On the Nature of Violence and Abuse

I was reading about serial killers in the newspaper today, and it set me to trying to explain what is involved in their act-out. And so I will start with a major assumption. Notice, this is writ large and there are many exceptions.

I have noted in many of my works that trauma to a carrying mother in the last trimester of pregnancy can damage the neocortical brain cells, the cells which, inter alia, control and shutdown feelings. They weaken the defense system. And they leave a mark or tag on the deep-lying brain cells; what I call the first-line. The mark is one of great impact since traumas to the fetus usually have a life-and-death urgency. A birthing mother who is heavily anesthetized seriously affects the baby who also may be profoundly drugged. He is fighting for air, for oxygen and for breath. He is terrified and that terror lingers on for a lifetime. It is the imprint; the first-line imprint. On this level lies terror, rage, deep hopelessness and helplessness.

The imprint leaves a residue of violent reactions which are only weakly contained. They add oomph to later imprinted feelings. So what should be simple anger at someone who insulted us, there is rage. Indeed, whenever we see these violent feelings and reactions we can presume that the first line is involved. Instead of feeling, “I would like to sleep with her,” there are attempts at rape. The imprint has left these powerful traces and at the same time has weakened the defense system. So being in a locked room produces terror, not simply fear. The first-line imprint is engraved by life-and-death experiences into constantly challenging control. So when we see impulsive act-outs we can be sure that the first line memories have left us with first-line reactions.

I once treated a rapist who did indeed hate his mother and by extension, women. But had he not had very early imprints I doubt whether he would have been a rapist. All this makes anger management superfluous. It is no different from those who have wild and weird ideas. The first-liner is pressured to concoct ideas that grow out of deep and painful imprints. It is a mental act-out as opposed to physical act-outs. Whenever we see someone into “booga-booga” we can bet there was serious early trauma. One case of a woman I saw who lost her mother when she was one year old, seemed to be making it well in life except for her strange belief systems. Those belief systems were the harbinger of a psychosis to come. When her husband lost his job she lost it. That added trauma pushed her over the top.

The trauma during womb-life provides the internal pressure for the impulse while that very same event also weakens cortical defenses. So the difference between wanting to have sex with someone and raping them is the difference of first-line. It is usually psychosis making.

And I might add that the difference between a slight headache and a migraine is the resonance factor; a current adverse event triggers off lower level pains and causes an overload and a symptom. If there were no resonance then the person might have an annoying headache but no migraine. On that lower level perhaps lives the contraction of blood vessels when there was so little oxygen during birth. And that reaction lives on in the imprint. When the adversity is bad enough in the present it can set off the original physiologic reaction. That is as true for migraine and high blood pressure as for acting-out violence; it includes the appearance of such serious diseases as muscular dystrophy and multiple sclerosis. All this might not be manifest were it not for “grandmother” pains that have lying around for possibly decades waiting for their summons.

There is also the possibility that later trauma, rape or incest can also produce violent act-outs but it is my experience that those cases are the exceptions. The serial killer is awash in first-line imprints. He may have wanted to kill his mother but without the first- line urgency he won’t kill women. If he undergoes serious continuous trauma with a violent mother he may later seriously act-out .

Remember those deep, remote memories are simply raw and vague impulses at the start. They are not embedded into specific scenes or images during childhood. They are what they are, undifferentiated forces. They become channeled depending on the life experience of the offspring. A seductive mother in a rapist I saw years ago, who constantly teased her son and drove him crazy, produced someone who could not control his impulses.

I should also note that most of these individuals are or have been on serious drugs; a sign that deep pain is driving them. And the drugs they take, ecstasy, for example, further weakens their defenses and exacerbates the problem, provoking feelings.

So in day-to-day life these people get in trouble because they do not have the mental power to contain feelings and then take drugs which further lessens control. I said before that anger management is useless because the source for the impulses lies way below cortical, cognitive processes. We cannot “manage” deep impulses; we need to feel them and experience what they are and where they came from. We need to connect what had been disconnected; the link between deep feelings and top level control.

