On the Diagnostic Manual in Psychiatry (Part 2/3)

Each of us  in  psychiatry has a right  to our own opinion, but no one of us has a right to our own science.  Facts are public and are in the domain of science. They cannot be argued against; we need to test them in a specific way.  That is why there can no longer be many different psychiatric approaches  with all those disparate  schools of psychiatry.   They all have concocted beliefs and theories that are not based in strict science and so of course they differ. No different from differences in politics.  It is just a matter of who has the best argument.  Is childhood sex a fact as the  Freudians believe or used to believe?   Or can you think your way to health?   This is the true underlying principle of all insight and cognitive therapists.  You cannot do that therapy if you don’t believe in that idea whether  explicit or not.  If you believe in insight as curative you are a  cognitivist, no matter how you deny it. It is again thinking your way to health.

 There can be no paradigm shift in psychiatry until we are bereft of the cognitive bias implied in all of this. And it is underlined by psychiatrist Michael First, who was an editor of this Manual some time ago. What he states, grosso modo, is that none of this can be helpful.  What it will help,  and this is acknowledged  by many of my colleagues, is billing insurance companies.  Why is there  such a debate among my confreres about all this?  Because each has a different idea of what constitutes  an affliction.  If you are a psychoanalyst you have one idea, and if you are a Jungian quite another. And  since it all is  part of intellectual fabrication everyone or no one is  right.  None of this is based solidly on neurobiology.  It is as if the brain and the body are two distinct entities that have nothing to do with each other.  These psychiatric disagreements occur because of the theories they adhere to; and those theories reflect the doctor’s  personality, and little else.  A feeling woman is never going to be a cognitivist; she knows feelings and the unconscious, and cannot adhere to the idea that we can make profound change because of a change in our ideas.  

     I have treated hundreds of anxiety states (as explained in my Life Before Birth book), but the origin is nearly always remote and deep in the brain.  How can anyone diagnose it so it can be treated in a few sessions?   It has its beginning often in the first months of life, not life on earth but in the womb.  So those specialists take what the anxiety behavior looks like, try to change it, and when the apparent symptoms go away they imagine there has been success. The problem is that the generating source is still there raging below; that promises early disease and a premature death.  That is what we get for ignoring history, especially the critical nine months of gestation.  We will ultimately be struck down by a reality that is denied or ignored.  We are creatures of need and history; there is no escape from ourselves.

 There seems to be no motivating source in what they do.  Yet the unconscious is merciless and relentless.   The imprints lying there do not go away, not with pleas, exhortation, shock therapy or mechanical  manipulation.  It will only go away when it is addressed, relived and integrated.  Only then.  It needs to be experienced because it never was,  and has remained an alien force inside our bodies.   A small part of the original experience may have been felt but the charge value, the valence or force had to be instantly repressed and put on hold.  It is still there waiting for full connection.  We must eventually address and integrate it into the system.   It is that motivating source that is the origin of so much neurosis and psychosis.   The emperor is naked!

     On any given day there are about five million individuals getting mental health help.   And what they get now is mechanics and count-downs;  cut down mania to 3 days and they believe we have really helped the patient.  I don’t see much science in all this except they say that when the patient is fearful  he  has greater neuronal activity in the amygdala.  OK. Agreed. Now what?  Of  course  the feeling centers will be activated when feelings are.  These are accompaniments, not separate diagnoses.  And the cortisol levels will go up  too, as  they should when we are on  alert. But what to do about it?    We will never find a cure in the minute examination of the neurons; we may find a way to help; i.e., drugs and shock therapy.  But in all this there is no talk  of curing anything.   Where does the illness come from?   Why is it there?  How did it start and why? These are the critical questions that should be asked.    Ask a superficial question and you get a superficial answer. That is   the dilemma those doctors are in; they don’t know how to ask the critical questions.   And why don’t they? Because  their theory and therapy doesn’t allow it. And why not?  Because  their personality and repression won’t allow them to adopt a feeling approach.   Because to speak of cure you need to speak of generating sources.  So they are Behaviorists out of conviction and that conviction emanates out of  repression . How do you beat that?  Moreover, Behaviorism gets paid, and feeling therapies do not.  You see, as I have said before, that if I knock you in the head every time you start to smoke, sooner or later you will stop. Now if my criteria for progress is stopping smoking and I have the research to prove it, then of course I will get backing because no one seems to criticize the criteria I use for progress.   In the same way if I tell a therapist that every time he treats a patient I will give him money (but only if it is cognitive or behavioral), then he will treat in the manner I want.   Or to put it differently, if every time the patient stops smoking I  will  give him one hundred dollars, chances are he  will stop. So isn't that what the insurance companies are doing?

