be the end of life. Total utter hopelessness as a newborn or infant can mean death. Institutional children do die or else suffer from learning disorders, emotional problems, physical afflictions and do not grow physically to their normal height. Hope points the way to fulfillment of need which spells survival. It guides behavior like an unconscious radar. We are fixated on a warm teacher because there is hope of love. Or later, we are inexorably attached to a partner because of the hope. When someone dashes that hope, watch out! Hope can mean survival so when that is withdrawn the person is in great danger; of the original feeling and its meaning—hopelessness. So, many of us are in a mad dash away from that feeling. Hope is the carrot that leads to “love” and salvation.

There is always the obvious hope such as belief in a deity who will love, protect and watch over us. But most of us hope is more devious. It lies in our very structure. We are alienated and reserved because hope means not causing any trouble nor risking any disapproval. So our hope lies not so much in getting love but in avoiding criticism or disapproval. Or there are those who continually in hope by being kind, generous, meek, undemanding and accommodating. Their personality structure is wound around personality and says with every breath, “love me.” Literally, we are the embodiment of hope. One thing we must do in therapy is help the patient feel what exists in every fiber of her being; get her to first feel the hopelessness by going to the original basic need and hope. Remember, it is lack of fulfillment of need that spells hopelessness. An aside: I believe that it is deep repression of that hopelessness, established very early, that is behind so many serious diseases later on. It is not that hopelessness leads to depression and cancer, as some of the literature has it; it is that repression of it can be fatal.

Saturday, December 20, 2008

Original Conflict: The Biologic Motor That Drives Us

We in clinical psychology today are in a strange position. We see people, both in and outside of our practices, suffering from some insidious condition that cannot be seen, tasted, touched, or pinpointed in any single location. The condition is often called mental illness or neurosis. A few question whether the suffering is real, describing the experience as a "trip" to be savored, and terming mental illness a "myth." Others see mental illness as merely a function of distorted thinking, something that will disappear with new thoughts. Among schools of psychotherapy that do admit the existence of mental illness, each one has very different ideas about neurosis and its genesis. Indeed, in no other area of medicine is there such disagreement about the nature of a disease, what its symptoms are, and how it manifests itself, not to mention its causes.

In short, the field of psychotherapy today is nothing less than chaotic. Why?

First, I believe, events that may cause mental illness or neurosis begin so very, very early, and remain so barricaded in unconsciousness, that the notion that early trauma affects how we act at the age of, say, 45, is beyond ordinary imagination. Second, we react with incredible diversity to early trauma, and we may imagine that phobias, migraines, compulsions, obsessions, depression, addictions, etc. must all have different functions. Third, psychologists themselves have blind spots of a function of their own neuroses - they cannot see, cannot bear to see, their patients' deepest pain - and find themselves gladly distracted by symptoms and by ideologies that do not directly address pain.

As a result, the field of psychotherapy may be characterized by a remarkable absence of cohesion, and patients' pain is addressed diffusely at best. Some psychotherapists will consistently prescribe anti-anxiety and antidepressant drugs for varying neuroses, in essence trying to kill patients' pain, but not identifying the pain or where it comes from. Others may manage symptoms through various techniques associated with different schools of psychotherapy: They may have the patient "dissociate from" a symptom in hypnotherapy; cognitively "analyze" it into oblivion; "act -out" the symptom symbolically in gestalt-type therapy; beat it back with mild shock as in conditioning therapy; chalk it up to "faulty beliefs" which simply need to be willfully changed, as in rational-emotive therapy; "control" it in biofeedback therapy; or reroute it in directive daydreaming and imagery therapy.

The myriad approaches in psychotherapy are treatments rather than cures. They all focus on the symptoms of neurosis instead of probing for its cause. It is possible that they all help somewhat; they do not cure, however. They may help control the symptom, not the disease.

The only hope for cohesion, and lasting help for patients, is to address the generating sources of neurosis or mental illness. What and where are these sources? I believe that the conflict between the imprinted Pain of early trauma and its repression is the central contradiction that generates neurotic reactions both internally (physiologically) and externally in the form of behavior. Repression, or the loss of access to feelings and sensations, is an evolved function that allows us to survive unmitigated pain early in life. The pain, however, stays in the body, unavoidably - as unavoidable as the experiences that originally caused the pain. And the pain will perpetually fuel a dislocation of mental and physical functioning to keep itself unfelt, for as long as it remains unfelt.

Therapies that do not address this original, central conflict at the root of neurosis may succeed in reconfiguring a symptom pattern, but cannot eliminate the fundamental illness. Why do therapies and therapists not go deep? Because of our Freudian legacy, which dictates that fooling around in the unconscious is dangerous and must not be done. And it is true that without a proper scientific theory and therapy it can be dangerous; witness the many mock primal therapies damaging patients every day by plunging them into rebirthing and other dangerous ploys. It has taken some thirty years to figure out this theory and therapy so I don’t wonder that many therapists avoid it altogether. But it is essential if we want to put an end to neurosis as we have seen it for one hundred years.

Monday, December 15, 2008

It's All in Your Head: No It's Not.

