Monday, August 31, 2009

On Connection (Part 4/6)

In neurosis there is a loss of integration among brain sites so that memory cannot be conflated with inner sensations and external reality. We lose our wholeness so that past and present cannot be differentiated. Remember again that when animals are traumatized and then put again in a similar situation without the trauma, the brainwaves are practically identical. The brain cannot tell the difference between past and present, and forces us to react as we did in the past even when that reaction is not called for. In neurosis we live in the past without being aware of it. We are shy with others because an angry father forced us to give in and submit unquestioningly. This kind of father takes the child’s “no” away so that later on she cedes to other’s wishes all of the time. Thus, she reacts in the present as if it were the past.

Without lower level connection to higher levels, we are only considering the late developing cortical brain and not the brain as a whole. Sadly and happily, no one can make a connection (insight) for us; it must come out of a feeling, and it must do so in slow orderly fashion. When the patient has the connection, we know it is time. When the insight is forced by a therapist, it usually is not the time—organically; it defies evolution—ideas after feelings, not before. Neurosis manages to fragment that reality (disconnection). Feeling therapy reestablishes that total reality. There is a unity of nature that happens only with connection. Connection, therefore, is the merging together of related neural networks on all levels of consciousness.

It should be clear that dissociation restricts consciousness, not awareness, and we need consciousness, not awareness, for control. I can make this same impatient individual aware (left frontal area) in therapy that he is terribly impulsive and cannot stand waiting, but that does not produce the bottom to top connection that allows for control—the connection between deep right brain and left pre-frontal brain. Even with full awareness, the right lower brain sends impulses throughout the body that gnaws away at various organs. The result may be colitis (often first line originated) or bleeding ulcers, which cannot be stopped without first-line access. The aware person can be totally unconscious of all of this. The unconscious has no way to become conscious in the neurotic. Neurosis means an altered state of consciousness. That includes defective or impaired bottom-to-top brain circuitry. In brief, the brain is rewired. In the adult, instead of feeling the need for love and caress, one may feel immediate sexual impulses or the drive to eat. The more that those circuits are deviated and continue to fire in a specific way, the more the rewiring becomes reinforced.
We need to go back and relive the times of first deviation if we are to make headway to resolving it. We go back to reset the set-points toward normal. That is why in our therapy, the naturally produced inhibitor or repressor—serotonin—is enhanced after one year of sessions. Its set-points have been reestablished. It is sometimes possible to get relief by delving only into later childhood traumas, leaving the prototype in place. If the threshold for symptoms is raised by this approach, all the better. There will be no overt symptoms but the tendency is still there. Thus, an alcoholic may not be forced to drink when some of the pain is relived, but he will always be in danger thereafter. If we are looking for total personality change, it will not be possible without addressing the imprint. If one is happy with having no symptoms, then so be it. It is the patient’s life, not ours.

Early trauma, birth, and pre-birth, will generally interfere with the proper evolution of the right brain and its connections to the left. It remains so excited that even neutral events can set it off. Do we need a therapist to help us see outside reality? No. We need a therapist to help us find the internal one; the rest takes care of itself. To be specific: We need to access the right brain because that brain (specifically the orbito-frontal cortex. And the lower brain, as well) contains a map of our emotional history and our internal state. With access we don’t have to figure out what happened to us at age two, we can re-experience and know it. And we will immediately know how that experience drove us. That is why recall is so different from reliving.

(Let me hasten to add that there are any number of limbic structures and adjacent ones that are involved, including the ventral anterior cingulate which seems to “straighten out our perceptions”. It is beyond my competence and intent to discuss them).

Monday, August 24, 2009

On Connection (Part 3/6)

Connection cannot be achieved when the connecting cable (corpus callosum) has been impaired or thinned out due to early trauma. Once the event has been dissociated, the right lower brain areas have a “mind of their own.” That is, the energy of the pain innervates (lead to, connect to) the heart and key organs and begin their ever-so-subtle damage so that years later, there is a serious illness and no one seem to know where it comes from. Suddenly the person develops high blood pressure or heart palpitations, or worse, a stroke. Because the origin is so remote, one could never dream that it was due to a birth trauma. The treating doctor says, “Have you been under stress lately?” “Not that I know of.”

How can we speak to a brain that has as yet no words? And no comprehension. The suffering component of infancy has direct connections to key organs of the body governed by the right brain. The left brain insists that all is well while the right is sending messages to the lungs, immune system, circulatory system, and heart saying things are terrible. All done “sotto voce.” After all, it doesn’t want to be overheard by the left. Once the secret is out it has to be dealt with, and the left just cannot do it. The truth of the hurt is already out, only it is revealed indirectly through the organs. There is a pain in the gut or in the heart (ischemia, angina). These are the somatic aspects—fragments of the memory— of an overall pain imprint, which as yet is not conscious. And it is not conscious because it is overwhelming in its force. Remember that there are nerve fibers from lower down that impact the pre-frontal brain area that can and do change its structure and function, particularly the right frontal area. A Primal means putting it all together, connecting the various disparate symptoms into an overall whole.