The problem is that we are often not aware that there are deep-lying pains surging upward for connection so we go on “managing” them, thinking we have no choice. We do.

On EMDR (Part 4/4)

Let us now turn to the other authors: Of course, Dr. Shapiro is key since she is the inventor of this method. One of her techniques is to have the patient hold a memory of a painful event and then watch the hands of the therapist move in front of her, and then to think of a different solution to the event, something more desirable. Therein lies the rub: first, for real traumas it is rare that a patient can easily remember them. In fact the more painful the more repressed and the less likely it can be retrieved. My patients may take many months of reliving before they can even approach incest, for example. The pain is ineffable, and no one begins to resolve and integrate it before many, many months of reliving. But assuming they can remember it. Part of the solution for Shapiro and her cohorts is to help the patient imagine other solutions; in short, to produce imaginary resolutions. We must keep that in mind because it will remain imaginary. It hearkens back to the technique of directed imagination therapy or directed daydreaming.

I cite Ellen Curran’s work: (Guided Imagery. Beyond Words Publishing. Hillsboro, Ore. 2001) “Healing imagery is a way to use one’s imagination in a focused way to help the mind and body to self-heal.” (introduction) She claims it makes one more open to the unconscious mind, “making it possible for the inner self to be heard and therefore to be healed.” These are wonderful, liberal thoughts, but lack a bit in the science department. We have treated many imaginative artists who have no real access to their feelings other than what they paint. Using their imagination doesn’t given them access to deep inner feelings because no act of will, a cortical function, can offer access to feelings. Access works from the bottom up, not the reverse; it operates in terms of evolution. It means to descend down below the cortical control mechanism to enter into a different brain; that is the meaning of access. We have developed the techniques over thirty years to accomplish that.

If we imagine a solution we get symbolic resolution, not a real one; and we do not get radical changes in vital signs that we do with real resolution. We see this in our therapy when patients in mock primal therapy (the practice by untrained individuals) come to us from past lives therapy (an oxymoron, if there ever were one) and trip off into wildly imaginative ideas. Here they come close to a real event, the birth trauma, which we have researched and measured, and then skip over it and fall into fantasyland. The cortex rushes to the rescue as the person is inundated with heavy imprints. In every case, the valence of pain is so high as to make the real experience impossible. It does not offer access to feelings; quite the opposite. It is a sign to us of lack of access and of a disturbed personality. That is why we proceed slowly in small pieces of the feeling at a time. We begin in the present with feelings that can be integrated and then ride the key feeling down to the past in ordered fashion until months later we arrive at the key underlying sensation/feelings. Take hopelessness. The person has lost her job and feels hopeless, but more than that, deeply depressed. We allow that present context with its load of feeling to occur and then take the patient back slowly to the next level down where a deeper part of the same feeling resides.

Curran states that imagery is thought. Thought is thought, a cortical function. Imagery is subcortical, often limbic. Dreams are full of imagination but they happen when thoughts have been put to bed for a while. Now this whole idea of changing images and/or thoughts runs through a wide gamut of therapies, including Behavior Therapy, Ego Psychology, Rational-Emotive Therapy, and many others. They believe that you must change your ideas to change your behavior; or, vice versa, change your behavior to change your ideas. Thus, you go into an elevator where you are phobic and imagine very relaxing images—you are floating on a cloud, for example. It is as true in hypnosis and in EMDR. You can imagine being relaxed but the imprinted memory is anything but, so that the frontal cortex, is playing mind games on the rest of the brain and body. It is fooling itself, thus cannot be a real, permanent solution. The cortex, with its unlimited ability at self-deception, deceiving itself away from real feelings lying below, is an expert at this game. But is that cure or healing? It is repression and anti-healing. If you are tense due to a lifetime of neglect, does imagining that you are floating on a cloud change that? It is another quick fix, and like all quick fixes, it must be temporary, at best.
You can imagine telling off someone at work who is bothering you. Or you can imagine floating in a pool while thinking of a troubling event. When you stop imagining who are you? The same old fearful human being, the person who is terrified of women because he lived with a mother who was a monster. No hand wave is going to erase that.