   We adopt the theory and therapy that suits our personality; that easily merges one with the other (therapeutic mode is therefore an outgrowth of one’s personality).  If we have never had a feeling and are not  close  to our pain, we will never adopt a therapy that will penetrate defenses and aim at feelings.  Theory, in so many cases, is part of the defense system—beliefs are one aspect of our defenses.   They emerge from the prefrontal cortex and help suppress rising feelings from the right limbic area.  Or to put it better,  beliefs are generated as a result from a surge of powerful feelings from the limbic area which galvanizes the cortex to rush into action to form beliefs which ultimately will hold back those feelings.  They dilute, vitiate and absorb the force or energy of the feeling through a myriad of ideas.  It makes the shrinks comfortable.  The rational we propose “works” and we feel better for a brief time; which is why we need to go back many, many times.

    Who would  adopt something that makes them uncomfortable.  We adopt beliefs, now called  theory, that helps keeps  feelings away.  Yes, we can call it theory but it is still a belief.  That is why real science plays so little a part in all this.  Those manuals of diagnoses never change how we do therapy.  We can still be Cognitive or Analytic therapists even with or despite this manual.   The frame of reference, the theory they adopt seems to have nothing to do with diagnosis.  So how come it never questions how we do therapy?  Why is it a given?  Because we need to go on doing what we are doing without having to change anything, particularly how we do therapy.  Our whole training militates against any change.    So on one side we have diagnoses, and the other side we have treatment.   I know from my training at the Freudian clinic of the West, that they never have anything to do with each other.

On the Diagnostic Manual in Psychiatry (Part 1/3)

Hello my children, and nearly every one of you is young enough to be my child; otherwise if you are too old you are not interested in what I have to say.  And I think of you all as my kids who want to learn; I take it as a sacred trust to fulfill that need.  I am also sure that many of you have an expertise where I could learn. We are all smart in different ways.  Anyway, I print the above from Time Magazine (March 2012) about the new DSM manual, now as thick as the Manhattan Telephone  Book,  to explain why this is nonsense and the  field of  psychiatry/psychology is bankrupt.  It has left science behind; well, not exactly.  It has addressed science through the new machines such as the MRI, but it is cloistered away from the actual practice of therapy.  And never the  twain shall meet.  MRI results never tell us how to do psychotherapy; they tell us what drugs to give or not give.  They tell us more about our neurons in the brain but not what causes them to act the way they do.  We take their actions as a given and go from there, very much like Freud’s Id.  We need to know why cortical neurons are sometimes hyperactive, not just how do we slow them down.  There is a whole system encapsulating behavior, not just something that stands alone without any background information, nor any interrelationship to other parts of us.  We are just “behaving” and the cognitivists/behaviorists say our task is only to change it.  Such a mechanical view of complex human beings.

Look at the above Time description and then multiply it by hundreds of pages to understand the garden variety of neuroses.  It is literally mind boggling.  What it does, as you see, is list behaviors; and the field  is captivated by the behaviorists who never see underlying motivations, who  count this or that behavior as a disease.  Eat too much?  Bulimia.  Eat not enough? Anorexia.  How to define this?  By behavior.  The behaviorists hold sway in the field today.  What you see is what you get; you look for the problem, you see behavior.  You look for the answer and you see behavior.  You look for progress, you look at behavior, and never, never look deeper.  So in their scheme of treatment a certain number of weeks of feeling down puts you in the pathological category called depression.   And, the insurance will pay for this therapy category, for a very brief time only.    I imagine if you were required to to be depressed for 25 weeks before we could diagnose you as depressed you would get grief from the insurance companies.  It all has to be brief; and therefore we are obliged to shorten our therapy accordingly.

