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.


  1. “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.

    Hi there
    i like this article of yours. it is a drama in my sight of view, as you describe it in one sentence above, that many people i know, have the same opinion "it's all in your head" while they don't know a damn thing. even those who can "see" and agree about the reality of our pain they prefer avoiding talking about it by saying something like: well it is like that, but don't bother your mind so much or you'll get crazy. or: you have to leave it behind, try to forget, stop thinking of the past,etc
    this big difference between me and those who "know me" makes me in their eyes as the poor man who bothers too much his head with what happens in that head. the poor me!! who "thinks" that primal therapy will save his life!!
    within years it became so true that i can do nothing to help people, even those who "scream" for help!!! And good for me, i try less and less now.
    I can hardly help myself!! A feeling is behind:(somebody help me, pleaseeee). the difference is that i can feel it now!! instead of thinking it: i need help!!
    As i learn more about myself and from your writing,it seems amazing to me how much the defenses manipulate every aspect of life in order to "protect us"? from what hearts us. luckily, for those who are in therapy triggering is always around. Contrary to the rest of humanity your patients have the chance of connection and resolution.

  2. Well thank you for your letter and comment. I want to make the blog a kind of public forum. After all, there are many smart people out there. We need the input. dr. janov

  3. Athanasios, if you felt what you don't yet know you fear to feel then you would understand that's it a whole body phenomenon.

    Janov, It's chaotic because the parts haven't met and been forged together. Their methods combined in a short time frame would render a break down of the circuitous encapsulated ruts of neurosis. Many perspectives make religious people nervous that is the first clue... Many perspectives especially those aimed at how people feel will break down neurotic defenses. But I also believe that other healthy activities and experiences also play into the mix and help the process. You can't heal a man starving to death or afraid he might be at any moment, with a very few momentary exceptions. Actually I think you would agree with me just wanted to throw this perspective into the mix.

  4. The best example of what I meant by combining various perspectives might be the old fable about the blind men and the elephant. Their perspectives put together in a sensible fashion looked like an elephant but each individual perspective was way off the mark. One thought an elephant was like a snake because he only felt the trunk and it how it moved. Psychology today is much like that. Art has "seen" and "described" the elephant as it is and knows it the central force behind all the observances.

  5. "you would understand that it is a whole body phenomenon"
    Thanks for responding Mitch. U made a point!
    At the moment i'm not in primal therapy. So, i can't say much for the "elephant"!!
    I live in Greece and "snakes" r endless here! Boy!! 10 million people? 10 million different perspectives!!
    Real snakes r plenty as well!
    I have accepted my own pain and deep unconscious as key factors for my situation in life. Most of understanding for myself was through reading dr Janov's books. Lucky me!
    Not following the rules of the "snakes", doesn't make life any easier. For sure. But it can make things more realistic. It depends. I have chosen realism as deep as i can "sense" it. Besides i don't like the "snake charmers". they use a snake(pain), that never really sleeps for their own profit.

  6. hmmm..
    u made a point Mitch.
    well i'm not in therapy so i can't say much for the "elephant".
    i live in greece where real elephants can only be found in circus!
    but "snakes" r plenty! real snakes r plenty as well. and what about the "snake charmers"? they make us believe they have power on the snakes! they make it sleep with their eyes open! it really looks charming! but it seems to me the snake is dizzy and tired and wants to sleep all the time!
    obviously humans have long being forced into lies and silly beliefs about almost everything.
    and it seems so many humans r thirsty for more dosage of lies as long as it works like a drug!
    and truth? truth hurts. feels like poison. isn't it the only way straight to the problem? everywhere i look i "see" a big label:solutions needed as long as it doesn't hurt. and what an irony. i work for a drug company!
    3 men walking in a desert. suddenly they see something. soon enough they r close. one says: hey, it is a mask! he tries it on. it fits ok but soon he feels uncomfortable. so he gives it to the other one. it fits perfect but later he feels uncomfortable too. he gives it to the third one and he says: that used to be my mask. but i don't need it anymore. i prefer to be myself.
    my point is everybody has the chance in a better life. a real life. but only a few will take the chance. our cells know the cause but our mind escapes constantly.

  7. What do you think about EFT(Emotional Freedom Technique)? Can we say that EFT has misleading outcome than the prediction as EMDR (Eye Movement Desensitization and Reprocessing)does? Do not really heals but suppressing pain ...a temporary escape?

  8. ipek later on today I will send you some of my writing on EMDR which I consider nonsense. I never heard of Emotional Freedom Technique. But one thing I do know, there is no emotional freedom without pain. dr. janov

  9. Dear Ipek

    As per your letter I will write a series of articles on EMDR I will the first piece then the second. etc. Here is the first.