Driven by Unseen Forces

When we do things we cannot understand we are driven by unseen forces. That much is clear. So when we believe in unseen forces, UFOs, for example, it is a logical extension of what drives us. When so much of life seems like a mystery; why we develop symptoms, why we act out in sexual rituals, why we get migraines or why we have high blood pressure, it is logical that we believe in mysteries, especially the mystery of life. So we go to church and they have answers for us. And they encourage us to pray to unseen forces and to obey unseen deities. And then we go to school and pledge allegiance to unknown entities, and of course, again a deity.

And then we grow up and want to run for office but we know that no one can ever get elected who does not believe in unseen forces; should you decide to declare that you don’t believe it is impossible to get elected.

So belief is pretty much decided for us. And what we can declare that we don’t believe is also decided for us; peer pressure is awfully strong. Wanting to belong, to be part of, is a powerful need, and sometimes we need to believe in order to fulfill that sense of belonging. So those who have no inner access are required to believe in mysterious forces, and that mystery is contagious among those with no inner life. And don’t think this is just in politics because when I talk about clarifying unseen and unknown forces in our unconscious the field of psychotherapy turns off, and this kind of believer becomes a pariah. It then becomes unsafe to believe in the depths of the unconscious unless we believe there are demons down there; an id, shadow forces and the like. As long as we keep it mysterious we are OK, accepted.

“Keep it unreal” becomes the motive, the slogan, and we fall in line. Psychologic truth becomes marginalized and the believers in mystery continue their hegemony. It is almost impossible for me to get an article in the N.Y. Times in or Psychological Journals because I eschew the mysterious. Now isn’t that a conundrum?

On EMDR (Part 3/4)

Kolk states that If you are stuck in old memories you can't have new behavior. True, but new behavior is not something one superimposes onto a patient. New behavior emerges dialectically out of the reliving of the past, for one simple reason: the agony portion of the past imprint has not yet been lived. It has led an underground life manufacturing ulcers, migraines and high blood pressure. When I say agony, I believe that until one sees it or feels it there is no concept of the depth of that pain; something that can elevate brainwave amplitude by hundreds of percent. (Hoffman, Eric. Long-term Effects of Psychotherapy on the EEG of Neurotic Patients. Res. Comm. Psychol. Psychiat. Behavior. Vol. 8, 1983 pages 171-185. See also, “Hoffman, E., Goldstein, L. “Hemispheric Quatitative EEG Changes Following Emotional Reactions in Neurotic Patients. Acta Psych. Scand. Vol 63. 1981 pages 153-164)

Reliving anoxia or hypoxia at birth, the patient turns red and struggles for breath as if it were a life-and-death matter, which it was and is. An imaginary ending would be to feed the patient oxygen at a critical moment, which would inter alia, abort the memory and stop the healing process. The patient is beginning a dying sequence, as dramatic as that may sound, and needs to complete it; she did not die originally, and she will not die in the reliving. But with a thermister, an electronic thermometer, attached rectally we see the temperature drop by many degrees as the patient approaches “ground zero”. Why is this necessary? Because the trauma and the ensemble of physiologic reactions form a template for survival—a prototype which guides future behavior. To change the prototype one must descend to its origins. Out of the original trauma evolve numerous ramifications, directing diverse behavior and diverse symptoms, from colitis to heart problems such as frequent palpitations. Until the prototype is relived the best we can do is treat deep problems symptomatically. Generally, the deeper in the body the symptom the earlier the trauma, not always, but often.

Feeling the terror in the birth canal reduces and eventually eliminates phobias of elevators, for example. No one has to take the hand of the patient and help her enter an elevator. That is Behavior Therapy and makes the mistake of taking the ostensible problem as the real one; taking the symptom and making “it” well instead of the person. The deeper one feels and integrates the terror the less there is to deal with.

