Tuesday, December 28, 2010

Elements of Primal Theory (by Peter G. Pronzos, a Friend and University Lecturer)

Isaac Newton, one of the most celebrated scientists of all time, once remarked that he could see far because he was, “standing on the shoulders of giants.” In the same way, Arthur Janov’s ground-breaking approach to psychotherapy, Primal Therapy, combines some of the most important elements of his predecessors while providing a deeper and more complete theory of the healing process.

This became clear to me as I was reading the second edition of Louis Cozolino’s invaluable book, The Neuroscience of Psychotherapy.

For instance, Cozolino writes that Freud’s psychoanalysis and the psychodynamic forms of therapy that grew out of it, share theoretical assumptions such as the existence of the unconscious, the power of early childhood experiences, and the existence of defenses that distort reality in order to reduce anxiety and enhance coping.

Janov, who originally trained with Freudians, practiced conventional psychotherapy until his work led him to discover what he termed “Primal Pain”. In general, this refers to traumas experienced by babies and children which are so painful that the hurt must be dissociated from consciousness. In the more than three decades that followed, he has refined Primal Therapy as a way to allow patients to connect with these feelings in order for healing to occur.

However, in contrast to Freud’s psychoanalysis and some modern psychodynamic methods, Primal Therapists do not interpret or explain to a patient what they think he or she is “really” feeling.

They don’t offer “insights” or speculate about the source of the trauma, nor would they ask a client to do something artificial, such as exaggerated breathing or play-acting.

Instead of such arbitrary practices, Janov maintains that patients must discover their own unique truths for themselves, with the therapist acting as a skilled and empathetic “witness”. This “client-centered therapy” was pioneered by Carl Rogers in the 1960s. As Cozolino explains: “Rogers emphasized creating a relationship that maximized the individual’s opportunity for self-discovery.”

In the same vein, a Primal Therapist does not end a session after 50 minutes or some other artificial time limit. The patient has as much time as needed, and a session often lasts two hours or more.

A session usually begins by encouraging the patient to get in touch with whatever they are feeling at the moment. That is the real “royal road to the unconscious”. It may be an emotion, a memory, a dream, a song in one’s head, or perhaps a physical sensation. This bodily focus was first used by Wilhelm Reich, who had studied with Freud and who, as Cozolino notes, understood “that memory is stored not just in the brain but throughout the entire body.”

In short, trusting the client to find their own way (with appropriate suggestions from the therapist) is not only the most reliable approach to access deep feelings, but, not surprisingly, is vital to build trust between the client and therapist – an element that is essential for a healing relationship to develop. While Janov does not agree with the belief that, “the curative element is the therapeutic relationship itself”, he stresses that the patient must feel that they are in a safe, supportive, and understanding relationship.

This empathetic situation is the opposite of that which existed when the damage was done, and it allows the client to safely re-live the trauma - this time in small doses to avoid re-traumatization.

When all of these elements are in place, the patient has the maximum opportunity to make the healing connection between the conscious self and the repressed pain. When the old pain is felt, there may be crying, fist-pounding, trembling – even curling up in a fetal position when re-living a traumatic birth. (After observing Janov’s tape of a patient experiencing a birth Primal, affective neuroscientist Jaak Panksepp observed that such behavior “could not be faked.”)

Janov’s position is that - most of the time - a therapist must allow the patient to go as deeply as he or she needs to in order to make a full connection (and he believes that too many therapies do not let a patient fully descend into their pain). After a deep connection, patients will have insights into why they felt a certain way or acted out neurotically. It takes many sessions before enough of the pain is released so that one is no longer driven by the old feeling.

Like Cozolino, Janov holds that the, “primary focus of psychotherapy appears to be the integration of affect, in all its forms, with conscious awareness and cognition.” (Not surprisingly, Janov contends that cognitive behavior therapy only addresses symptoms – ideas – while ignoring the cause - buried emotions. Ideas are one of the most common defenses against feeling one’s pain).

Over time, this “integration of affect” leads to increased neural integration and information flow, as Daniel Siegel notes. The healing is not merely psychological - neuroplasticity means that there will be physical changes to the architecture of the brain itself.

