Tuesday, October 18, 2011

An Examination of Psychoanalysis (Part 9/13)

Wish Fulfillment

Contrary to Freud ’s theories , n eurotic dreams, particularly recurrent dreams, are attempts to deal with imprinted pain. Monsters, chaos, and catastrophes all depict the condition of the dreamer's feelings rather than the fulfillment of the dreamer's wishes. In the dream, no matter what the story, there is often a feeling of impending doom; the same feeling that arises just before a patient slips into a devastating pre-verbal primal.

While some dreams may contain wish fulfillment, it is definitely not the essence of dream material. Dream material is woven out of the concrete events of waking realities. If Pain is the chronic ingredient of that reality, it likewise will be the prime mover of dream activity.
Wish fulfillment is a seductive concept that again veils Pain behind a dangerous illusion of insight. Worse, it rarefies the unnecessary Pain of deprivation into an inevitable conflict of infantile desires.


For Freud and his followers, the preferred method of dream analysis – that has r emain ed unchanged for the last century -- use s language, words, and ideas a s the main tools of unravelling. Freud believed that when traced back to its origin, a neurotic idea would "crumble" and the patient would be "freed from it." Unfortunately, intellectual tracing seems quite limited because the neurologic system allow s us to go only so far before barring the gates. Ideas can alter, deny, distort, and repress feelings, but they cannot crumble them. Feelings don't "crumble." They are felt and resolved. And with that resolution goes the ideas which were used to defend against them.
Dreams utilize the first and second levels of consciousness -- primarily the second -- and are another type of language. They use scenes, pictures, sounds, scents, and images to portray feeling. While dreams are still symbols for the feeling, they are closer than third-level ideas to the inner reality. Making associations -- interpreting dreams -- thinking about meaning, just results in more symbols to cover the feeling
Analyzing dreams is the same as analyzing an idea and finding flaws in its logic. You can analyze a paranoid idea -- "people are laughing behind my back," for example -- all day long and not change it one bit. When one succumbs to the feeling of the dream, then one is directly experiencing the unconscious. That means giving into the feeling -- which might be one of terror or blind panic -- and riding the feeling to wherever it leads in the unconscious.

Structuring the Dream

Freud's dream work model requires that the analyst structure the dream for the patient. This action in itself modifies the dream, for the analyst can only superimpose his own view and theory. The dream will have a Freudian slant in psychoanalysis, and a Jungian slant in Jungian analysis. The theory is a preconceived set of ideas laid onto the dream in order to make sense of it. However, no theory is necessary at all, because the memory-imprint is all that is needed to make sense. The dream when felt will lead precisely to the time and place of the trauma. No theory need intervene. The analyst cannot possibly know more about the patient's unconscious than the patient himself. And even if his guess is correct, his insight communicated to the patient will not alter the problem within the patient. It will only give him one more idea to think about, and one less reality to feel. Only the dreamer, not the analyst, knows for sure what a dream means, but he won't know until Pain opens the gates and diminishes repression.
Let's take one of the examples Freud used to show how the application of his technique explained the dream.

A lady related that as a child she very often dreamt that God had a pointed paper cap on his head. How are you going to understand that without the help of the dreamer? It sounds quite nonsensical; but the absurdity disappears when the lady says that as a little girl she used to have a cap like that put on her head at table, because she wouldn't give up looking at the plates of her brothers and sisters to see whether any of them had been given more than she. Evidently the cap was meant to serve the purpose of blinkers; this piece of historical information was given, by the way, without any difficulty.

The interpretation of this element and, with it, of the whole short dream becomes easy enough with the help of a further association of the dreamer's: 'As I had been told that God knew everything and saw everything, the dream could only mean that I knew and saw everything as God did, even when they tried to prevent me.' This example is perhaps too simple.[1]

For Freud it was "easy enough" to see the historical parallels between the dream symbols and the dreamer's past. The patient as a little girl was made to wear the cap, so in her childhood dreams she puts the same cap on God -- she saw the plates of food "even when they tried to prevent me." And Freud believed that arriving at an "accurate" understanding or interpretation in this way was sufficient to undo the trauma.
There is a certain intellectual satisfaction in arriving at such a neat and clear parallel. In fact, Freud felt that "this example is perhaps too simple" because the meaning was so easily discerned. We have found that no matter how simple and transparent the meaning of the dream is, experiencing its feeling is, without exception, never "simple." While the intellect can view the connections as a well-fitted package, the body experiences the connections only through confusion, fear, and finally , agony.
What matters in this dream is the Pain that drove this little girl to her compulsive behavior, and the further Pain of her parents' reaction to it. Beneath her insistent need to see if her brothers and sisters had been given more could be the Pain of rejection and neglect. The dinner food was only a symbol for the love she wasn't getting. It would have been best left to her to tell us what it means, which she could have done had she been encouraged to sink into the feelings in the dream, feeling the Pain of that little girl as a little girl at the dinner table. She must re-experience the rejection and the lack of love; she must feel the Pain that drove her compulsive glances. She must feel the even deeper hurt inflicted by her parents. Not only did they not recognize her desperate need, they punished and humiliated her for it