Giving fancy names to psychiatric disorders does not make it scientific; it just makes it complicated. And when you rely on lists of names instead of feelings you see how complicated it gets.

All this has to be complicated because when you leave the arena of feelings and travel to the disconnected neocortex you have ever-widening verbiage with less and less sense.  You arrive at an intellectual never-never land.  I guess the whole idea is to make it so complicated; that no layman can understand it, therefore it has the patina of something really “scientific.”   Look, I have two advanced degrees, have been in practice for 60 years and I cannot understand it.   It is just mystifying.  What compels all these names, diagnoses and lists is the behaviorist belief that behavior alone accounts for afflictions.  And since behavior is as broad as the entire human condition, imagine the difficulty in diagnosis. They have built themselves a trap: they define in terms of behavior and then have to list almost all behaviors in terms of neurosis or not.  Whew!!  Let’s see, now I have to count how many months someone has been hypomanic to see if she qualifies for my concocted diagnosis. More important, to see if she qualifies for money.  The diagnosis has to fit, not science, but finance.

So in the category, Expansive Irritable Mood, it needs to go on for days to earn the diagnosis.  Now who decided that?  What about 3 days or six days?  What they conflate is average with normal.  The average  period  is about 4 days; ergo, the diagnosis is for those who suffer for four days.  Below or above can be normal.  If I don’t eat hardly at  all for six days you are anorexic,  but if only 3 days you are normal.  You see the trap in  counting the days.  How about the forces that drive all that?  Examine the fear of elevators.  I have treated dozens of these cases, and the generating source is most often a post-birth trauma of being enclosed in an incubator just after birth.   `The terror of being enclosed all alone with no kind and warm human contact is imprinted at the  time and remains embedded in the system.  Anything later that can trigger the memory (resonance) can set off the original terror and the phobia.  So why dance around the behavior instead of going to the source?  Because  the source is never recognized, particularly with cognitive/behavior therapists who have no place for generating  sources in their psychiatric schemata.   Their theory does not allow it.  “Stay on the surface” is their motto, and they do.   Can anything be more spurious?    We have a whole history of experiences that could help us understand who we are now  and it  is all ignored.  They only want to correct behavior,  which is the modus operandi of the Behaviorists. Only correct what we can see.  What we cannot see is forgotten.

You see the patient has to recount to the doctor whether something is mildly annoying or really terribly debilitating so she can note the depth of the probelm.  I have an article before me written by a patient who was anxious for years and never knew it. Why would they do in this case with our diagnosis?   She was only mildly aware. So is she severely neurotic?   Look at the obsessive-compulsive disorder.  I have treated many who suffer from it. Often there is imprinted terror down deep in the brain that underlies it.  It surfaces as, “If  I try the doorknob twenty times I will be safe.”  It has little to do with a doorknob and more to do with underlying terror that drives the search for trying to feel safe.   If you ignore the underlying force you need to make a list, many lists, because one key feeling can drive multiple behaviors.  


Are you compelled to try the door five times a day or twenty?  If twenty  you are obsessive.  If five???    If even once you are still compelled to try the doorknob to feel safe and that is the underlying motivation, and if you have to do it everyday, I offer you my diagnosis—compulsive.    If the generating source is ignored you have to spin a diagnosis that is off in intellectual never-never land.  Let’ s see, I go to my office, see a patient, and then I have to count her number of episodes.  And then I have to take her word if it is annoying or not.  Yes, I refer her first for an MRI, magnetic resonance, and it comes back "agitation in the amygdala," now what?  Is there  someone who will connect the two (the MRI and the patient’s complaint) from a comprehensive diagnostic point of view?  Will it dictate the therapy we do?    Doubtful.  Each specialist is off on their own.  I have an MRI that shows what happens in the brain when I am compulsive but who notes that there is underlying terror and why?  And above all, what to do about it? For that we need an overarching theory that encompasses theory and therapy so that one informs the other.