Monday, December 27, 2010

On Getting to Need

In the old days I used a fake telephone to have patients call their parents and tell them everything, what they needed, the pain, etc. One patient picked up the phone and then complained to me, “There’s no one home.” This was clearly a double entendre. There was never anyone home, and when they were, there was still no one home. But I used the telephone to make a point: patients were always saying, “What’s the use? They are never going to love me.” And I say, “That doesn’t matter; what matters is that you feel and express your need.” In that need lies a world of pain. We can use the left brain to rationalize, “I don’t need it or them,” but alas, the need remains unabated. It drives so much later behavior.

So we rationalize with one brain while the other is hurting terribly. It does matter whether they can love you or not because that never changes the need; that need tells the truth of our lives, or our history. We do not want to cover over that history. In it lies liberation. For unfulfilled need means pain. Why? Because we are being warned that something essential to life and survival is missing. The trouble is that it becomes an imprint that dogs us for a lifetime. We are on constant alert, agitated and stimulated by that need no matter how much we try to relax. If we successfully repress it, the tension in our muscle system can lead to all kinds of maladies. Or we just ache all of the time.

If we never get to the right brain and the deep brain we will never get to need. It is covered over by the hyperactivity of the left prefrontal brain. We need to find a way to bypass that verbal, intellectual, rationalizing brain and get back to our nature; our feelings, which are our nature. Those who are distant from that nature cannot value our environment, or animals, or anything that belongs to nature. First they have to feel what is inside of them. Not an easy task; worse, when they chose a therapy they often chose one that also bypasses nature and flees to the safety of the intellect. Ay ay ay.

It is interesting about the right and left brain. A new study found that those humans with left brain injury became more creative. (New Scientist. Dec. 18, 2010) That is, they seemed to have more access to the right brain and feelings. After all, it is feelings that allow an overview, an ability to make the connection among facts. The left brain seems more point-by-point, punctilious; seeing each fact as an entity onto itself. Feelings seem to be more global and provide a deeper understanding of events. What the study seems to show is that the left brain can smother creativity, and of course, feelings. Language is wonderful and terrible. The more intellectual, the worse you are, as odd as they may seem. And yet, where would we be without Einstein. He was certainly creative. Yet he never got onto the Heisenberg theory. It is just that intellectuality in the social sciences seems to be deadly. How else to explain the lack of interest in a feeling therapy?

Wednesday, December 22, 2010

To Continue on ADD but on Addiction

to my readers: Before reading this piece please refer back to my recent article on ADD.

We understand how very early experiences even in the womb leave a trace, something engraved in the entire neurophysiologic system—an imprint. The imprints send information to higher levels of the brain as it evolves. The information that sends is loaded with a force, an energy or valence. The earlier the imprint the more loaded the information because it is usually a matter of life and death—not enough oxygen, for example. Or a mother taking drugs or drinking alcohol, or just being totally depressed.

The severity of the experience taxes the strength of the gates. That is, in order to relay information (often via the thalamus)to higher levels there needs to be a smooth flow of information; what helps keeps it flowing and not overloading higher levels is a system of gates. Thus, we produce chemicals such as serotonin and others that impede the flow of information when it is too much. Early trauma can overtax the gating system producing either faulty gates or what I call “leaky gates.” Thereafter those feelings and sensations intrude into our mental apparatus, and cause us to feel miserable or unable to concentrate. As lack of love, neglect and abandonment continue it weakens the gates so that we are chronically anxious or upset. We no longer produce the chemicals we need to hold back pain and keep the gates functioning properly. All this I have made clear.

What that intrusion also does is make us seek out those chemicals that were weakened or depleted in the service of repression early on. We are looking to be and feel normal. So we thrive on pills that enhance serotonin (prozac, Zoloft, etc.)or other drugs affected early on. So of course someone with a parasympathetic imprint takes cocaine or even coca cola and suddenly feels better and energetic. The ADDer often needs a boost for the prefrontal cortex, and so they are prescribed Adderral or Ritalin which is an upper that makes those neural cells more efficient. Or when there are leaky gates there is trouble sleeping as the deep imprints surge upward and force the prefrontal area to churn and ruminate. And there are many of these non-sleepers. But if the pain is great but the defenses hold and the gates are not leaky then we can look forward to cancer, or at least a shorter life. This is only an assumption but based on decades of clinical work. It is when repression is most massive and blankets feelings that our lives become shorter. If one can see the pressure in a Primal one would know immediately what happens to the cells from early pain. It is not simply a theory; it is observable every day in our clinic.