[1]Outline of Psychoanalysis, p. 124.


  1. I have not been reading all these articles about Freud , but some did prompt me to re-read parts of Freud`s and Breuer`s "Studies in Hysteria". Now that is one fascinating and significant book. One has to admire the compassion, acute curiosity, and especially the persistance by which both authors went about their work with these very ill hysterical patients, work which helped them considerably it seems.It`s hard to beleive Freud came up with all these other dubious concepts and procedures after these very important initial discoveries. Perhaps I am wrong, but I can see a continuity with these studies on hysteria and Dr Janov`s work.


  2. Marco: Eventually old Sigmund would have become a primal therapist. he needed to live another 100 years. I am sure he wouldn't be a Freudian. art

  3. Dreams, my “Camino Real” to the cure which You and PT made possible.

    For decades, the pattern of a dream has been that I start a joyful trip, walk or adventure of some kind. However, it takes more time than I expect. Suddenly I cannot find my way and I’m getting an increasing feeling that people around me are changing and starting to threaten me. I become uncertain and the situation, now a full blown nightmare, feels utmost, painful and unbearable.

    15 years ago, and earlier, this stage turned sometimes into an epileptic seizure and sometimes into a feeling when I lived and felt the pain and horror of a prolonged birth process which was a painful struggle between life and death lasting for hours. A number of times, during a 20-year period, my dreams / nightmares / imprinted pain took me on dramatic sleep walks. Once I climbed a tall oak tree and had to be brought down by paramedics, another time I went up to the top floor of a Hilton Hotel in Frankfurt and a 3rd occasion I went down into a ravine in the middle of the winter. During my sleep walks, I was only dressed in my underwear, the way I normally was dressed when I slept.

    Having been through these painful feelings during my birth many, many times, the process has over the last 2 decades turned into a process which I now in my dreams can recognize, and these days I can feel a flash of my birth process and be able to “leave” the confusion in my dream, which I now can interpret. Often, I wake up. If I feel tense I can go with the feeling and live my birth, which nowadays is a very light experience to what I went through 15 years ago.

    This is an excerpt from an article, “Dream a little dream of me”, which I wrote a few months ago:

    “Last night I really had a dream. It was a very realistic and positive dream, filled with music and good feelings in which cramps were understood, and I came alive.

    A dream figure, a physiological and psychological creature, who represented someone completely adapted to gravity and with a feeling mind. I wanted to be that creature and in between, I was. In the dream, I was singing and listening to “Dream a little dream of me”. Simultaneously, I had feelings, in which I resolved cramp after a cramp. During a moment, I had a feeling of being close to a seizure, being numb and feeling dead, something, which happened when I was 18 (before I developed epilepsy) though without knowing then what was going on.

    During moments, I felt identical with the creature in the dream, even if it was not me. The dream which felt very realistic lasted for “hours”. In spite of sensations of cramps and crude feelings, it was a very pleasant dream. I cannot understand how I, who have always been perceived as tone deaf during the dream, from my memories, could retrieve words and music to “Dream a little Dream of me” and sing it during the whole dream with the timber of Nat “King” Cole. I have not heard that song for many years. Both immediately after waking up and now hours later I feel calm and balanced. Physical health and mental health are the same thing!”

    With a simplification, I can say that my dreams are one side of the history of how PT helped me conquer my epilepsy and my pain ropelled neurotic behavior.

    Jan Johnsson

  4. hi,

    so what do you think and feel about Jung then?

    I mean people are pretty big about Jung here in Europe. It's hard to ignore his ideas about the shadow and collective unconscious when you see how we humans get along.

    It's still and intellectual view though isn't it? There's also a sort of emotional flavour and many therapists refer to him in Europe. But Jung never seems to come right out and say "How do you feel"? Nor do his followers, except maybe my body - work therapist.

