The Anxious Mind

Look at this review in the Sunday N.Y. Times (Oct 18/09): “For millions of children with anxiety disorders, Jerome Kagan*’s groundbreaking research has relieved a burden of blame by identifying highly reactive responses as hard-wired and thus nobody’s fault. The other burden that can be relieved is anxiety itself — the most common mental disorder but, luckily, the most treatable. With empirically proven cognitive-behavior therapy, children can learn to reinterpret their overprotective brains and their unreliable first-reaction data and, in doing so, outsmart the worry and not let their amygdalas ruin their days. Although Robin Marantz Henig’s excellent article ended on a note of resignation, given the proper tools even the most anxious children in this age of neuroplasticity can override their neural presets and make a world of difference in their lives."

This is a professional’s view of Kagan’s work. If I interpret this right it is our job as therapists to ease the guilt of patients. Since most anxieties are hard-wired according to this, it is no one’s fault. And they say, very treatable. I think it is just the opposite: anxiety is the most difficult to treat because it starts its life almost when we do, at the very beginning with a newly developing nervous system that organizes the midline responses generated by the lower brain such as respiration, digestion, heart rate… blood pressure, body temperature, stress hormones, and so on. It is our most primitive system that alerts us to the presence of danger. It is basic to survival. Anything that profound is not trivial and certainly not so easily suppressed. Remember, this is a basic survival strategy not some esoteric bizarre reaction that comes out of nowhere. Kagan is a well-known name in our field, which is why I shall spend time on his ideas.

What happens is that very early trauma, in the womb or at birth causes great pain because of the danger, for example of lack of oxygen, and it is immediately repressed in the interest of survival. Constant pain and life-threatening reactions to it are a menace to the system. So what happens when early-on the pain is compounded by infancy, childhood neglect and lack of love there is an increasingly compacted agony so that alarm reactions (more cortisol secreted), are set in place. Those primitive reactions continue their life extracted from their painful roots. Thus, seemingly “out of the blue.” A mystery? Not if we access to the deep unconscious where we can observe raw terror as it is taking place. And we now see the context of it all, which in the reliving, is resolving. We don’t have to guess any more.

We see a situation where the patient is in full terror mode with no words or scenes to put to it. Afterwards, the patient will know exactly where the terror, now called anxiety, comes from. Absent this one must guess. In science we call it something else, (hypothesis) but it is still a guess. What if we did not have to guess? Isn’t that preferable. We guess because we don’t think we can access the deep unconscious, and we are not even sure it is there. I have not seen this level of consciousness/unconsciousness discussed. It is not in the lingua franca of the scientists in our field.

But it is not just observation that counts. We have done blind studies of our patients and found that cortisol levels (stress hormones, part of alarm system), high when entering therapy, normalize after one year of treatment. The only variable to account for this is primal therapy.

It is interesting that, by the by, they agree that there are neural pre-sets, that certain biologic functions are in place. They think they are genetic, that is, hard-wired. And the general effort, they believe, is to over-ride the genetic tendencies, to hold them back, suppress, and get on with life There is not much discussion of epigenetics; what happens to those genetic tendencies as a result of trauma in the womb and at birth. If scientists don’t pay attention to the latest in neuro-biologic research they are going to neglect an awful lot.

It looks like science, the fancy laboratories, men in white coats, all the accoutrements of science. But it lies within certain boundaries that bind the investigators; that the deepest levels of the brain are inaccessible, that they are fixed and unchangeable; that these basic hard-wired tendencies are not changeable and are genetic. There is no question as to why they are in place and their basic biologic function. They take it all as a given and go on from there. Kagan sees in children a way to outsmart their pain and fear and keep the amygdala from ruining their day. This is basic cognitive therapy given the patina of research, but the guess (hypothesis) already has a frame of reference lodged in cognitive therapy; that we can think our way to health, that we can overcome our biologic reactions, that thoughts, beliefs and ideas can hold down all difficult feelings. This is forgetting that feelings and sensations are survival modes and are not meant to be suppressed. I suppose for intellectuals, locked into their heads, it is a solution but a costly one.

Just because we can suppress anxiety doesn’t mean it isn't doing great damage on lower brain levels and their bodily counterparts. Eventually strokes and cardiac attacks are the result. The brain wasn’t meant to suppress its survival mode except to keep the thinking brain functioning. Hiding the truth, which is their basic proclivity, is not a healthy option. Since intellectuals do that as a matter of course, they think it valuable for all of us. This is a neurotic strategy raised to the level of a scientific principle.

*Jerome Kagan, Yale Child Study Center.

On Being Touched

I saw a movie last night. The mother walked by her son and ruffled his hair and moved on. A seemingly innocuous event. But wait! So many of us never had that; so what does it mean? It means that someone acknowledges your existence. If parents walk by you, never smile, touch you or make you feel you exist, you come to believe you don’t. No one has to say you’re bad, I don’t love you. It is all in those very little events. Having hair ruffled day after day means you exist and are wanted, important and loved. When it does not happen day after day it means the opposite; and you come to believe it without ever realizing it. You begin to act as if you don’t exist for anyone. You shy away, never say the kind things you should because who you are and what you do does not matter.