The behaviorists are caught in a trap.They have to decide on a diagnosis based only what they can see.  So four days of one behavior makes it a disease but three days does not.  And you need to be depressed for at least one week to qualify; and for what?  To get paid by the insurance companies for a disease called depression.  And it is now called a disease, not because of scientific input, but because of money to be paid.  Here the insurance companies and the psychiatric profession are imbricated and merge into a financial arrangement that suits both well. Behaviorism pays and it helps the insurance companies lower their payouts: brilliant!  Everyone should be happy—except the patient.  Doctors will correct your behavior and your ideas until  you reach what they decide is normal, and voila!, success.   We have become willing tools of the insurance companies whose key role is to keep costs  down; and too, of the psychiatric establishment who has a financial incentive to find quick ways to treat, with diagnoses that lend themselves to quick fixes. And what are the costs?  Us.    The quicker the cure, by  their definition, the quicker the end of therapy. This obviates feeling therapies that do not lend themselves to quick fixes.  The problems are more long-standing, deeper and more remote.   So we accommodate to the companies through specious diagnoses and rearrange our treatment modes.   And then we really believe that we are dealing with real biologic states.  We are  really dealing with financial states with a veneer of psychiatric lingo.  Did I say that the 
APA  brings in millions of dollars through the world-wide sales of the manual?  This is really where finance, politics and psychiatry meld into one. The APA hired a Pentagon spokesman to defend their work,  as if it were a matter of promotion and influence,  not science.  Maybe it really is indefensible.  And maybe it has to be promoted just because it is scientifically indefensible.   And maybe scientists were not engaged to explain it because it cannot be explained within the realm of science. If it were clear and solid science it would not have to be "promoted."

Can Love Save our Lives?

Over the years, I have cited one study after another showing how loving parents produce healthier children in every way. I have also cited a good deal of our work noting how we have normalized stress hormones, serotonin, immune function, and vital functions (vital signs: all summed up in my book Primal Healing). There is also a good deal of evidence about how love changes animals and also makes them better suited to life. The NY Times (“The Spirit of Sisterhood” April 24, 2012) has discussed this.

Let’s look at some of the recent evidence. A growing number of studies suggest one potential mechanism linking stress and adversity in childhood and in the womb to cellular aging, disease, and mortality in humans: telomere erosion (Drury, et al., 2011; Entringer, et al., 2011; Epel, et al., 2004; Wikgren, et al., 2012). In the first prospective-longitudinal study with repeated telomere measurements in children while they experienced stress, Idan Shalev and his colleagues (Shalev, et al., 2012) tested the hypothesis that childhood violence exposure would accelerate telomere erosion from age 5 to age 10 years. “We examined telomere erosion in relation to children's exposure to violence, a salient early-life stressor, which has known long-term consequences for well-being and is a major public-health and social-welfare problem.” Violence was assessed as exposure to maternal domestic violence, frequent bullying victimization and physical maltreatment by an adult. Participants were children recruited from the Environmental-Risk Longitudinal Twin Study, a nationally representative 1994–1995 birth cohort. Each child's mean relative telomere length was measured simultaneously in baseline and follow-up DNA samples (using the ratio of telomere repeat copy numbers to single-copy gene numbers).

Compared with their counterparts, the children who experienced two or more kinds of violence exposure showed significantly more telomere erosion between the age-5 baseline and age-10, even after adjusting for sex, socioeconomic status and body mass index. “This finding provides support for a mechanism linking cumulative childhood stress to telomere maintenance, observed already at a young age, with potential impact for life-long health.”

So here again, if you’re subject to violence you may live less long. But don’t forget the violence done to you in the womb when mother smokes or drinks, or is very anxious--that trauma occurs so early that it cannot be observed. Yet it happens when the whole neurobiologic system is just being organized, and it severely impacts the baby. The trauma is there, and can be implied through biologic measurements that I have discussed previously in my works, and in shorter telomeres in later life (Entringer, et al., 2011). One measurement, cortisol/stress hormone levels, rise, indicating the baby has suffered and is suffering inside. No one seems to notice, least of all, the baby/child/adult. But telomeres tell us: look out, there is misery there. And when there is overt suffering, as in violent homes, the telomeres shorten, resulting in our being on earth for a much shorter time. We sometimes can say, “I was hit every day after school,” but it is hard to say, “I was ignored every day after school.” The punishment and hurt is still there.

