Friday, November 13, 2009

On Vital Signs in Primal Therapy

For many years we have measured the vital signs of patients before and after each session and over the long term. Our results show a normalization after one year of the therapy (when we took the final measurements). Of course, when we measure vital signs we are measuring vital functions; those functions that keep us alive and allow us to survive. When any of them exceed normal limits we are in trouble. Whether too low a blood pressure or too high a heart rate or a continual body temp far over normal range, the minute we are dislocated one way (high) or the other (low) the body is telling us that something is wrong. And it tells us in what way is something wrong, and sometimes even why, if we know how to read the signs. Over the years when these signs are excessive we can almost be sure that disease will occur early in life, followed by life threatening illness later in life. It is ineluctable.

These vital signs mean vitality. And they reflect our imprints quite accurately. They also reflect what nervous system is in charge and is dominant. We know, for example, that many vital functions are either controlled by one of two nervous systems mediated by the hypothalamus. I thought for some time that the parasympathetic, that of rest, repair and repose, controlled body temp. But it may be that the direction of the dislocation depends on two different nervous systems. Thus, high is controlled by the sympathetic, the galvanizing, mobilizing, alerting system, while a swing to the low end is controlled by the parasympathetic. (This may also be true of the systolic and diastolic blood pressure). Thus, the direction tells us the kind of imprint we are dealing with. Today I heard from an epileptic, a breech birth, suffocating and strangling on the cord who had to conserve oxygen and energy to survive. His modus operandi was to hold back, not use energy. His imprint was parasympathetic, something that will dog him for a lifetime and determine his interests (writing), his non-interests (exercising), whom he marries (the aggressive one) and how he will treat his children (passively or with indifference). And that is not the half of it.

Now why all this? Because the very first life-saving effort becomes imprinted and remains as a guide for future behavior; what saved her life at the start will go on being utilized despite any reality to the contrary. Personality is formed out of this matrix and a certain biologic state. Of course, later experience helps shape it all, as well. But that first imprint is vital, in every sense of the word.

When patients come in for a session and we do measurements, we already have an idea of where we have to go. One of my depressives came in consistently with a very low body temp of 96 to 96.5. She was mired in hopelessness. As our session went on (almost 3 hours each time), she started to normalize. That was important because a whole lifetime was wrapped around the vital functions. It wasn’t just the body temp that normalized but a whole host of biologic responses and personality features. Later on, she smiled, had energy and felt “up.” She could go seek a job, something she could not do previously. And of course, she never had enough money to buy proper food because she could not hold a job. A previous therapy informed her that hers was a “loser trip”. That didn’t help much except to put a label on her behavior. As she went on reliving the prebirth and birth traumas, a mother smoking and taking tranquilizers, suppressing her whole system, which was also imprinted, her body temp came up and stayed up to 98 degrees.

When a patient comes in with a very rapid heart rate and a brainwave signature of beta (very fast) our first job is to bring him into the feeling/primal zone. If we do not do that he remains above the primal zone. He will not feel and certainly not integrate. When the patient is too low the same law operates. We can only feel in the primal zone. We need to adjust medications to allow that to happen. We cannot and must not cajole a patient into trying to feel (and often the fast ones are also the tryers).
I believe that the parasympath operates on the low end of all vital signs. We can go to different doctors and be treated for a heart rate that is unsteady, another doctor for high blood pressure, and yet another for lack of energy. But the leader who sets the tone is the imprint. Unless we recognize this we will be bifurcated in our efforts and miss the essential. One key thing we want to know after each session is was there integration? Sometimes there is, after weeks of feeling one key feeling. But often there is a dredge effect; the patient feeling one feeling which resonates with a connected deeper feeling (hoplessness and helplessness). We know here that there is more to come. It may be that the patient will need tranquilizers temporarily to get over the hump. We need not be afraid of this since it is not an end in our therapy but a means. It is not THE therapy, as is the case in so much psychiatry, but something to use for a bit of time. We want patients off drugs, not on them. While on them there is a superficial and artificial state. Drugs nearly always hold back feelings and aid defenses. That is not the business we are in; quite the opposite, we want feelings to come up but in ordered, measured ways. Primal Therapy will get you there if you let it. If you stay with it the direction is nearly always right. I often say, “It is not a miracle but it is miraculous.”