    I was seduced by the Jungians because their 'mystique' is very engrossing; it is the mystical review of the mystical and once you 'know' the language and punctuation of Jungianism you can always feel a little superior for having 'understood the symbols'.

    Paul G.

  5. "Eventually old Sigmund would have become a primal therapist. he needed to live another 100 years. I am sure he wouldn't be a Freudian. aj"

    maybe, but somehow i doubt it; Freud was inflexible when it came to the tenets of psychoanalysis; he tolerated no dissent in the ranks; it was his way or the highway...there's a very interesting Wikipedia entry on Otto Rank, one of Freud's early disciples who broke with him; mainly because Rank posited a pre-Oedipal "birth trauma"; shades of PT! anyways, Rank, while shunned by Sigie, went on to have quite an influence on the burgeoning Gestalt movement, which i found quite interesting; i hope you'll find time to weigh in on Rank, Art; he seems to have been your forerunner in many ways.

  6. About 15 years ago I read a lot of Freud,to see for myself what he had to say. Earlier, I had been highly influenced by the humanistic and neo-Freudian networks to dismiss Freud, but I wanted to see for myself. From what I understood (so much was so incomprehensible), nothing then changed my generally negative opinion of Freud (except for my appreciation of "The Studies on Hysteria"). I even wondered why anyone would even go through the trouble to refute his later formulations , like the "id" and the " death instinct" , which seem to go against common sense.But I also realised afterwards that his general pessimistic attitude was perhaps understandable relative to the era he lived in, and the general rampant psychological illness of Western Civilisation. Freud wrote that "Man is a wolf to man. Who can refute it in his day-to-day experience? " At first I balked at this statement, but after living more than 50 years in this civilisation of alienated sick individuals ,I can now bitterly understand why he came up with this statement, following Schopenhauer, and the Catholic Church's "Original Sin", not to mention the rampant Social-Darwinist ideologies of his era, culminating with The Nazi philosophy. Still, all this pessimism goes against common sense. It`s comforting that Reich and Janov have proof that we are all pretty decent under all the suface muck, but how sad that some people would need this proof to overcome their hard-bitten cynicism and pessimism.

    If some observers feel they need to refute Freud,they may be right. For whatever it is worth, here is an excerpt from another observer who also did refute Freud, Alexander Lowen: "...if we admit innate destructive tendencies in the child, then the development of teeth may be regarded as an ominous sign. Soiling the diaper may also be regarded as anal-sadistic behavior. However, Freud`s death instinct is not a true evaluation of the natural agressive tendencies in the living organism.That is not to say that destructive tendencies do not develop in the child.They can be traced analytically to interference with the child`s natural needs and rhythms, and that is what we wish to avoid.So too an anal-sadistic character structure can result, but it does not correspond to any natural phase of ego-growth and it cannot therefore be used a generic character type.It will appear as a variation of one of these types." Excerpt from "The Language of the Body" (1958)


  7. Paul/Art

    The difference Paul... the difference if it will be a lifelong process or not… probably depends on whether we get help from the Centre or not… help is probably crucial... because our defense working against our selves. But we don’t know… don’t know as there are probably “some” that do PT on their own and also do it very well.

    Art should have therapists who traveled around the world ... met people who were interested in PT and did an analysis of who would manage… manage to do PT by Internet or by phone. It might catch those who have great potential… but impossible to sort out an economy that is required to travel to the center. The proliferation of PT might axle and spread the science of its effect much faster.
    I do think… that help from the center would be crucial in our process… a better way… just by have some help whether we have participated at the center or not ... many will try by their own anyway… by themselves… alone... regardless of the warnings that Art gives. It might would help those/us pore souls to a progress… progress better than we continuo alone.
    So we would like to see someone from the center here in Sweden… to meet us and see what could be done? We will also se to the cost of cause… cost for what it will be… and also bring back to the center for thanks to come.

  8. Marco: OK Now you got him, you can drop him and concentrate on what will really help people, Art.

  9. Grumpy: NO NO NO not at all. Read him carefully 9/10s bull shit and a few good ideas,......and no science at all. art

  10. Paul G: Mystique is the operative word. I have written on him and I will dig it out and run it. It is an intellectual head trip of the highest order and not my cup of tea. art

  11. Art have you already written a book about all the prominent shrinks throughout history? all of these multi-part posts are very well written. they sound ready to be published

  12. Frank: We have no one who can travel, I go to Germany next week for stem cell therapy. We do Skype and phone therapy as well right now. art

  13. I don't know if Art's "NO NO NO not at all." response to Grumpy was about Otto Rank, but it does describe my take on him. He seems more like the forerunner of Stan Grof. Both of them have had some good ideas, but they tried to marry mysticism and anthropology and then convince the patient that it was real.