So once we know what happened in our womblife; was the mother a smoker, a pill-popper or drinker we have a good idea why we need the drugs we do. Or to put it differently, once we know what we get hooked on we can estimate what happened to us during womb-life and at birth. It is all no longer a mystery. So if you drink coca colas four times a day it may well be because you mother was depressed and down. She also depressed you. Contrarily, if you need to slow down with tranquilizers it may be because your mother was speedy and anxious while carrying. We are always looking for the other half of our nervous system.

Gates are good because they keep us sane and functioning, but they are not great when we lose access to ourselves and our feelings. They those gates are dangerous. It is usually a matter of too tight gates or leaky gates, and we can make our diagnosis and prognosis for therapy from there. Leaky gates puts us over the primal/feeling zone, while dense gates often place us under the feeling zone. A truly loved child lives in the primal zone all of the time.

From a Patient

"A coward dies a thousand deaths, but the valiant taste death but once"
Act 1 Scene 2 Line 32 of "Julius Cesear", by William Shakespeare.

This was sent to me by a patient:

Throughout my life, in every major endeavor, I have given my all in the struggle for success. Each time I would work long hours filled with enthusiasm, damn the sleepless nights, damn the overwork, damn every obstacle, whether it was my restaurant, my advertising agency or whatever all along the way. And with each I would progress to what I perceived as the pinnacle of success… and then, almost like magic, it would all collapse and turn to shit. I would be left broken, awash in pain, feeling helpless and worthless, and thinking of suicide. Oft times it would take years for me to recover enough to begin anew on to the next big project, culminating with the same results. Over and over I was dying my own thousand deaths.

Finally, in my late 50s, at the end of my last great failure, I became extremely ill and convinced my life was over, I was welcoming the opportunity for death. But in 2005 some weird fortune landed me in Primal Therapy.

I had no trouble getting to my feelings. I was what they call a mélange. All my feelings, at all three levels, were coming up at once. On the surface it was an ugly business with all that pain, but at the end of each session, I would be more relaxed and feel better than at any time I can remember.

Early on in my therapy I began descending into birth feelings. Now I was quite skeptical of the whole notion of birth Primals. I could not wrap my mind around the idea of having a clear memory without pictures in my head. Nonetheless, here I was: I was in the middle of a devastating toddler feeling. At that time in my life I suffered severe eczema. My parents would put socks on my hands and tie them to the bars in my crib, so I could not scratch myself bloody, then leave me there alone to cry myself to sleep. The itch, the helpless feeling of being so restrained, and the abandonment by my mother was hideous.

But then the feeling took a new turn. It slowly became all physical. I started to cough. The itch and restraint became the pain of being crushed. I felt smothered. Then as though there was some camshaft-like machine inside me, my body went into a writhing, waving dolphin motion. My head pushed against the padded wall in the therapy room. Time lost meaning. It was just forever. The feeling of suffocation was like sharp needles from deep inside my chest jabbing out through every pour of my whole body. This next is a little difficult for me to explain because during the feeling there were no words. The words came after, when I was integrating the feelings and connections with the help of my therapist. I pushed and strained and pushed and strained as the feelings became more intense. I felt like I was doing something wrong. There is something the matter with me. It’s too much. I was dying. The terror and panic accelerated until I got to a point when I thought I had made it through, and was finally going to be free… but too late. I was spent. I gave up to die. My whole body gave up the ghost and collapsed. Then my body went into wave after wave of the most radical trembling I could ever imagine.

This sequence repeated itself (I didn’t seem to be in the driver’s seat) again and again until my body just quit. The feeling slowly dissipated and left me drained, but so relaxed. It was as good as feeling gets. No fear, no panic, terror, or tension. Life felt good.

Then in discussing with my therapist what I was going through, I made the connection that what I had just experienced is the pattern of my life: struggle, fight, suffer, and plough forward to success… and then collapse – give up the ghost to death. I was amazed at the clarity, and simple obviousness of the connections.