29 comments:

  1. Hi,

    Some comments again:

    I think that the 'imprinting' effect of the first early trauma may have a lot to do with the first trauma setting the stage for the *method* of defence in response later trauma. So, as I suggest, the imprint is effectively reinforced from later traumas as the same basic defensive mode is activated and utilised, and in turn continuously reinforced into our personalities. If that's the case, then I would imagine that a birth imprint would be less obvious and pronounced in someone who had less compounded trauma after birth...as the imprint is lesser reinforced? So the original imprint itself is functionally weaker?

    Also to say Dr Janov, I remember you saying somewhere (I think?) that once a person has resolved a birth trauma (or an 'imprinting' equivalent) the behavioural patterns are still there, but the "force" is gone. That would make sense to me. The 'force' would be the compulsive dynamic removed, and the remnant behavioural effects should ultimately just be learned behaviour of which has sculpted our personality over the years. We must always be ex-neurotics in that our entire developmental history has been based on and guided by a neurotic foundation, and that's one dynamic that can never be changed with or without PT. (Not to suggest that some level of 'post' development could not occur - of course it could and would. We never stop developing).

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  2. I find it hard, as a feeling, to further complicate the theraputic process with scientific means of verifying (even though I understand cognitivley why). The whole threapy process is via feelings, both the feelings of thereapist's about what the patient is feeling, and the patients feelings. The only caveat needed, IMO, the therapist is not bringing his/her old feelings into the therapy room. For the trainee therapist it is going to take an extensive amount of' 'practice' to accomplish this. Hence your insistance Art on a thorough training that has an experienced supervisor.

    Since the scientific community and the medical science community in particular, insist on objective scientific veracity, I understand your attempt to comply, but alas, whatever you do they have dismissed Primal theory out of hand and have no intentions of even looking at it. I feel the jury is rigged against you, there's too much vested interest here, just as there is in politics.

    To me, youth is our only hope, Their inner rebelliousness could save the day. If they were to understand Primal theory (it's so simple and elegant), for they are struggling between what is left of feelingfulness, and the neurotic system that we adults have already bought into. How might that be initiated I don't fully know, but I am making my bid with my book.

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  3. Not sure if I can post here, but what the hey. It's worth a shot.

    I tried Primal Therapy in Boston during the early 70s. Having recently read a lot of Alice Miller (whom I LOVE), I think I was retraumatized. Alice tried Primal, too, though I don’t think in California. She found much to like, but became disillusioned when the therapist she'd endorsed was accused of having sex with his female patients. She also came to believe that venting deep feelings alone was not enough; they had to be integrated with cognition, too.

    Anyway, there were originally 4 therapists in the practice I frequented. In retrospect, they were a motley crew, akin to those who ran the infamous Center for Feeling Therapy (http://tinyurl.com/yld88fa). All had been trained by Daniel Casriel in NYC: A couple; the married woman's brother; and all 3's friend.

    Early on the brother and sister parted ways for unknown reasons. Two different “schools” ensued.

    Soon after, the wife separated from her still-leading-groups husband. She started having sex with some of her "patients."

    The 4th "friend" (a mythic Great Santini-like tough-guy) also began sleeping with some of HIS clients. It also turned out that he’d slept with the then-married female therapist back in New York.

    In short: A practical and ethical mess.