Retrieval of early memory activates the right hemisphere more than the left. When our patients are deep into reliving early trauma the limbic system is fully activated, and we believe the information is then transferred to the left hemisphere for final integration. In our brain research there is a shift of power from right to left hemisphere. Kolk: “Traumatic memories are often stored in the limbic system, which is responsible for attention, arousal, and attachment, but are usually stored as somatic (body sensations) memories. Traditional therapy does not even begin to approach the limbic system to resolve the trauma, so a therapy that accesses body memories (like attachment therapy does) is much more effective. EMDR is useful for resolving many traumatic memories, although it is not at all clear why it works.” Dr. Van der Kolk suspects that it works because doing the eye movements distracts the person from the traumatic memories and allows the brain to be changed.

There is a basic contradiction here. If eye movement therapy distracts the person from memory it defeats the ability to fully access that memory; it then cannot be integrated. He is right. Eye movement is a distraction that aids in the process of repression, which is exactly why the person feels better. Prayer can do it, “om” can do, thinking other thoughts can do it, directive daydreaming can do it by offering other images instead of the real one, etc. The fastest way is a good dose of Paxil.

Let us discuss what integration means. First let us see what disintegration means. Feelings stored on lower brain level, and this is where pre-birth,` birth and post-birth traumas reside, due to their valence of pain cannot rise to the prefrontal cortex for connection and integration. They are inhibited by various neurotransmitters and kept below the level of conscious-awareness. This is disintegration; the higher levels do not know what is going on in the various lower levels even while they are being driven by it. Paranoid ideation can help be quelled by tranquilizers that work on deeper brain levels, indicating the provenance of the higher level ideas. The person is not aware of the deep-level imprint but is driven to develop strange ideas by it. He does not need to feel a little bit of it, say being abandoned in infancy, or living in an institution for the first year of life, and then told to change his ideas or his behavior. He needs to relive the early traumas bit by bit over many, many months or years until the ideas driven by them evaporate. And they do. Solutions provided by a therapist are his solutions, not the patients’; therefore not real. Reality lies in the reality, as banal as that may seem. Reality lies in the truth of the memory and only there; certainly not in someone else’s brain.

We can only heal where we are wounded. The seeds of cure lie in the problem. We do not teach people how to live or how to manage in the future. Once free of their past they can figure it out themselves.

On EMDR (Part 2/4)

Van der Kolk says that the child never made the proper psychologic assessment of the trauma and therefore never prepared for the future. I submit that the assessment is inherent in the trauma itself. Reliving never being touched as a child makes immediately clear the reason for one’s nymphomania. It puts the need for touch in the past so that it is no longer acted-out in the present. If there was insufficient skin to skin contact very early on, we can be sure she will get it later on in her sexual act-out.
The patient does not need to be told how to appreciate the trauma; everything is understood within the feeling, provided it is a full reliving. We seem to think that nymphomania is some kind of sick symptom, rather than seeing it as a survival mechanism; trying to be touched to make up for a terrible early lack. Almost every symptom may be considered a compensatory mechanism that should not be altered without regard to roots. Symptoms are anchored in those roots.