“So,” you say, “that’s all nice, but what does that get you?”

The short of it, in Janov’s language, is that when those feelings come up at times when they are re-stimulated, the valance will be reduced. (Here I should add that this Primal was not a one shot deal. After some years I am still having to relive that scene or related scenes. This is because I can only tolerate such excruciating pain for from 10 to 30 seconds at a shot, and my birth was besought with all this agony over a course of at least hours. That’s a lot of pain to feel in order to free myself of it.) In addition when those feelings come up, I know what they really are, and I can separate those historical feelings from my present life.

But let me elaborate to give you a more concrete context. After about a year and a half of reliving those birth scenes repeatedly, I realized that I was not close to death, and had a brand new life to live. I decided to go to graduate school and get my MS in marriage and family therapy. Applying and getting accepted is no easy chore, especially for an old man. CSUSB gets a lot of applications but they only accept 12 students a year. From the git-go all those old birth feelings come up. I feel weak and helpless and I’m convinced my efforts will be for naught. I tell my therapist, “What’s the use. Even if I got accepted, which I probably won’t, I’ll be 70 when I graduate.” And he said, “yes, and you will be 70 even if you don’t.” Every time I would think about all I had to do just to apply made my arms feel weak, and found myself thinking, what’s the use? I had to get really great references, and it had been so long since I was in college, most of my old professors were already dead. I had to write a letter of intent, which meant the best pitch letter I’ve ever written in my life. But I could do all that because I have felt my pain in its proper context. I knew the enemy, and had sufficiently weakened it by reliving it to where it no longer had complete control over what I did. I didn’t have to fail.

I got accepted and quickly found out that the battle was just begun. I started the program on my 69th birthday, and found myself face to face with 11 beautiful women, all brilliant scholars, with young facile minds and energy that far eclipsed mine. This is where I really began to understand the connections I had made in my sessions. I continually feared that I would struggle, do well, and just at the point of graduation, or sometime before, I would fall on my face. I felt like it was all over at the end of every quarter. That old feeling would start to overwhelm me, but this time around, I could just lay down and let myself have the feeling, or I could hold off until my next session, and grapple with it again.

This time success was mine. I not only graduated, I managed to get the best possible placement with an organization filled with great people. But I’m not through yet. I’ll have more opportunities to give up and collapse in agony. I’ll also have to feel those feelings so ruinous in my past, and make them work for me as I continue to live my life with all the fullness I can muster. And, of course, I never fail to be amazed with every Primal and the personal growth that comes with it.

By Frank Robinette

Wednesday, December 15, 2010

More on Attention Deficit Disorder

I would let this go, except that last night there was a one hour special on PBS about ADD, with four major specialists in the subject. The diagnoses they came up with is what I think is the problem with the whole field of psychotherapy, psychology and psychiatry.

Not once in the hour did I hear what the origins of ADD might be and why it occurs. Most of the time, it was spelling out how to cope with it. So we also might add how to deal with phobias, obsessions, migraines, high blood pressure and on and on. It is tantamount to saying that the illnesses stay but how we deal with them changes. It is all about our attitude. So you still have the allergies and you avoid this and that to cope with your allergy. Or you have a chaotic mind, try to avoid clutter.

The first point they made is that diagnosis is essential. And they list ten things that make you an ADDer. You need to be impulsive, not able to focus and concentrate, unable to pay attention, hyperactive, unable to sit still (I am adding here), low self esteem, learning disorders, can’t listen, needs to talk constantly, cannot wait, no long-term goals, lose temper easily, act without thinking, very impatient, a bad memory, an underachiever, etc. I added here some from a list of the Brown Scale for ADD. It pretty well covers it. But you have to be suffering from this for six months or more, they claim.

What the experts concluded was that a diagnosis was critical. Once you are aware, they claim, you are half-way there, because you know what to do; which includes: making future plans, making your environment work for you, find a calm partner and a job that suits you, making an effort not to lose patience, and above all, they claim that the therapy for this is success. Once you have a success you can build on it. And you will have a higher self-esteem and won’t be an underachiever.