Unloving homes may also be terribly traumatic with effects on the telomeres. One way we know is that our entering patients, nearly all, begin therapy with high stress levels. And those levels, as shown in our vital sign and cortisol studies, move toward normal after our therapy. And we do know that chronically high levels of cortisol indicate possible telomere shortening. These patients are not all aware of their suffering when they start therapy. But the read-out screams suffering.

In almost every mammal there is the expression of love in one way or another. Chimps groom each other, while elephants rub trunks. Monkeys hug and kiss each other. There is something about touching and rubbing that shows love in almost every species. We need to translate that to humans who think that saying “I love you” is enough. It is not. It comes from the top and is not physical. If you could groom your child, rub his head and his back and cuddle him every morning—that is love and it has a direct physical effect. It is saying, “I am giving you life and I will help you be healthy and live a long time.” And, Oh yes, I will lengthen your telomeres. It is not hard to do, that rubbing and hugging, yet if we do it every day with the children we will rear great kids. It is that easy. You leave yourself 10 minutes very morning to brush your teeth and do your hair; take another 10 minutes and cuddle and kiss. That is all you need to do. Just kiss and hug and then watch. And that is very hard to do with a child who was unwanted; who was in the way and came at an inconvenient time. Faking it won’t do it. It is a feeling we are after. And sometimes resentment is there first and foremost; the child never had chance, unwanted from the start. And he will be resented for getting born.

It may seem like magic, all this, but it is not. The magic is love. It begins by fulfilling each and every need; in the womb it means a healthy life, no drugs, and proper nutrients. At birth, it means a natural one with no anesthetics if possible, with holding the baby immediately close to mother’s body, in a warm, calm environment. And, of course, to avoid cesarean whenever possible. I list what happens in my new book, Life Before Birth, when a good birth does not happen.

From then on, it means touch and hugs, listening to the child’s moods and understanding and reacting to them: I am just trying to list what I never got that made me a wreck in childhood to suss out what the needs are. It means caring and being interested in the child; not being distracted and occupied elsewhere in your mind. Being close to the child emotionally means he will be able to be close to others without fear. He won’t hang back and hide behind mother’s skirt in the presence of strangers. A loved child doesn’t do that. I have had loved children around me. They are always a joy. I can pick out in a group of children which child has been loved and had a good birth. I have done it before with success. They are different; they are normal. They act normal, look normal and their bodies are normal. Don’t forget the body in the talk about normalcy. That is what any psychotherapy should aim for. It is what we all want and need.

What we do not want is a therapist setting up some arbitrary goal of normality, and then guiding us toward it, so that we end up leading his life, his wants and desires, and not ours. It is our own body and brain that dictates a goal, if needed at all, and leads us to it. If we are normal we will lead a normal life. If we concentrate on behavior alone we will never be well. We must focus on the whole system that gives rise to that behavior. We can go to therapy and try to learn to act normal, and then we die prematurely from early lack of love. Remember, it is an act. If you were not loved early on it has to be an act. We do not grow out of our childhood; we only grow away from it.

Most mammals have pals or love objects that they hang with. It gives them strength to deal with life. Mice who have pals give birth to more offspring. They are giving life. A lioness will suckle another mother’s baby…giving love and life. A close friend is soothing and calming.

The critical period for when to be loved is closed early in life and that is that. Daddy leaves home soon after his baby is born, comes back years later and wants to make up for lost time with his kids. He can’t. It is too late. It helps a bit but does not change anything. It softens some of the blow and prevents serious compounding of the imprint. The kid still feels unwanted and unloved…it is an immutable imprint. We cannot erase history, but let me tell you what we can do about it….