When I mention a “total reliving” it can mean the reappearance of the original bruises from an early beating or the forceps marks from the birth procedure. We have photographed these marks. The whole system must be involved in reliving, because it was originally. That is why, it is being recognized more and more, that simply discussing the past trauma will not get the job done. That is, by and large, a cortical operation that remains in the area of thought. It is the inordinate pain portion that is limbically (and brainstem) stored and held away from conscious-awareness. And that is what constitutes the unconscious. It is that portion of pain that must be relived. Waving a wand in front of the eyes is most certainly never going to help a girl get over being raped by one’s father over and over again for four years at the age of ten. In my mind that is not science. It is magical thinking to believe that being abused by an alcoholic mother for ten years of one’s childhood can be eradicated by waving a few fingers in front of the eyes of the patient. If the reader could see the amount of pain this engenders he would understand right away how impossible this is. The caveat here is that it is not possible to understand the depths of feeling until a therapist has seen it. It then becomes clear.
Another point by Kolk: As I pointed out, he describes the PTSD sufferer as someone who cannot integrate memories of earlier trauma and instead gets mired in, “a continuously reliving of the past.” He states that those PTSD individuals suffer from persistant activation of the biological stress response. Part of this reaction is decreased serotonin levels, or a deficit in inhibition. This translates into an inability to modulate general arousal; hence impulsivity, irritability and hyper-excitability. Good neurologists who lack clinical experience do not have enough patient information to get it right.
What he says is true. The early trauma is obviously imprinted into the neurophysiologic system and produces repetitive or “neurotic” behavior. There is often a decreased serotonin response and therefore faulty inhibition. The imprinted trauma “uses up” serotonin supplies and produces lifelong deficiencies. I call it a faulty serotonin pump. There is just so much repression the system can produce. He suggests that serotonin uptake inhibitors which keep higher levels of serotonin in the brain, help keep the past in the past, allowing the person to function in the present. This is not entirely true. Drugs help normalize the system artificially and, above all, temporarily, but the imprint is implacable and immutable, and does intrude into everyday life; hence migraines, high blood pressure, phobias, etc. These are the sequelae of the early trauma. They are part of the memory.
But suppose we could raise serotonin levels by purely natural means. Would not that be preferable? We do. We have done a double blind imipramine binding study on our patients and have found that levels normalize after one year of our therapy. Our rationale for the imipramine study is that we can consider it an analogue of serotonin; that is, what happens in the blood platelets would be mirrored in the brain. It is not only imipramine binding that we have studied but also salivary cortisol (stress hormones). Cortisol levels normalize after one year of therapy. (See research on imipramine platelet binding, done in conjunction with Open University, Milton Keynes, England).
Van der Kolk believes that we need a high level of arousal to heal a patient. He is right; not any level of arousal but the same as inherent in the original trauma; and we must remember that one of the greatest traumas of all is not being held enough during infancy. Further, when any situation including sex, reaches the arousal level of the original trauma, it sets off the prototypic reaction of survival. For example, total shut off or repression in response to being strangled on the cord. This is the “freeze” reaction that Kolk describes. It continues on into sex, and the frigidity will not be cured until that original trauma with the whole panoply of physiologic responses are reawakened in context. But Van der Kolk has a conflicting message; he states that we must relive with the same intensity as originally, yet using EMDR will tend to block a full reaction, hence cutting off the healing process.
Again, no one has to help a patient integrate; the neurologic system does that all on is own. The lower level stamped-in feelings move to frontal cortex for connection and integration when that feeling is not such as to inundate the cortex. That is why integration takes place over months or years as the neocortex allows more and more pain to connect to conscious-awareness.
There is a point where all of the EMDR theorists merge. They believe that after moving the wand or hands the patient needs a different solution to the trauma. Kolk stated that, “If you are stuck in old memories, you can't have new behavior. Only changing the outcome of past events can result in new behavior in the future because the purpose of memory is to prepare you to deal with future events. There are a few problems with this: it is basically non-dialectic. Instead of having a patient relive totally an event as it happened, they provide a different solution, not recognizing that the solution lies in the imprint itself, not a different ending, which when we think about it, can only be imaginary, a false ending, because it never happened. The deeper one plunges into the agony of the imprint, the less pain there is to repress. The person is then free to deal in the present. The deeper one feels one’s very early hopelessness (someone who did not have a nourishing mother right after birth), the more hope there is. One way we verify this, is that the vital signs move from very low to normal after a reliving—the physiologic sign of the resolution of hopelessness. The patient reports feeling more hopeful, at the same time. We have treated thousands of patients over the decades and have seen beneficial outcomes through the five year follow-up studies we undertook. (see Primal Man. Janov, a. Holden, M. for results) The symptoms do seem to remain resolved.