When a parent massages you head it says volumes; I like you, I love you, you are very important, my attention is totally on you, I want to make you happy. That is all absorbed unconsciously and sometimes consciously. “Sometimes consciously” because if you never have had it you then realize something, but if you always had it, it is in the nature of things; nothing exceptional. You deserve just by who you are; and it means you can be who you are without anyone saying anything like that because it is implied and absorbed. You don’t think it matters? It matters.

On Revolution

I have discussed the importance of evolution in primal therapy. Now I want to address revolution, the overturning of the basic structure of psychotherapy as it has been for about one hundred years.

It is my belief that profound change cannot take please within a reformist attitude, making the system work better. The problem is the system. Just take the 50 minute hour. It is based on the comfort and profit of the therapist, not the healing of the patient. Our patients stay as long as necessary. No time constraints. Or take the fine furniture and well appointed drapes. It is designed to not getting at the deep unconscious. Our patients are in a therapy room with mattresses, relatively sound proof and somewhat darkened; all to encourage the descent into the unconscious. You cannot get there in a well lighted therapy room with a sit-up chair, ashtray and fine paintings on the wall. Early on, I tried that with primal and soon I had holes in the walls and broken furniture. I learned.

The theory and the therapy have to be revolutionary and not egocentric. In cognitive/insight therapy the doctor is the last word. He/she knows more than the patient and they even know what is in the patient’s deep unconscious; which is nonsense, but we all hope there is some godlike human out there who really knows us and will direct us properly, like a good daddy. The theory has to put the patient first and foremost. She knows best and she knows when to come for a session and when not to. She knows when she has had enough therapy, period. No one has to tell her that she needs three times a week therapy when that is a profit decision not usually a therapeutic one. And no one has to tell her that her time is up for the day. Can you imagine a patient crying deeply and then ushered out of the room? What magic is there in coming twice a week instead of three times?

Remember in every domain including the political, reform will never get us there. We can tinker and tweak all day long and still be dealing with a flawed system that turns out bad techniques and faulty logic; just like in neurosis where almost every bit of behavior is neurosis-generated. So we go on changing behavior and change not at all the basic problem.

Yes, overthrow by force and violence is disturbing and unsettling but necessary, and neurosis will not yield its arms easily. After all, it is there to protect us and keep us from feeling. But we are feeling human beings and need our feelings to guide us. We do not appeal to the patient’s good sense to help us overthrow the neurotic structure. We appeal to her feelings to her unconscious, to the subtext to surplant that devilish prefrontal neocortex. That is the revolution; feelings over thoughts and beliefs; insights will never get us well; they just help us rationalize how we behave. Our problem is not the lack of insights; it is the lack of feelings. A therapy of feelings will humanize us; what more could we ask for?

On Evolution and Revolution (Part 3/3)

A patient who never wants to discuss her life but sinks immediately into her past will abreact and not get well. And when we observe a person’s history we are also witnessing ancient history at the same time. A patient who cries like a newborn can never duplicate that sound after a primal. One way we know this is in observing a patient make motions during reliving birth, and cannot duplicate that movement later on, no matter how hard she tries. Too often we see abreaction in patients who start in the present, begin a feeling and then immediately skip steps and goes to some kind of birth trauma. That kind of reliving becomes a defense. It interrupts and does not enhance connection.

In dialectical fashion we descend to deep unconscious levels and immediately become conscious on that level. The unconscious is transformed into consciousness. This means that we will no longer be driven by those specific unconscious forces. We have access to our inner states. We thereafter will not suffer from such things as a bleeding ulcer or colitis without being aware of it. Chances are, however, that we won’t suffer from such afflictions.

Each lower level of brain function is designed to keep us alive. We can use lower levels to modify higher ones but it does not work in reverse. Imagine if that were possible; the higher level neocortex could permanently modify brainstem functions?
But we survive because it cannot. Thus feelings can certainly sway ideas but ideas can only suppress feelings, not eradicate them. We see in our therapy how physiology and limbic feelings directly affect ideas and beliefs. A very rapid heart rate can push someone to go and do, yet no matter how hard we try we often cannot alter the heart rate, especially the rate that is accompanied by anxiety. That is why we cannot “will” a slower heart rate over time or consciously drive away anxiety. Ideas are hundreds of millions years away from physiological and emotional functions.

I remember seeing a patient who had just started therapy who told me that since he forgave his parents he feels much better; proof that ideas can trump feeling. Yet when he was measured his stress hormone levels (cortisol) never changed. Thus the neo-cortex can trump what we think are feelings without ever touching feelings, per se. The neo-cortex is most adept at deceiving itself. It can produce the thought of being well without really being well. Ideas here function as anesthetics. In therapy we certainly don’t want to being anesthetized in order to get well.