So let me see: you tell the doctor that you are impulsive, impatient, cannot wait, cannot concentrate nor sit still, and she says to you that you have ADD. Ok there is the diagnosis, now what? She has told you what you just told her in more simple terms. Have we made progress? Is that what a diagnosis is? Saying things in esoteric language? The doctors have then many suggestions: don’t do too many chores at once, stay in a calm environment, jog to work off tension but do not over-talk. Don’t work amid chaos. I say to the doctor that I cannot stand crowded restaurants and he tells me to avoid them. And he adds “do not take so many risks in your life”, yet he adds it is the risk takers who invent and innovate and tend to be more creative. Now I am confused.

Not once did I hear in one hour the word, why? Where does it come from and what I can I do about it. What is the generating source of all that? So now you will read my opinion about it. It is an educated opinion since I have treated many cases. What happens is that cognitive/behavioral approaches have taken hold so that the psychiatric diagnostic manual indicates all these behaviors, and it is assumed that to treat it all, we need to change behaviors, hence, behavioral therapy.

Let’s go back to womb-life; there is a good deal of evidence that a mother’s hyperactivity, the drugs she takes, such as cocaine can leave an imprint or a residue that affects the offspring for a lifetime. If the mother is “hyper” the child may also be. Just that can set up a child who is revved up from the start. An Israeli study found that the children of holocaust survivors, very anxious people gave birth to anxious children. At first they thought it was because the parents told horrible stories to the children but then they discovered that the anxiety came down through the genetic chain; that is, it was descended from the mother’s physiology—epigenetics. (Laura Spinney, 2,Dec. 2010. Internet) Then there is the trauma of birth and infancy where the child may be left for days without warm cuddling. And then harsh parents who fill the child with feelings of rejection and abandonment. All this sets up imprints down low in the neuraxis. This is then transmitted to higher centers (as they develop and evolve) where the child is filled with input from inside that frazzles his brain; that feeds constant and varied input to the neo-cortex, no different from listening to ten people at once all talking at you. Except...,except that this information is constant from inside not outside. It competes with stimuli from outside but it all gets to be too much. It is paying attention to too much input which is normal, not an aberration. The disease, if it exists at all, is stimulating information that floods the cortex with electrical input just the same as being flooded with shock therapy.

Of course, he is hyperactive, he is being prodded all of the time from below so that any new input is overwhelming and he starts to crumble. He cannot manage complex instructions; you go to the right two blocks and then one block to the left and then go straight to the roundabout and then………we have already lost him because the internal input is crowding out the information. And of course, he cannot sit still because there is information that needs connection and resolution, the integration. That cannot happen so long as he has no access to his early imprinted memories. The information is constantly climbing upwards and forwards for that connection so that the system can function better.

And then he cannot get down to things, quickly start a paper, a project or an article because there is so much going on in his brain for him to focus on just one thing. So others get impatient because he did not turn in his paper on time. He was so busy, doing this or that, as his moods dictate because he is being twisted and turned here and there internally with little cerebral control.

So why so little control? Because trauma in late pregnancy can damage or prevent the evolution of prefrontal cortical cells, as well as the cells that carry information from down below via the right to left brains, the corpus callosum. So there is damage or impairment of sorts. They do not have the cerebral equipment to control impulses thereafter. And we know that the prefrontal area works often times to control right subcortical feelings in order to shut them down for a time. When control is weak it is harder to put off an impulse, to wait for later to do something, to reflect and ponder rather than act. But those impulses are the imprints originating deep down in the brainstem centers. The impulses, the same as with the salamander or snake or shark, are there for an evolutionary reason: to strike, attack or flee at the instant when it is necessary--survival. They come out of those primitive brains and are essential, as well, for our survival—needing to swerve to avoid a car accident, for example. Here we do not want to be too reflective. Immediate reaction is called for.

Now think of the snake; he too must act immediately for his survival. It is not an aberration unless the snake brain overtakes the rest of our cerebrum and runs the show. In a way, in ADD he is running the show. What are we fleeing from? Danger. Menace. Feelings that are overwhelming. Pain that is much too much. Suffering that threatens our mental stability. It has to be contained. Think of this when we are dealing with ADD, and believe that a different turn of behavior can solve things. Think of this when we offer advice to “Make your world comfortable to you. Make your world work for you.“ Think of what and whom we are talking to because the salamander brain is doing its best to deal with matters and it isn’t getting much help from the impaired neo-cortex. Remember, then, it is an ancient survival mechanism there for a reason and very necessary in our evolution.