In neurosis there is a different brain. UCLA neuro-psychologist Allan Schore believes that early trauma overrides genetics in our personal development, and I agree.

The reason for the descent down the chain of feeling to be orderly and methodical is that as we descend, the valence of the pain increases. Thus, in birth where death may have loomed, the pain is horrible. It should only be experienced after many lesser and later pains have been felt. If we try to get there with hallucinogens, for example, as some therapists have done, the result is often wild symbolism as the neocortex scrambles to circumscribe and contain it. If the therapist sees this as normal and even healthy, then all is lost because the patient is lost. He now lives in a labyrinth of convoluted ideas that have no relationship to internal reality. Instead of feeling that reality, he is encircled and dominated by it.
Early trauma impairs the proper evolution of the right brain so we later misperceive, cannot sense nuance, and over or under react. We cannot sense nuance because that is right brain, and we are disconnected from it. Thus there is a tendency to be literal and not see the implications in certain situations. Right brain impairment may also cause us to lose our ability to empathize because that too is right side. Anything that involves feeling, in short, is missing with disconnection. It is critical for a therapist to have right brain access, and even more importantly, to be right-left brain integrated. She must see beyond the words of the patient. Or more important, see beyond the words of a politician. The right brain senses insincerity.

In the example of the inability to wait, it is clear that unless we go all the way down the chain, we will not have complete resolution and change. If we relive the waiting in childhood (the need to go home after being in boarding school), we would resolve only a part of the trauma. There will still be an urgency about waiting but not so desperate as before. What gives waiting its life-and-death urgency is the birth trauma, which, indeed was a case of life and death. This is a general rule about any problem or act-out. The compulsive-obsessive aspect of it is largely driven by preverbal traumas, which are usually pure impulses. It is what makes sexual act-outs so difficult to treat. And unless a therapy arrives at the prototype, they will not be eradicated fully. The difficulty here is that first-line trauma underlying the act-out already has an urgency about it. The devilish aspect of this is that there is no way to go deep without first going shallow—no visiting the past without first dealing with the present. We must obey evolution, albeit evolution in reverse.

Monday, August 17, 2009

On Connection (Part 2/6)

With connection, feelings have found a home, and the system can rest. The person no longer has to engage in compulsive hand washing because she unconsciously feels “dirty.” Remember, that the higher pre-frontal regulatory systems have connections with the brainstem/limbic areas with information going in both directions. We can feel our feelings, and we can block those feelings when they are too hurtful. With a weaker pre-frontal cortex to handle input, we have amygdala-driven feelings that impact our higher centers directly, possibly driving us into unceasing mental activity. If there were ever a universal affliction, it is that unceasing activity. People cannot sit still and relax. Movement as an imprint may have meant life at birth, and it does so now as a memory.

Reconnecting the Brain

There is more and more evidence that brain tissue at the extreme anterior (front) part of the pre-frontal cortex is responsible for integration of emotional states. The recent work of a Yale team, Patricia Goldman-Rakic and Pasco Rakic, focused on the corpus callosum (the bridge between right and left brains) in which they developed a model of symmetry in the brain. What they state is that cells in the corpus callosum are marked so as to attach to mirror image cells on both sides of the brain. There may be either a certain resonating frequency that helps each side recognize each other or there may be a chemical affinity that allows cells on one side to join up—connect—with cells on the other side (or both). As I mentioned, (unproved) connected memory may exist when lower level imprints resonate with the same frequencies higher up in the brain. When the pre-fontal cortex and sub-cortex meet, there seems to be a pattern of recognition; it’s kind of like finding a soul mate. More possibly, the lower level imprints rise to seek out their other half higher in the nervous system. Once joined, they form an integrated, unified circuit.

It would seem that brain cells “know” when they have arrived at connection because the receptors on axons are found only on the correct target nerve cell. There is some evidence now that even in the womb, the brain is preparing itself for life in our world. So the fetus has recapitulated life in ancient history and is now preparing for life on the planet where each new level broadens our conscious/awareness. Each new level is an elaboration of the previous lower level until we arrive at full consciousness. Critical here is the concept of connection; the merging together of related neural networks. There is a unity of nature that happens only with connection. Neuro-psychologic laws do exist. It is up to us to find them.