The brain is a complex proposition and to stay on any one level in therapy to the exclusion of the others means that any progress made in therapy is partial. To do reprogramming of the brain to achieve so-called “normal brainwaves” (biofeedback) is deficient and cannot lead to cure.

When we wonder if we should call a therapy scientific we have only to ask, “does it elucidate and clarify the properties of nature?” We do not ask if it works because that is subjective and not always accurate. It is the difference between asking a scientific question and one that requires a moral perspective alone. Do we know more about humanity in this therapy or are we only after some sort of pragmatic, mechanical solution? Are we doing deep breathing or matching brainwaves to some ideal? Here the focus is on the technique, not the patient nor evolution; a major difference. When we focus on how the patient evolves we learn; when we decide on how we treat her beforehand we don’t. In short, can we learn from this therapy how to treat other human beings in psychotherapy? It is not a matter of defying evolution, but of harnessing it for the good of mankind. That is Darwin’s legacy.

On Evolution and Revolution (Part 2/3)

The Brain's Evolution and Therapy

Do you ever wonder why it is that we fall asleep in reverse order of evolution? And why we come out of it in correct order. In means, first of all, that we are prisoners of the brain’s evolution; and when we start to become consciously/aware we move to the highest level of the brain. We come out of antiquity into modern life as though we have gone through the centuries or the millennia in proper order each day in order to achieve consciousness. We do the same thing in Primal Therapy; and in doing so we must strictly obey evolutionary edicts. We can no more change that order than do so in our sleep. And when we trump that order in sleep, psychosis lurks. If we do not have enough dream (second-line limbic consciousness) sleep we suffer. And we develop physical and mental symptoms. Now what is crucial here is if we trump that order in Primal Therapy we suffer from those very same symptoms. That is why re-birthing is so dangerous; it trumps evolution. That is why cognitive therapy cannot work; it trumps the feeling areas of the brain and ignores evolution.

As with dream sleep, Primal Therapy enters the deep unconscious, slowly in ordered progression. Down on that deep level lies so many of our remote and life-and-death pains. It shows itself in our nightmares which are associated with terrible terror/anxiety states, and it is demonstrated in deep Primals where heavy pains reside. Until we have access to those imprints we can never know about life-endangering memories, nor include them in a therapeutic process. What this tells us is that we are evolutionary beings who biologically must adhere to the history of mankind; there is an order to the universe of which we are part. I cannot stress this enough. We do not take patients into birth traumas in the first weeks of therapy anymore than in dream sleep we go directly into deep sleep. Evolution is an ordered affair. We must not superimpose our ideas, our theory or our techniques on patients. The rule is that it is not up to us to decide for the patient, as for example, that she needs dream analysis, or neuro-feedback or rebirthing. It is always the patient and her readiness that dictates our approach.

Each new brain level in evolution helps out with survival, otherwise it would not be there. The brainstem and early limbic system have everything to do with survival—breathing, blood pressure, heart rate and body temperature. Evolution continues with its survival strategies finishing up with the neocortex. What this structure can do is detect enemies not only without but within—our feelings. And when it does it helps us survive by disconnecting us from the source of the pain; a self we will never meet again until we have access to deep brain structures. That may be never; and that may kill us prematurely.
As we travel through evolutionary time to the neocortex each adds its physiologic contribution. The reason that ideas cannot trump feelings is that feelings are integral to survival. They are a survival system. The neo-cortex is also very important to survival but in a different way. When we are in a coma without any neo-cortex really working our survival functions (heart rate, blood pressure, etc), are still operational. Animals survive very well without a complex neo-cortex. They won’t survive if the brainstem is damaged. We have to breathe no matter what.

Each lower level of brain function is designed to keep us alive. We can use lower levels to modify higher ones but it does not work in reverse. Imagine if the higher level neocortex could permanently modify brainstem functions? We survive because it cannot. Thus feelings can certainly sway ideas but ideas can only suppress feelings, not eradicate them. We see in our therapy how physiology and limbic feelings directly affect ideas and beliefs. A very rapid heart rate can push someone to go and do, yet no matter how hard we try we often cannot permanently alter the heart rate, especially the rate that is accompanied by anxiety. That is why we cannot “will” a slower heart rate over time. Ideas are hundreds of millions years away from physiological and emotional functions.

We know that the amygdala is pretty well mature at the time of birth so that we can code and register inchoate feelings. But the hippocampus is not yet fully developed for several years so that precision regarding the time and place and scene or origin is beyond its capacity. So we can dredge up feeling on the experiential level but not on the verbal one. So for those who claim to practice rebirthing we have to ask if there are any words to go along with the event. If there are, it is not a true event. We cannot overlook brain evolution in our therapy and perform what amounts to magic.