It seems crazy but I believe it to be true. You cannot change your telomeres and stress hormones by an act of will; it changes as part of a systemic change. But in a session, if you feel unloved within that early timeframe, you can normalize and live longer; and I believe the telomeres will not shorten as fast. Let me repeat: if you can go back in time to feel fully unloved when the imprint was laid down you will live longer. If you cannot do that and want to get on with life, life will bite you back and make you die sooner. I think that is a biologic law. You have to feel your need again; it is biologic.

When we get love very early in life it endures for a lifetime; it becomes the world’s best painkiller. And it avoids the need for later painkillers and tranquilizers. Love loads us up for a very long time with natural anti-pain medication. And when it was not there, we play catch-up all of our lives, taking pills to ease the pain over the love we never got. A love we never knew existed. So what to do? It is so easy to love a child from the day she is born; and that is pure prevention for a lifetime. It ensures health and longevity. Who can ask for more?



Drury, S.S., Theall, K.P., Gleason, M.M., Smyke, A.T., Devivo, I., Wong, J.Y.Y., Fox, N.A., Zeanah, C.H. and Nelson, C.A. (2011, epub). Telomere length and early severe social deprivation: Linking early adversity and cellular aging. Molecular Psychiatry, 1-9.

Entringer, S., Epel, E.S., Kumsta, R., Lin, J., Hellhammer, D.H., Blackburn, E.H., Wüst, S., and Wadhwa, P.D., et al. (2011) Stress exposure in intrauterine life is associated with shorter telomere length in young adulthood. Proc Natl Acad Sci USA, 108:33, E513-E518.

Epel, E.S., Blackburn, E.H., Lin, J., Dhabhar, F.S., Adler, N.E., Morrow, J.D. and Cawthon, R.M. (2004) Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA, 101(49):17312–17315.

Shalev, I., Moffitt, T.E., Sugden, K., Williams, B., Houts, R.M., Danese, A., Mill, J., Arseneault, L. and Caspi, A. (2012) Exposure to violence during childhood is associated with telomere erosion from 5 to 10 years of age: a longitudinal study. Molecular Psychiatry advance online publication 24 April 2012; doi: 10.1038/mp.2012.32

Wikgren, M., Maripuu, M., Karlsson, T., Nordfjäll, K., Bergdahl, J., Hultdin, J., Del-Favero, J., Roos, G., Nilsson, L., Adolfsson, R., Norrback, K. (2012) Short Telomeres in Depression and the General Population Are Associated with a Hypocortisolemic State. Biological Psychiatry, 71:4, 294-300.

Chronic Fatigue Syndrome: What is it?

We had a staff training today; our practice is to bring in patients who need extra help to discuss their problem with them. Today, we saw a gentleman who has been sidelined for four years with Chronic Fatigue Syndrome. Very few know what it is, which is why he has been shuttled from one doctor to another, getting one type of medication after another and he still is unable to work. He did receive the diagnosis, however, which shows how useless a non-dynamic diagnosis is: Chronic Fatigue Syndrome. He is exhausted at all times, cannot drive or go to work; just lies around. Let me explain this affliction and see what can be done about it. And in do so doing I will try to help us see what the act-out is. And the act-in, as well.

Chronic fatigue can often be so subtle as to be undetected. In the case under discussion exhaustion was his act-out. What that means is that he is not just tired now because he has no energy. There is an imprint of exhaustion from far back in time that that dominates his life and drains his energy. He really is tired in the same way that someone deprived of love early on acts out sexually trying to get touched as much as possible to make up for that past deprivation. She really needs love and touch, and is really sexual; driven by the past and its imprinted pain. Or in the case of early food deprivation, especially during womb-life, (the mother on a strict diet to keep her form), they are really hungry…out of a memory!

All of these patients are acting out their need from the past in the present; that is called symbolic acting-out. It is never satisfying or fulfilling no matter how much one does it; and if one is dissuaded from the act-out in therapy the need and imprint are still there doing damage down below.