    Still, in those post-Sixties times, none of that seemed to matter. What were boundaries after all, but “bourgeois” contrivances of The Man? We paying clients felt in no position to question those in charge. We believed their warning that Primal Therapy was our one and only hope. Besides, they seemed to have their shite together: Marriages (sort of), fancy cars, nice homes in the burbs, etc. We, on the other hand, were lost souls seeking shepherds.

    Years later, sadder truths unfolded.

    The former husband, now divorced, was injured in motor vehicle accident in Thailand. Many believe he'd been on a sex tour. He became a paraplegic and ultimately killed himself.

    The "friend" (aka "Major Payne") therapist went into a coma in the 1990s. An effort was made to have former patients record messages to try to bring him "back to life." Only one person participated. The therapist never recovered. Few seemed to care.

    The brother of the sister/wife, I heard, went back to using drugs.

    A gay patient killed himself.

    One woman had her intestines removed, living ever since with a colostomy bag.

    A quasi-therapist patient who co-led groups recently drove his car into a pond, apparently trying to commit suicide. His son, once so full of promise, rots in prison. His wife (also a former quasi-therapist) divorced him, becoming an alcoholic. She moved back to her college town to sleep with young male students. The guy who tried to kill himself had re-married, this time to a woman who looked just like his former Boston therapist.

    Another woman went from having sex with just about everyone to becoming a born-again Christian.

    Another female, a holistic “wiccan,” now uses medication to control her “depression.”

    You can’t make this stuff up. To say, as Arthur’s website does, that "This therapy is dangerous in untrained hands," is not an understatement. Trust me.

    Anyway, in addition to any “scientific” importance that monitoring vital signs might bring, doing so probably provides a level of comfort for patients. Maybe it’s just a placebo, but still: It’s nice to know that if you feel like you’re going crazy a bona fide doctor will be nearby. It might make it easier to let go. If, worse come to worse, you DO end up playing handball with your own stool someone kind and caring will look after you.

    Why does writing that make me feel so sad?

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  4. [I’m adding the following in case the prior post is accepted. It might help explain a bit more of my “Primal” experiences back in-the-day…and why current practices would have helped a lot.]

    What did I or anyone else know 35+ years ago other than "primaling" was powerful and seemed to offer hope? We thought the louder you screamed, the healthier you got. And faster. No years and years of couch talk. "Bellowers" become favorites, too, lording it over others in a Primal pecking order. “Ratpacking” those who found it hard to Primal was forbidden, yet common.

    Ultimately I stopped going. Not because I thought it was a hoax or harmful, but because I felt stuck. I felt like a failure, too afraid to FEEL. I’d opened Primal’s Pandoran box, but no longer trusted those in Group to support me. Instead, I stayed silent, urging others to scream louder-louder-louder.

    I felt doomed. I knew the power of feelings, but no longer felt able to go down deep into them.

    I could go into more detail but I'm not sure I can post here...or if this will even appear. I just know that I experienced SOMETHING profound the few times I felt safe enough…or scared enough…to “let go.” Unfortunately I also learned to be guarded around my therapist (of course, I’d chosen Mr. Hardass!).

    I also thought all the therapists had missed something that Arthur might have taught them if they’d trained with him. Maybe humility…or at least SOME respect for the powers they were dabbling with…and unleashing.

    But, as I said, credentials not only didn't seem to matter (part of the 60s opposition to the Establishment?), they were also deemed a “cop out.” Traditional medical metrics and practices were considered part of the problem.

    I certainly thought so. I didn’t question much of what I experienced. The screaming reminded me of my manic-depressive mother’s breakdowns. So I thought the way out was MORE craziness…like screaming ever-louder and longer. Like those movies about amnesia where the cure is being bonked on the head again. Or living in one of R. D. Laing’s “sane homes” where sick patients made fecal paintings to get healthy.

    If you didn’t get sane parenting, how do you know what’s normal? Your radar is miscalibrated. You’re like the abused protagonist in SLINGBLADE who thinks mustard-slathered biscuits are comfort food.

