Saturday, December 12, 2009

Why Are We Anxious? (Part 1/6)

Why are we anxious? What is it? Where does it come from? How do we make it go away? We don’t. But I am getting ahead of myself. First, we need to know what it is and what it feels like.

The symptoms of anxiety are basically controlled by the brainstem and some ancient parts of the feeling/limbic system—primitive survival functions: shortness of breath, (“I can’t catch my breath.”), needing to urinate, feeling crushed, pressure on the chest, butterflies in the stomach, cramps, palpitations, the inability to sit still, problems with digestion, a feeling of being scattered and unfocused, loss of concentration and, above all, feelings of doom and gloom—death is approaching. Associated with that feeling is a deep sense of being helpless and hopeless. In addition, there is the constant feeling, “am I going to make it?” That is the precise fear felt physiologically during the birth process where the successful ending was not at all sure. The substrate may be, “I won’t make it,” which shows up at the end of semester final exam in the body of the person as a pure anxiety state. It is anxiety because resonance from the final exam has set off the early terror where making it was problematic. And what it set off is clearly deeply unconscious and so defies conscious/awareness. It set off the real feeling of desperation and hopelessness because not making it meant death; never articulated but felt from experience. The articulation is in the anxiety. And the body now expresses precisely.

We might include in this is the horrible fear of failure. Because taking a final exam set off the anxiety over failing when failing meant possible death. Again, no one has articulated this but the body in its great wisdom has in its own way. Anxiety is a survival mechanism that alerts us, galvanizes us into action to avoid death. The problem is the inability to come off this vigilant state. I want to reiterate this point: anxiety is not just a pesky feeling that needs to be eliminated; it needs to be embraced as a warning signal to save our lives.

This is what I call “first-line.” The inability to concentrate comes from massive pain input from below. It disrupts the normal functioning of the neo-cortex. And all this is logical since death was approaching in the original event. It could be a carrying mother terribly anxious and agitated, a mother who takes drugs, who does not eat enough or properly, and who is just miserable, for any number of reasons. The brain researcher J.K.S Anand, found that when a needle was inserted into the mother’s abdomen (amniocentesis) the fetus attempted to escape it; grimacing, turning his head, while the secretions of in-built anti-pain chemicals skyrocketed. The fetus was not anxious, he was terrified. When he grows up and is far from the memory it will be called anxiety. Still the same terror that the salamander in us is carrying around.

Why the feelings of doom and gloom? Because it was a logical reaction to menacing events. Doom was in the offing, in the same way that a massive dose of anesthesia given to the mother during birth, largely shuts down the baby’s system and is experienced as doom. In the memory the menace is still active and present; we cannot shake it loose because it is now imprinted into the neurophysiology. Once we get to that memory and experience the entire circumstances and feelings involved we can finally relax and feel comfortable.

Take for example the feeling of anxiety suffered by one of my patients at the Department of Motor Vehicles. She went to get a new license. As soon as she arrived the obstacles began; long lines where she had to wait; she needed to fill out this form, needed proof of this or that. It was interminable. It all piled up and she became anxious and feeling agitated with no way to stop the feeling. In the afternoon session she felt the helplessness behind it all, and relived that helpless feeling at birth when no matter what she did she could not get out. She could not be in anyone else’s hands and could not trust anyone with her feelings. For her death was menacing, and anxiety began. Any serious helpless feeling dipped into the original one where it was a matter of life-and-death. This patient was far enough along in her therapy to have deep access; not always the case. Waiting (to get out) bothers many of my patients because of the resonance factor where that primordial waiting could have spelled doom.

One of my pre-psychotics was in the waiting room bar waiting for his restaurant table. He kept being put off by the concierge. He exploded and started to break the dishes hung on the wall. His pain was right up to the surface (which made him pre-psychotic). It wasn’t like he was waiting to get born back then; it (the feeling/sensation) was absolutely here and now. He was desperate and he never knew why—until he felt. And needless to say, no one put any ideas about all this into his head. But we watched during the reliving as he gagged and turned red, obviously losing breath rapidly.