What is behind a lot of this, is anxiety; that is the major prod. It is pure terror engraved down below from traumas in the womb that have been reacted to just in terms of the non-verbal brain system. Or imprints from a bad birth that was life-threatening.

The ADDer is an underachiever because he could never stay with anything long enough to learn it properly. So he becomes a salesman; someone with a gift of gab who runs off at the mouth, running off part of the tension and energy of anxiety. When he recognizes this maybe he suffers from low self esteem, as the project stated. He must know that he cannot succeed because success requires sustained effort; his scattered mind cannot do that. But he may find a job that suits him and that will allow distractability. But do not ask him to be calm and to follow directions because his brain is revolting. To infuse too much input into his brain, even a simple idea, is overwhelming and that is how he feels—overwhelmed. The cortical level is being overwhelmed so he should feel that way. It is all too much. Literally.

I cannot help but feel that current therapy for ADD and most other psychologic afflictions is just “get over it”. One psychiatrist tells his patient that you must first identify the problem and then develop good habits to overcome it.”Do not live in a cluttered environment.” But he needs chaos because it reflects his brain. And as one specialist in ADD said at the end, “I am not interested in making you normal. I just want you to be successful.” The reason he is not interested is that the depth of the problem and its origins seem so mysterious, arcane and recondite that the condition, like Freud’s Id, becomes a given, not to be tampered with; an immutable force, part of genetics—our inherited weakness. All because the field and the populace is not used to considering womb-life and birth experiences as critical in our development. The science is now there; we have only to use it.

In my previous books I have discussed the notion of the parasympath and sympath. These are two different personality types governed by the hypothalamus. The parasympath is the slow, reflective type and the sympath is the hyperactive unflective type who keeps driving and going and doing. This largely is set up during womb-life and at birth; was the end of the birth difficult? Was the newborn shut down by anesthetics given to the mother, or was the end a success because the child struggled and got out successfully? He learned that he could not wait because waiting could have meant death. He wants out! It sets up an inability to wait, impulsivity and a driven brain. The parasympath is much more passive, less driving and less spontaneous. Keep in mind that those experiences happen to a brain that could register, code and store. The memory endures. And it creates a hyperactive system that is largely beyond our control. It goes to where we are weakest and most vulnerable. Trying to go to sleep is a big effort because impulses from down below are activating the mind into constant rumination and won’t let us relax enough to fall asleep. That is, it won’t allow us to go below the top thinking level and into where sleep might happen.

One of my senior therapists who has stayed with doing therapy for years was a classic ADDer. He never went to college because he was sure he could not concentrate enough to do classes. He can now and is on his way to a Ph.D.

I have treated enough of those who have ADD to know what a successful therapy entails and it is not advice, even though that might help a little. It is a deep voyage to the antipodes of the mind to where it all began.

Thursday, December 9, 2010

On Being a Psychopath

We have all met them; they are the conscience-free, manipulative, unfeeling and uncaring humans (if I may say that)that leave a well of destruction wherever they go. They know nothing of love or helping and above all, of gratitude. Once you give they want more and only see you as a sucker and pigeon who can be worked for more. How did that happen?

I could quote statistics. You know that a recent study of psychopaths found that they have damage in their feeling centers; no surprise there. (see “A Brain Gone Wrong.” Scientific American/Mind. 3, Sept. 2010). But we get that. They cannot feel and they cannot empathize; they do not seem to have the capacity for it. They have the shell of a human without the internal mechanisms that gives us our humanity. They have learned how to act charming, the better to manipulate others by obtaining their trust first. But it is short-lived and then the truth comes out. They care about no one. There are partial psychopaths who have some of these traits but manage to care once in a while, sporadically and with no depth of feeling. Nevertheless, they seem to be human. They do not scam or cheat others but they are not against it if they have to. Look at the driving business man or politician for examples. They raise prices, the rent, anything, because they care about themselves and profits and not others. They need to get 10% return not matter what it means to others. They don’t hate others but they love themselves more. That is not exactly true since they really have little love to give even to themselves. The politicians care about votes and staying in power; we all know that. They will say anything to stay in office; they are master manipulators and are able to twist other’s needs to make them vote against themselves and their needs. They all care not about others. It is no doubt the sine qua non of going into politics. There are some exceptions and you know who they are. They tell the truth, which is why they cannot stay in office.