    I also thought others had the key to unlock my stuckedness. I still think that. Since others muck us up, it only makes sense that others might set us straight, too. The problem is, how do mucked-up people pick healthy helpers? I’d had few “enlightened witnesses” validating my feelings and experiences growing up. So I found it hard to believe that "trained" therapists could be effed-up, too.

    In many ways Primaling was like dropping acid: A way, albeit dangerous, out of the doldrums. A book for the era might have been titled, "We Were Young Once, And Stupid."

    The last thing I wanted, but needed, was calm. I was that fabled kid who ran away from a neglect-filled home into cold, rainy woods. Finally spotting the smoke of a cabin, I stood on its porch. A kind granny led me to a couch inside, wrapping me in blankets while she went to make cocoa. When she came back I was gone. It was too painful to stay and start thawing out emotionally. To feel her warmth and care I’d have to also feel the years of neglect and cold. It was too much to risk. I’d cared for a crazy mother, after all. To cope I’d stuffed my feelings. Who’d catch ME if I let go? I thought by therapist and fellow Group members would. Mostly they badgered and shamed.

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  5. Trevor. thanks for the letter. I think the primal therapy now is far more advanced scientifically and far more safe. I think finally after forty years of work we are getting a handle on it. In the last 5 years our therapy has progressed more than the thirty years before. It takes a long time to perfect a therapy, and it took us a long time. We try always to be careful, tell everyone it has nothing to do with screaming, etc. but still you build a ford before a rolls. art janov

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  6. Trevor. Since we never had a clinic in Boston you obviously went to mock therapists and then think it is primal therapy, which gives us a bad name. We have been working on the neurology and biology of our work for decades. It is unfair to to lump us in with charlatans. Why not go to the right place, in the first place? When you say you tried Primal Therapy.....NO YOU DIDN'T. Nor did Alice Miller. I know her and know she did not go to us. Going there makes you sad because you wasted your life. I cannot control the world. I can control our therapy which I think is now state-of-the-art. dr. janov

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  7. Trevor:

    You post was interesting - thanks.

    On normal:
    With respect to normality I think many or most people develop an 'idea' of what normal is, then judge their sanity by their ability to live up to that idea. Of course that proves nothing of sanity in itself, and only the need to live up to a stereotype. And there's a whopping great price to pay for this kind of "normality" too - you tend deny yourself too much of what is real and right for you, with respect to whatever your neurotic and non-neurotic needs may be, and all in the name of living up to socially-abstract exceptions.

    I think one of the virtues of Janov's writings is that they help to clarify the meaning of 'normal' by providing a "cut-the-crap" penetration into the meaning and reality of human nature, at least in humanistic terms. I think it can help some people have to courage to be more true themselves and their own nature, by rightfully 'dethroning' what are often irrational expectations from others.

    Mock therapy:
    In rememberer reading a small amount about a mock therapy (claimed PT-based) called "the feeling centre", or something like that.
    I understand they had a hierarchy system where those who were supposedly more feeling had special conduct-rights *over* those who were less feeling. With such pathetic power-tripping codes like that I can understand how important it is to avoid B-grade therapy. Obviously there are some seriously erroneous practitioners out there!

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  8. Hi Art

    I was intrigued by this comment " In the last 5 years our therapy has progressed more than the thirty years before." I wonder if you could give us more details; also what do you see ahead for the therapy in the next 10 or even 20 years.

    Thanks
    Steven

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  9. Steven: I have no idea about the future except that I do know that it will be the therapy of the future. How could it not since it is the most efficacious therapy existant? It is also the therapy that dovetails with most current research, especially in neuroscience. art janov

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  10. Art,
    You ought to try to recruit Andrew Atkin. Pay him to train (if need be) to become your successor. People with brains like Andrew's don't grow on trees!

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  11. Pbef: thanks. do I need a successor? AJ

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  12. Pbef:

    That's quite a compliment!