Those early reactions were not irrational or neurotic. Who gets anxious when they have to fill out long forms? They were proper at the time but continued on because the sensations and feelings associated with the early event are now imprinted and dog us forever. It is only the context that has changed; once we plug into the imprinted memory it all makes sense. When we do not consider the imprint it seems terribly neurotic. We don’t just have those feelings mentioned above as a sort of caprice; we don’t manufacture them out of some whim. They should be there. It is our job to find out why. The feeling when about to take a test is explained by a patient, “I am not prepared to present a paper. I know I won’t make it.” He said he felt like a “wreck.” His wife called him a mess.
Anxiety means that the lower brain is at work, the brain we have in common with the salamander; and indeed, the salamander brain is almost intact in the lower reaches of our brain. We do have a reptile inside our head that does what reptiles do. It still reacts like it use to when it was inside the animal brain. That brain has remained largely unchanged through millions of years. It reacts immediately, often without reflection, and prepares us for the onslaught of incoming events (both external, and more importantly, internal). Those internal events are feelings that seem alien to us and which we attempt to repress at all times. When we cannot, we become anxious; the harbinger of strange feelings approaching consciousness. The reptilian brain is largely tamed or mollified by the later developing brains. But once we remove the newly evolved brain caps (as we do in the psychologic sense) we see it largely intact as it once was. We can see the reptile inside. We observe as they make the primordial “S” movements during a reliving of birth, something the patient cannot duplicate once out of the feeling.

Why does that sound strange, the salamander rummaging around in our heads? No more strange than the fact that ancient flippers became our hands and arms. We carry around vestiges of our ancient past in most of our organs. Rats have brains and kidneys too; and it turns out that their genes are not that different from ours and are almost as plentiful.

The impulsive neurotics, rapist, killers, acting-out impulsives, usually have a great deal of what I call first-line trauma and pain. (Discussed in a moment). Their neo-cortex was never properly developed and there is a great deal of damage (impairment) to the lower brain; that damage leaves a residue of impulses that are barely contained. So are they human? They are basically primitive animals, deficient in neural tissue for control; lizards with an add-on. Others may have impairment to their feeling brain; this would occur after the first few months of life on earth and will determine how they relate to others, or whether a person can relate to others. I would call this, limbically impaired. I often think of it as a “missing feeling band.”
But it is rarely one or the other. Damage in the womb will later affect so many of our functions: the brain, the visceral system, organ systems and vital functions. The goal is to have our human brain meet up first with the chimp brain and then the lizard brain so that they can be intimate, know each other and communicate well among them. When they do we are normal. And we are conscious because all three levels interact fluidly. That is what consciousness means.


  1. Art
    So far away… yet so close... it's amazing that life can pass us by with the natural physiological "laws" so close... with a truth we deny because we do not have the basic physiological needs satisfied. What a tragedy for man… the "science" to distort the laws of nature... silence the truth for needs that never will be satisfied. “God” I wish you will be heard Art.
    Frank Larsson

  2. Dear Art Janov , I can´t help but each and every time I read this article I am flabbergasted(the right word?...) how exactly my life reactions et. are described therein! Thanks 1 Yours emanuel

  3. Dr Janov,

    Using myself as an example, I think much of our aggression may only be a symbolic deriviatve of fear:

    I once had a dream (birth-related?) that I was about to go through a tunnel and I was extremely scared before I had to do it. I felt completely vulnerable and "pathetic". I then created an aggression within myself and a determination to drive through that tunnel - so the fear then seemed to turn to a determined aggression.

    I find it interesting how I tend to feel anxious, when I do, when I have to be inhibited on certain levels. I think my inhibition undermines my ability to be aggressive as a key defense, which in turn forces me to feel vulnerable (depending on the particular conditions and 'triggers') which in turn gives way to my anxiety - almost certainly, no doubt, linking to a birth event.

    --To say, maybe the "fight or flight" response (fear or anger) could be better referred to as "flight or fight". In evolutionary terms, it makes sense that the run-away option would be embraced before risking personal injury. Very speculative - but maybe all aggression is first derived from a feeling of being backed into a corner.

  4. Andrew, I think all traumatic events involve a feeling of being backed into a corner (inescapable and hopeless). I think Art's theory is plausible: whether you become aggressive or conservative depends on the unique ways you adapted to early pain.
    It seems like a natural continuation of other types of learning. Scientists reckon babies take time to learn how to use their 3D vision. Maybe jungle people are better at seeing the distance between trees, while desert people are better at seeing the distance between sand dunes. One neurotic desert dweller gets angry when he runs around a corner and straight into a tree. Another neurotic desert dweller runs into the same tree but begins to cry instead. A normal desert dweller avoids the collision as he didn't feel the need to run. Nothing is ever simple. (I have never run into a tree but I did walk into a pole which was positioned in the middle of a footpath, at the same height as my groin, by some thoughtless city planners in Sydney)


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.