    The hottest new therapy for a wide variety of afflictions is Eye Movement Desensitization Reprocessing (EMDR). It is subscribed to by many therapists and a good number of specialists in neurology and psychoneurology. There are variations on the theme but it is essentially watching hands or a wand moving back and forth in front of your eyes while imagining something that has created anxiety or painful memories. After a session the individuals, by and large, feel better. Each session focuses on key memories, finding the honed essence of the event, holding the feeling about it while watching the therapists hands moving some 20 times back and forth across the field of vision of the patient.
    The essential technique is not unlike some of the techniques in hypnosis; it also borrows from Behavior Therapy, directed daydreaming, rational-emotive and insight therapy. It is claimed to have success with phobias, depression, anxiety and stage fright. They have trained some 40,000 therapists world wide. It has been adopted by some insurance companies because it is quick and theoretically efficient. And a number of insurance groups and HMO’s do reimburse for it. EMDR therapists claim good results with such shattering events such as incest. The claim is that individuals can come to terms with great trauma without being re-traumatized, a very attractive proposition.

    One study funded by Kaiser Health Group found that after three sessions of EMDR patients felt better than those who were in standard therapy. Conclusion: EMDR is more effective, or so it seems. In a short time period 77% of the EMDR group no longer met the criteria for post traumatic stress syndrome, while only 50% of those in conventional therapy met those criteria. (See Los Angeles Times. March 25, 2002. “Trauma Therapy’s New Focus.”). I will discuss this research in a moment but first I want to examine in greater detail what this therapy involves.
    One case described in the L.A.Times article concerns a social worker who remembered an event from years back that was still painful; a professor had interrupted her during a practice interview. She was instructed to think about the episode while watching the therapist’s hands as he waved them back and forth “like a metronome.” “The therapist then told her to think about how she would like her mental picture to change….All of a sudden the professor’s head got as big as a balloon and then it popped into pieces and he wasn’t there anymore.” Within five minutes her shame and resentment evaporated. And now she is free of it.
    The usual session begins with the therapist asking the person to envision a safe place that can be called to mind “should the person feel threatened.” The patient then is told to think about the disturbing event while concentrating on the therapist’s hands. Meanwhile the patient talks about his feelings regarding the event. After repeating it several times they report that “they are able to distance themselves from the traumatic experience.” This distancing is the linchpin of EMDR. Essentially, a successful therapy is when the patient says she feels better and reports that her memory/feelings are dimmed and no longer troublesome.

    EMDR was discovered by Francine Shapiro in 1987. She has a doctorate in English literature, has had a lifelong interest in Behavior Therapy, which is essentially reorienting the patient’s attitudes and behavior. The therapist takes the behavior, say of a phobia, and attempts to change the behavior so that she is no longer afraid to enter an elevator, for example. Or, the alcoholic, is given a mild electric shock every time he thinks of drinking. This is called aversive therapy, part of the overall Behavior or Conditioning Therapy. Or the smoker is forced to stare at full and disgusting ashtrays each time he thinks of smoking. Or the smoker is given a medication that will make him nauseous each time he smokes. This is what is known as pairing one stimulus, cigarettes, with another, the medication. The mind then associates nausea with cigarettes and is conditioned away from smoking. EMDR is an extension of Shapiro’s interest in Behavior Therapy. Essentially, it is taking a symptom and bludgeoning it until it disappears, not unlike spanking a dog each time she urinates on the carpet. It is treating the symptom as a viable independent entity.

    In her book, “EMDR,” (Guilford Press. N.Y. 2001) she states: “The rape victim may begin by feeling intense fear and shame. She may have constant images of the rape intruding on her present life and may experience negative thoughts such as ‘I am dirty. It was my fault.’ After the clinician has worked with her using EMDR procedures to focus on specific internal responses, the rape victim may be able to recall the rape without feelings of fear and shame.” (page 2) This then empowers the patient who can say, “I did very well…I managed to stay alive.” She now has a positive change in her thoughts and beliefs and will no longer have intrusive thoughts of rape. The belief she has now internalized is “I am a strong, resilient woman.” She is no longer stuck in her childhood feelings but has an adult perspective on them.

    The rationale here is that negative beliefs become less valid and become linked with more appropriate information: “The patient learns what is necessary and useful from the disturbing past experience and the event is restored into memory in an adaptive, healthy, non-distressing form.” (page 2) The patient learns from negative experiences in the past and incorporates templates for appropriate future action. This is essentially Shapiro’s approach and rationale. Later, I will discuss the neurologic aspects of this therapy. Shapiro describes what this therapy borrows from: behavior therapy and conditioned responses; beliefs of cognitive therapy; the emotions of experiential therapies and the imagery work of hypnotic therapies.

    What EMDR proposes is that early traumas have never been fully processed. They therefore color our perceptions and actions in similar circumstances in the present. A crucial quote: “When an event has been sufficiently processed, we remember it but do not experience the old emotions and sensations in the present. We are informed by our memories, not controlled by them.” (page 3)


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.