We have all heard the complaint; “Stop whining. Get over it. It’s just in your head”. Well, that latter phrase is just not true. Someone who is suffering emotional pain, “She hurt my feelings. He ignored me”, is using the same lower brain pathways as with physical pain. It is not just in the head but also in the deep brain processes that affect many organs of the body. Those pathways do not distinguish between physical and emotional pain. Hurt is hurt. And it hurts the same whether a smack on the face or an insult of rejection. Unfortunately, we cannot just “get over it” as some implore. Or just change our attitude, because those admonitions are fighting deep brain processes.

What some may mean in “get over it,” and change your attitude, is that emotional hurt is not really physical; it is just somewhere in space without physiologic effects. All late research reports that it is. A slight insult may set off earlier ones so that the reaction may be inordinate and out of keeping with the importance of the insult. The way to get over it is to not accept reassurance or means of distraction from others, and feel the root pain that lies just under that feeling that produced the attitude, in the first place. Too often current therapy tries to change ideas and attitudes without changing the underlying feeling; the feeling that gives rise to the attitude. “It’s all in your head.” Where else would it be? What most mean by that phrase is that it is in your imagination which you can change. Ah no! It is lodged deep in the brain where psychologic access is impenetrable. And until those feelings are addressed and integrated we cannot get “over it.”

The problem is that there are antecedents to an attitude. Even when the feeling is deeply sequestered, its raw emotional content continues to drive attitudes. Thus someone who is pro-war may have deep rage inside. Or those who are fearful see danger everywhere. They cannot just get over it. None of this may be conscious. Consciousness is what is required for integration yet so many therapies function in suppressing it, mostly because it means being aware of one’s sequestered pain. Consciousness, in one respect, is the main force for integration and resolution. It means having access to various separated neural functions.

Think about it; pain has so many diverse dimensions. We have to be aware of it so the neocortex is involved. There are feelings involved so that the cingulate and other limbic/feeling structures are included. And there is the force or valence/intensity of the pain, which involves the brainstem and some limbic areas. All go into making the pain experience; and to treat only one dimension, the ideational, is to leave the other two very busy, gnawing away at the physical system. All of this is going on unconsciously.

Pain is perceived as less intense if there are distractions going on. This help explains EMDR (Eye Movement Desensitization and Reprocessing), which helps through suggestion to make the deep feeling seem “alienated” (their word). It means alienating oneself from one’s feelings. Usually that is a definition of one kind of neurosis, not one of health. It is well known now that there are descending pathways from the top-level cortex to the limbic/feeling areas that help repress feelings and keep them unconscious. Those nerve pathways help control feelings so that they do not emerge and rise to the cortical level. They are partly responsible for dissociation. Similar ascending pathways are used to translate emotional pain/feelings to the top-level cortex to make us aware.

Friday, December 5, 2008

Pregnant Mothers and Neurotic Children

More and more research is helping us understand who we are. Although the thrust of current psychologic thought maintains that genetics play a big part in our development, I claim that the state of mind of a carrying mother is very, very important.

If she is depressed or anxious the baby and the developing child will have high stress hormone/cortisol levels. Think of the implications. The mother’s emotional state may dictate how our lives unfold. (See Early Human Development. April 2008. 84(4) pages 249-256). This also helps explain why so many of our beginning patients have consistently high cortisol levels (secreted by the adrenal glands). In studies of anxious or depressed mothers (mood-based changes) compared to “normal” mothers the offspring had high stress hormone levels and more activity in the emotional right frontal brain. Anxious and depressed mothers are important predictors how we will do in school and later in life. Don’t forget the fetus has an environment; that environment is the mother and her status. That environment sculpts the fetal brain. The mother doesn’t have to say a word to her baby; her physiology does it for her. That sculpture plays heavily on our future behavior. It is a good predictor of the baby’s temperament. And of course, who we are later, as well. We must remember that the stress hormones of the mother can pass through the placenta into the fetus and affect all kinds of hormone balances. And this mixture becomes the crucible for later development and personality. It is here that we can start life already handicapped. And how we react to birth may be predetermined by womb-life.

We do know that womb-life maternal anxiety can affect the sex hormone level of the offspring. It all happens so early that when a homosexual says that it is genetic or a natural state he/she isn’t aware of the impact of the mother’s state on her fetus/baby’s development. It also explains why so many of us believe that who and what we are is normal. The deviation has begun so very early, before we had an operational thinking brain that the deviation seems normal; we have nothing else to compare it to. Moreover, when we look for causes of later Alzheimer’s disease or Parkinson’s affliction we never would imagine that our life in the womb could be a major contributing factor. So we don’t look there, hence avoiding important information. We need to study brain dementia cases and check their womb-life, when possible. Several European countries already have that information. It dictates how we react later on. Do we have a predisposition to threat; that is, are we too ready for attack and therefore on a chronic high state of alert all of the time? All this based on an “attack” by mother’s high levels of stress hormones while she is carrying; that raised the cortisol level and made hyper-vigilance a steady state. And when we need constant tranquilizers as adults we cannot imagine that womb-life is the culprit. But if we see through research that stress hormones are chronically high in emotionally disturbed patients we see why they seek out pain-killing drugs.

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.