    Would I be an effective therapist? I really don't know. My relationship to all this (on the blog) is essentially academic. I have no compelling desire to be a therapist as such.

    When I hopefully get therapy I could maybe one day expand into it to participate in PT on some level (other than a patient)...but that is absolutely "open book". Though, I would certainly not want special treatment and I don't consider myself to have superior (relevant) capacity to others! But hey, like most of us I'm sure I have my talents.

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  13. Dear Art,

    In reply to that you wrote: "do I need a successor?"

    No, you don't; but I am fairly sure that the availability of best practice primal therapy would be less likely to be maintained (for as long into the future) without someone (or more than one person) to fill your shoes. This "filling of shoes" would have to be about someone(s) being similar-enough to you in analytical style and in having the ability and tendency to stay on the course (toward the 'core of the PT kind of cure').

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  14. OK I agree. It has to be someone who is long in our therapy. That is the problem. We don't need academics and intellectuals. The world has enough of those. art janov

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  15. I hate to say this but I think the success of Primal Therapy will jump start when Arthur Janov departs. The staying of the current course will not achieve that. What is needed is the ability to accept the current state of the science for what it is and to make a roadmap that begins there and pushes forward in a way that does not alienate critical support. In contrast, the current course dismisses just about everyone who could be part of a meaningful change. It pits itself against a staged intractable foe and plays the helpless victim. It has appeal to a certain kind of damaged soul (you know who you are), and it makes no mark whatsoever on the rest of the people of the world.

    I hated saying that.

    Walden

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  16. Walden: Well I guess I now have to jump off a bridge. You know Marx never directed his efforts in trying to change the capitalists. He aimed at the exploited by capitalists. I try to aim at the hurting people and hope one day that the professionals will get on board. It aint gonna happen. You know , if you leave open other approaches you get what you get in the treatment of addiction by Promises. A hodge podge of many modes of therapy none of which are effective, but the hope is that if you pile on one thing after another there is bound to be progress. Tell me one person who could be part of meaningful change that we have neglected; since you have no idea what we have done or who we have reached out to it is better to ask than advise. art janov.

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  17. Walden,

    As a prospective patient, I would be far more worried about Arthur's PT turning into a mock version of itself, in response to his departure. That is, if it started to confuse itself with state-of-the-art cognitive philosophies which are probably completely detached from the real business of getting me into my pain.

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  18. What you don't want is so-called democratic tendencies to leave the way open to everyone and all therapies. If a therapy is scientific and is effective, stay with it and do not invite the world in in order to assuage some sense of being democratic. Art janov

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  19. ....Hope I'm not over-beating the drum, but I wanted to send this comment too,

    Walden and everyone,

    When a new technology or system of any given type develops, it usually develops with aggresive progress in the early stages and then it tapers off with more 'refinement level' progress as it gets closer to its natural optimum (or state of perfection, if you like). So is Primal Therapy 50%, 90% or 95% the way there? I don't know. And neither do most people on this blog because we're looking from the outside in, and you obviously have to be on the inside (with the right experience) to answer a question like that.

    My point? If is so happens that PT is about 90% perfected or more, then it's not going to make any "giant leaps" in terms of its internal progress. A "revolution" will have more to do with Infiltration, than development. And if thast is the case then yes, Primal Therapy must be competitive with the staus quo - not compromised by it.

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  20. "You know Marx never directed his efforts in trying to change the capitalists. He aimed at the exploited by capitalists."



    I think the word exploitation is a psychological projection of Marx's own ideology by creating the exact situation he academically claimed to save people from. Not to mention his reponsibility for the deaths of 100 million people (www.victimsofcommunism.org) In the socialist gulags/forced labor prison camps people were truly exploited because were forced to work whether they wanted to or not under a monopoly of one government employer with no other competing employers. They had to do whatever the intellectuals wanted them to.