    But I'm generally not as harsh as Art is, and can even see the value in failures, particularly Freud's. Failure is part of the ladder to success (but see below for my reservations about the failures). That said, we now have a functioning system of therapy that is curative, as well as a new generation of brain scientists making discoveries every day that would have taken 20 years apiece when Art first studied psychoanalysis. There is no reason to continue with the failed efforts and false starts -- particularly since some of those failures have been disastrous. And that's my reservation about the failures: real people have been badly hurt and sometimes died on account of them.

    Most academic pursuits have gotten extremely insular in the past 30 years or so. Now that the Internet revolution is knocking down those walls, Primal Theory will start getting the attention it deserves.

    If Neuro-Linguistic Piffle and EMDR can be taken seriously, there is no reason to regard Primal Theory/Therapy as anything less than a serious discipline.

    -- Klaio
    (who used to post as one of the several Davids)

  14. HI Dr Janov: You wrote in reply to my last comment that "Now you got him, you can drop him". I don`t understand your comment. Who did I "get" ? And what`s this "getting"? Do you mean that I nailed what Freud was all about, and that I should now concentrate on something like Primal that will really help people?


  15. Hi Frank,


    The difference Paul... the difference if it will be a lifelong process or not… probably depends on whether we get help from the Centre or not… help is probably crucial... because our defense working against our selves. But we don’t know… don’t know as there are probably “some” that do PT on their own and also do it very well".

    It seems to me that what Jan & Tony are saying is that PT is not a quick fix. We know there are others who have come to their true feelings, not been able to rely on any 'therapists' in their vicinity and travelled to California to find the 'right therapy for them'.

    So PT is likely to be a life work and most clients don't (potentially) live any where near California. Perhaps there are those who have primalled so deeply and quickly that they are 'done' with quickly, I doubt it.

    Seems to me the majority of seekers (around the world) are into a quick fix by forming a relationship with 'professional trainers' whos' techniques can adequately be described as Cognitive, Behavioural. I dunno, who could have done the research to tell? I want to believe that all people looking for help would choose PT if they knew about it but something tells me the situation is a bit more complex than that.

    Only a minority are willing to commit to actually undoing the harm and even Art doesn't know how many that would actually be (around the world) if Primal Therapy were actually available. It could be a life work then even if you do get to California.

    For me it's already started, outside the castle walls as I already said. I have no other choices left. But when I eventually arrive in California I will not expect to be cured overnight / week / month / year. . . improvements, yes. Probably feel things more strongly and scarily than ever before.

    I am already benefiting from what has started (in me) so I know things can only get better with specialised supervision. Even more so for having stumbled onto this blog via a reference from Alice Millers' books.

    Paul G.

  16. am looking for a copy of "The Trauma of Birth", actually; am curious to see how closely it coincides with your writings on the subject.

  17. An email comment: "You're a very clear thinker Art, and with all that we know now about how emotion cannot be left out of thinking, about how being in connection to emotion helps thought, this discovery of yours can mean a great deal to every human enterprise, and most importantly to the future of the human race. I hope the human race will finally respond and recognize the value of your work. Actually, I have every confidence that they will, because they will have to see what is central to the many neurotic symptoms as they understand the outskirts of the problem and keep asking questions. Finally, science will see the elephant in the room: feeling. Then we will have a true paradigm shift not just in science but in the approach to social technologies as well. People are looking all around for signs of a world change, but when you want change you have to look where most haven't. People wanting change need to look within, where no one wants to look, to the pained need that promotes false views of the world and of themselves. Yet the new perspective needs to be felt not thought about, this new "looking" requires opening the "eyes" of feeling. Without this we have the blind leading the blind.

    Thank you Art, because of you I see a new and better world to come, if only the right things will into place, and if the human race has time. Yet, I sense that it will come, and sooner than we might expect.

    From my heart, thanks Art for opening the eyes of so many, eyes that can now see and help to create a better world."

  18. OK, Dr Janov, if I should stop criticising Freud, why did you waste your time writing all these article against Freud?

  19. Anonymous: It is not against Freud; it is explaining exactly what he means and what that kind of therapy can do. It is clarifying not a jeremiad. art


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.