Very early feelings exist in a sensory-only language have, in the past, been impossible to access and resolve. The lower levels “talk” to us all of the time in their own language (racing heart, highs blood pressure), but we never listen and have lost the ability to communicate with them. We don’t talk their language, and yet we must for survival. Otherwise, we fall sick early in life and our lifespan is much, much shorter. Because though the language is a one-way street we continue to drive on the wrong side of the nervous system (the left intellectual) and lose our orientation. We try to get to the right feeling side with the left, and we can’t get there from here.

We know that early events even before birth are imprinted throughout the system and largely onto the right brain. These events can occur before there is a functioning left pre-frontal cortex to make sense out of them. And by the time we do have that portion of the cerebral cortex the pain on the right, severe because it involves matters of life and death at birth and before, is repressed and results in a disconnection between the two sides and from lower to higher brain centers. Moreover, the connecting links are not as yet matured. This process is called repression or gating or, as it is often called in the scientific literature, dissociation. Remember, it is the very early prebirth traumas that find their way onto the right brain. The right brain, then, becomes the repository of the unconscious. Becoming conscious means reconnecting the pain to conscious-awareness. Connection means awareness even when the event has no words or scenes. We can be aware of a lack of oxygen during birth or of the agony of being twisted around due to breech presentation. That awareness is every bit as crucial as an awareness of events at the age of six even though there are no words to explain it. Sensing/experiencing the pain is awareness. It doesn’t need words.

Friday, August 7, 2009

On Connection (Part 1/6)

Someone wrote to me asking about the difference between abreaction and a Primal: the key difference, of course, is connection, which takes place in a Primal but never in abreaction. Why is that? Several reasons, not the least of which is that it takes great skill to produce a connected feeling and no skill to permit abreaction.

The two most important factors are: 1. that the patient arrives at a feeling/pain/need untrammeled by other feelings, (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 years and much experience to know how to do it. If the wrong feeling is addressed we get abreaction, which is the discharge of the energy of a feeling on a different level. Secondly, We need to know on what line or level the patient is operating on so that we confine her and us to a single level and not a mélange of levels. The idea is to remain in the feeling zone, the only zone where connection can take place. If the pulse is too high or the heart rate too fast we will be over or under the feeling zone (I call the Primal Zone); no integration can take place.

Once abreaction takes place the vital signs go up and down in sporadic fashion. In connection they rise and fall together. Generally those on the high end of vital signs stay there and then have to keep feeling and feeling because nothing gets resolved.

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 he will shut it down in the patient. He 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.
What we are after is to hook up the feeling/instinct brain with higher levels so that there is a proper lock-in. This means that the historical need/feeling/pain has been fully addressed and experienced (with all of ourselves); experience means that it is not confined to a neocortical level where intellect lives. It would seem that there may be a chemical affinity between higher and lower sites so that feelings recognize each other through their chemistry. But in any case when the vital signs do not reflect integration you can bet that connection never took place.

To put it differently, we can often tell how much of a feeling has been resolved by the amount of change in cortisol levels, all vital signs or other biochemistries. I must emphasize that abreaction is a non-feeling event. It looks like feeling, often to both the patient and therapist but there is a qualitative difference. It produces awareness without consciousness. And of course the most important is that with feeling we get well. Abreaction is destructive to any feeling therapy. To a well-trained therapist there is a hollow ring to abreaction. It doesn’t “smell” right. A therapist who is not feeling cannot pick out the difference. A patient may use abreaction as a defense against feeling, slipping into crying the minute she lies down. Or simulating a birth primal. If the patient doesn’t have her feet and arms in a specific position we know it is abreaction. Each level of consciousness is an entity onto itself. If someone is reliving something emotional and then begins birth movements it means to us that there is intrusion from another level; it may be that it is a defense against too strong emotions. If she says one word or tears up during a session of reliving birth we know it is abreaction. Defenses are tricky and we need a long training to pick them up correctly. In Primal Therapy we make it safe not to block pain, because feelings are preserved with their early scenes intact. Because each higher brain level elaborates the same sensation/feeling/need differently, we can ride the top level down and it will eventually take us to the bottom—to origins. Once down there, the system on its own will move upward toward connection automatically, following the paths of evolution for connection. We then move again up toward the right OBFC and then to the left prefrontal cortex for final connection. How do we verify this? We note that in almost every reliving there is a mounting of vital signs to inordinate levels; these levels drop with connection to normal, healthy measures. In a feeling without context, which is an abreaction, there is never this kind of organized, coordinated vital function movement. A random discharge of the energy of the feeling/pain will find its reflection in the disorganization of vital signs movements. There is no harmony to the system. And our brain research found that after one year of our therapy there were systematic changes in brain function toward a more harmonized cerebral system

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.