    His so called exploitation theory fell apart by any empirical test of noticing the simple fact that in a coercion free market employers in competition with each other, unlike the government, cannot set wages no matter how hard they try. Employees are free to work for another employer commensurate with the value they can provide. So much so that now there are now contracts bound by time to prevent the employee from exploiting the helpless employer.

    The word exploitation as used is a misnomer as well, characteristic of Marx's shameless linguistic abuse. In that sense, anyone that provides anything of value to another person such as a grocery store, will be said to be exploiting peoples hunger. But they don't make people more hungry, they voluntarily offer them products to make them full and satisfied.






    "I try to aim at the hurting people and hope one day that the professionals will get on board."




    That sounds like a solid plan Dr. Janov, it certainly is the case me. However in the context of Marx, it is not a movement of the people!!!!! Pushers of coercion are ALwAYS from the top not the bottom. Reminds me of a quote:




    "When one observes the nightmare of the desperate efforts made by hundreds of thousands of people struggling to escape from the socialized countries, to escape over barbed-wire fences, under machine-gun fire—one can no longer believe that socialism, in any of its forms, is motivated by benevolence and by the desire to achieve men’s welfare.

    No man of authentic benevolence could evade or ignore so great a horror on so vast a scale.

    Socialism is not a movement of the people. It is a movement of the intellectuals, originated, led and controlled by the intellectuals, carried by them out of their stuffy ivory towers into those bloody fields of practice where they unite with their allies and executors: the thugs."

    -Ayn Rand

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  21. For all the viability and validity of Primal Therapy, in the end, therapy is attempting to "mend the already damaged" When Art departs (if he goes before me) I will cry for my loss of one of my two heroes. The first one is already gone: Shakespeare. Sadly, I suspect there will not be successor to Art and as a consequence there will perhaps be many off shoots of Primal Therapy. However effective any of them will be, it will still be "attempting to mend the already damaged". We need prevention, and from what, to me, is Arthur Janov's genius and greatest contribution to mankind is; his formulation of Primal Theory. The theory implies that it is our child-rearing practices that cause our problems. Can we extrapolate from his theory a way to begin to not damage the children of tomorrow?. I feel it could, and hope it might.

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  22. Any decent system has to grow organically from well people. Otherwise neurotics get corrupted and turn it to shit. art janov

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  23. Jack: How very kind. I too love Shakespeare. Am now reading and rereading The Rape of Lucretia. There are insights there that are mind-blowing. The great great genius. art janov

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  24. One last thought Kaz. When I see what outsiders do to my therapy I cringe. It is no less true about socialism, a good system turned to shit by the corrupt. art janov I am not a fan of Ayn Rand.

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  25. Yeah I am NO fan of Ayn Rand either! Her message to the unemployed is : " DIE if you can`t make it; why should my taxes support you on welfare?! And if you are sick and can't afford health care, tough! Stay sick" . There is a well-known LA psychologist and author named Nathaniel Branden who was her close disciple, and then broke from her. But he still spouts a sick pro-capitalist fundamentalist line in his books .There has to be some balance between the socialist ideals and the freedom to exchange. The whole world is groping towards that with much debate and experimentation. Luckily we have edged away from the nuclear confrontation that could have destroyed a good part of the whole world because of this capitalist-socialist debate! Marco

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  26. Macor22:

    The problem with left-wingers is they tend to create the very poverty class that needs all that support in the first place.

    Left-wing versus right-wing? It is all bullshit. There is only the right thing to do - government staying out of peoples lives except in exceptional circumstances, not playing funny games with the labour market that forces people to sell their labour for an appallingly low price, and only helping people out when they really need the help - but yes, certainly helping them out in those circumstances.

    After that it's just big fat empty debate that stops people from developing a considered and reasonable understanding of public policy. We're all supposed to just "join a camp" rather than demand respectable policies.

    -Hope I'm not getting too political here Dr Janov?

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  27. Being political is necessary cause we all live in this world. art janov

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