What a World it Could Be

Today my children I am going to tell you about a world we could have, not for our children or grandchildren, but for us. And we can do it easily. But first in order to explore the subject I want to tell you about an article in the paper today. A man had a quarrel with his girlfriend. He left home and came back with a knife and stabbed her 50 times; this with their children in another room. No thoughts about those kids and certainly no thoughts that he was taking a life, savagely.


I thought to myself could I go out and get a knife and stab anyone 50 times? Of course not. Then I said, “Is he really from a different species than I?” And the answer is “yes!” What? Do I mean that? Absolutely. Now we have to go back to my three levels of brain development and revisit the first line. Remember we start out in the womb with a brainstem and little else. That brain structure is primitive, equal to the whole brain of the crocodile. It allows quick and immediate responses to get out of the way and save our lives. It allows impulsive reactions and is the base for the deepest aspect of feeling—hopelessness and helplessness. It organizes terror and above all, rage! When we need to fight to save our lives. When adverse events occur while we are being carried, it impacts the brainstem and first line.


When something happens as adults it can resonate with those first line reactions, unless of course there is adequate gating to hold down those primitive responses. But when a child is neglected, abandoned and unloved and untouched growing up, the pain grows and is compounded, weakening the gates between levels of consciousness. Gating is defective so that when there is resonance it reaches all the way down to first line. And rage ensues or other great pain hidden in the antipodes of the brain. Normally that reach does not trigger off first line reactions unless our lives are in danger and we have to react to save ourselves. Those with faulty gates are immersed nearly all of the time in first line. And that is what we often call the hysteric, who overreacts to almost anything.


So mister killer got jealous, she looked at another guy and that’s all, and the rage bubbled up and he killed. He for the moment was a complete crocodile with no cortex or limbic system to help out. When he was enveloped in the crocodile brain there was no longer the adult human brain to control and think things out. He was no longer human; no longer part of us. He was a different species. A primitive species with no human thought or compassion. When he was no longer triggered he will be overcome with what he did and want to kill himself but that comes later when he can think and feel without being overwhelmed by first line.

I remember when my father got mad we knew to stay away because his eyes began to water and turn red; we knew something deep and terrible was lurking down below. We did not know what to call it but now we do. His first line, Lizard brain was on the march. Watch out! Because that brain has no control. The reason is that when adverse things happen while we are in the womb it literally diminishes the development of the neocortex, controlling, thinking/reasoning brain. There is damage to these developing cells, particularly during birth where there may be a serious lack of oxygen.


So now we grow up without all our cortical marbles and with serious imprints on the brainstem/limbic/feeling areas. And we begin to eat like there is no tomorrow; and literally for the first liner there is no more tomorrow. Eating becomes life and death; urgent! Because the drive behind it is so urgent. There may have been starvation during womblife. Or some other serious trauma. The same with violent act-outs. Here the idea of anger management is ridiculous, unless we expect the person to grow new cortical cells. What they do offer is a cortical/third line buffer against upcoming pain. It will hold only for a short while; better to let it all out in a safe environment with slow emotional steps in a methodical way.


Any extreme behavior is usually first line derived; suicide, overeating, oversexed, addiction, and so on. Certainly, we can include psychosis in all this. And we know now what it takes to treat all these symptoms and behavior.


Now suppose there comes along a therapy that deals with first line? Modestly, I say it is mine. What will that do? It will make a world without uncontrolled rage. A world without serious alcoholics and drug addicts, a world without suicides. Don’t forget that all of what I am describing is at base emanating from first line. I have seen it and my staff have treated it successfully. It ain’t easy but it can be done; slowly, methodically and carefully. But we can make a decent world we can safely live in. And we can do it now! It is no longer a mystery except to those who have no access, which is most of us. So now children, before you fall off to sleep let me assure you, we have it in our power to make a much better world right away.