This damage to the limbic/feeling structures can happen during womblife and is highly exacerbated right afterward when there is an absence of close human contact; perhaps weeks in an incubator with little or not human warmth. Then to compound matters there is indifferent unloving parents who never touch the child. I say that there is an “emotional band missing.” They seem to be short on feelings. It can begin when the mother is chronically anxious or depressed while carrying; they baby suffers and is already damaged before coming onto this planet.

So what about morality? Psychopaths seem to be immoral, but they are unfeeling; that is what the research evidence shows. They cannot feel or empathize with others so they, as Clinton said in reverse, cannot feel their pain. So anything goes. They cheat their closest friends, a la Bernard Madoff. They don’t feel bad about this “immoral behavior” because they cannot feel the pain they are causing; cheating people out of their life’s savings without a hint of caring. Their feeling band is missing and nothing anyone can do can put it back. That is why when they are caught they can never confess to their crimes; it is always someone else’s fault. We in Primal Therapy cannot treat them because they incorporate the therapy into their psychopathy and often decide to become therapists with no training. They harm many people and advertise so well that they con many. They scream and yell (we have taken them out of prison for the court) but never feel; they go through the motions of being human without being human. We cannot give them back a full brain. The damage is too early and too severe.

A research study at King’s College, in London, came out explaining the origins of the psychopath. He remains as I have described him (and psychopaths are mostly males) but the origin of the personality disorder needs to be pushed back a few weeks. In the study,[1] the investigators used an imaging scan (MRI), on psychopaths (killers, rapists, etc.), and concluded that there were differences in their brains from those in the general population. Two of the culprits were the prefrontal area of the cortex, and aspects of the amygdala. There was an impairment between the connections in those two areas. In a normal brain, when there are emotionally stimulating events, the amygala responds. But in psychopaths there is a breakdown in this response.

The grounds for this condition, set up before birth, are exacerbated by birth trauma and lack of human contact right after birth. It would seem that in psychopaths the neural circuitry that connects feelings to higher level brain processes is deficient. Another way to put it is that feelings are not part of the conceptual, day-to-day cortical functioning. So while the person can be charming on the exterior, there are no sincere feelings underlying this facade. It is all a dumb show. Perhaps if the trauma did not exist before birth to damage the connection between nerve cells responsible for feelings and those in charge of comprehension the lack of touch after birth would not have such disastrous effects. However, when there is a pre-birth impairment of the connections between feelings and thoughts, the lack of physical contact right after birth is catastrophic. The result can be someone who not only has no control over his impulses but also has no means to experience his feelings. There may be learning but not emotionally integrated learning. The implications of the study were that psychopathy, in fact, could be a brain disease. I think it is more likely explained by epigenetic trauma.

The important lesson, though, is that psychopathy, much like other aberrations in development, bears the signature of what went wrong earlier in our lives. Memories are made indelible in our biology because they form guides to our future, instructions on how to behave in order to survive. That is, they become part of our “apperceptive mass;” always ready to serve our interest for survival.

Here is what one of my students wrote:

Psychopaths shed light on a crucial subset of decision-making that's referred to as morality. Morality can be a squishy, vague concept, and yet, at its simplest level, it's nothing but a series of choices about how we treat other people. When you act in a moral manner—when you recoil from violence, treat others fairly, and help strangers in need—you are making decisions that take people besides yourself into account. You are thinking about the eelings of others, sympathizing with their states of mind.

This is what psychopaths can't do. . .They are missing the primal emotional cues that the rest of us use as guides when making moral decisions. The psychopath's brain is bored by expressions of terror. The main problem seems to be a broken amygdala, a brain area responsible for propagating aversive emotions such as fear and anxiety. As a result, psychopaths never feel bad when they make other people feel bad. Hurting someone else is just another way of getting what he wants, a perfectly reasonable way to satisfy desires. The absence of emotion makes the most basic moral concepts incomprehensible. G. K.Chesterton was right: “The madman is not the man who has lost his reason. The madman is the man who has lost everything except his reason.”

[1] Reported in Science Daily, August 5, 2009. D. Murphy, Marco Catani and Michael Craig. Aug, 2009. See also, Michael Craig, “Altered Connections on the Road to Psychopath.” In Molecular Psychiatry, 2009. DOI 10. Pg 1038.

Friday, December 3, 2010

On Depression

The following letter to my blog was ostensibly about depression but I found something in it that to me is astounding. it also sounds kooky but it is not. She grew an inch at age twenty three. And she made no big deal about. "I grew" and then she went on to other matters. Growth happens pretty often and the patients always seem to have that "belle indifference" about it. Like it is expected and not surprising. I guess with all the other emotional improvement it may not be a big deal, but it is to me because it means that when you undo repression you undo not only a "mental" phenomenon but a total physiologic one, as well. And it means too that the patient has already gone very deep and normalized some hormones, including those that control growth. How else to explain it. My wife's foot size grew by a size and she could not understand it for years until we began to get many other reports about growth. And I have noted that there is sometimes a wisdom tooth growth after the age of forty. I have never much pontificated about this so as not to influence patients and others but it seems to me to be a monumental affair, not because of the growth but because it means that so much has been liberated in the entire system. So, yes, I would expect the depression to be lessened or eliminated. It is all of a piece. The system is one integrated affair so that change in one area means change in many others, as well. Yes, it is great that depression was cured but the "proof" of that is found in bone growth. and....and.....change in brain waves, vital signs, etc.

"Looking back to the way I was at the beginning of therapy, I can see how many things have changed. For a start, I have grown over an inch since my twenty-third birthday. I am much more relaxed in general, able to go out and live life without too much anxiety. I am not nearly as afraid of people as I used to be, and I do not let anyone push me around or take advantage of me. I am more spontaneous, following my impulses whenever it feels safe and appropriate to do so. I have periods of optimism and enthusiasm for life when it seems that I have been given a second childhood. During these times I feel good to be alive whether playing sports, listening to or playing music, watching a movie, talking with friends, or simply sitting quietly and doing nothing. I have more friends, and I can be myself around them, rather than trying to impress them or get them to like me. I have less anxiety during stressful situations, and I make better decisions to resolve problems. My memory has improved; I am not scrambling around to take care of myself anymore. I am less stuck “in my head” and more aware of what is going on around me. (People used to think I was stupid because they would say something two or three times before I heard them.) I have better coordination playing the piano despite almost no practice and I have discovered that I have a fair talent for ball sports. I can cook for myself now, which is a recent and exciting development -- I have had a huge block in that area. Food tastes different as well. Before therapy I had to smother my food with herbs and spices to give it any flavor, whereas now a small amount seems to go a long way. I get depressed from time to time, but even when I feel really bad I know that it is just a feeling and I do not consider suicide. I notice my act-outs and curb them. For instance, when my job is going badly I find myself obsessing about winning the lottery. When I feel bad about myself I tend to bounce from therapist to therapist, afraid to stick with the same person in case he or she grows impatient with me. Going against my fears is the way to feelings. Most importantly, I have a sense deep down that I am going to be all right, which I could never have said a few years ago.

In conclusion, I would say that depression is a state of emotional flatness resulting from a strong system of defenses. There is a voice beneath conscious awareness complaining that all is hopeless and that there is no point in living, but it is never heard because the defenses are working overtime. How does one cure depression? The platitudes my parents fed me certainly did no good, and I suspect that most self-help systems only push the “voice of doom” somewhere more obscure but ultimately just as damaging. The only real changes in my life have occurred after feeling, connecting to the source of my pain. The voice is being heard in part; one is not feeling sad for no apparent reason but for a reason that is known and felt. This second childhood is a great gift. To anyone reading this who is a long way from being able to do therapy, let me say that there really is hope. Above all, find friends that accept you for who you are, and look after yourself. You deserve the best."

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.