During the birth process our fatigued patient struggled mightily to get out only to be smothered by a massive anesthetic given to the mother. He couldn’t struggle any more, so that failure set in. He exhausted any and all resources he had in the battle to get born. The exhaustion became an imprint. Later, he felt chronically fatigued and unable to struggle. It wasn’t so evident during growing up except that he disliked exercise or “making a move,” and he had less energy. Making a move originally was impossible. He gave up easily when he should have pushed forward. So when I say “he gave up and couldn’t struggle any more” I am indicating nothing thought-out; it was a biologic memory that had nothing to do with conscious-awareness. The imprint was purely physiologic with no awareness counterpart. It can only be understood after the fact of reliving the imprint when the feeling rises to the top level for comprehension, at last. Clearly, there is no “reaching” for the imprint because the patient does not know it is even there. So he cannot deliberately think it out to go there.

Our fatigued patient began to run off the imprint over and over throughout his life, with no idea what was wrong. The distance between the birth trauma and current-day fatigue is so large as to make it seem absurd. It is not. One way we know is through patients who suffer from it; they relive and relive, first the terrible struggle to get out, then the lack of oxygen and near death sensation back then from massive anesthetic given to the mother, followed by shutdown of many key biologic systems, and giving up…the struggle-fail syndrome. It is that syndrome that is carried through life and acted out without cease…until there is conscious awareness. For it to stop one needs connection; it is the only way, the only way, to stop the act-out. Yes, we can smack some man who gets erect when seeing a picture of a nude man or of someone who salivates at the sight of a juicy steak but it is only temporary until the imprint again rears its head, which it will certainly do. That is why anger management cannot work. We can find tricks to push down anger but the imprint dominates and never lets up. Nearly every treatment in the anger management armamentarium has to do with suppression, pushing back. Anger is not to be managed; it needs to be felt in context; then it is over. We have to manage it, like food and sex addiction, when the person does not feel the feeling. So either feel or manage. It is one or the other.

The imprint is a memory that is unconscious because that is where it resides. And it resides there physiologically, put in place long before the neurological capacity for full comprehension. It is an imprint, nevertheless, and agitates us and forces the act-out without stop. It was physiologic originally and remains so. It is impelling and compelling. Because it is purely physiologic, treatments that work on the physiology such as tranquilizers do work. What is diabolic is that the there are mental consequences, impulsions from below, that force compulsive ideas that lead us to believe, somehow, that it is mental in origin. Not so.

Obviously, the reliving cannot be faked because the memory has been hidden and does not become conscious until it is relived. No patient can foresee this and “decide” to relive it. And no one would want to fake it since it can be uncomfortable. Since several thousand patients have gone through it with success, some long before I wrote about it, we have a good idea that our hypothesis is right. There is nothing quite so liberating as that reliving process. Once relived and the sequence completed it is over and one is no longer driven by it. The compulsion is over because the imprint has been experienced. Meanwhile, until then, it captivates and rules most of our lives. We are often bedeviled by our need to eat, or our constant exhaustion. Now we know what to do about it and treat it properly.

Until there is connection for this fatigued man the smallest effort now leads to exhaustion and giving up; he does not want to try any more. The birth has been hijacked and is run off continuously. Effort, struggle, blocked, smothered by drugs, anoxia (diminished oxygen) exhaustion, failure. To be clear, the physiologic component of the original imprint is run off and will be run off until it is experienced and made conscious. That is, the entire biologic panoply, all of the physiologic components of the imprint, are there and active all of the time. We act it out because there is no conscious connection; like a headless chicken.

If our patient even thinks of going to look for a job he is literally paralyzed into inactivity. It is as if the anesthetic is administered all over again after his birth struggle. In this case, the act-out was giving up and failure. This was then a repetition compulsion where any kind of effort he made exhausted him, the analogue of the birth imprint. Unfortunately, he could never waver from this scenario because it was held fixed by the imprint itself, which never allowed any wavering or alternate behaviors originally. If we want to know the hidden feeling we have only to examine the act-out; it is nearly always a direct reflection of the hidden feeling. As we see in chronic fatigue. This is not to say that it is always thus, but close enough. It is often hidden by some kind of concocted philosophy or theory but it is still the outcome of an imprint.

Why isn’t the act out fulfilling? Because it is symbolic; the fulfillment is for a past event and not current. And it is not fulfilling because it is driven by an unrelenting memory of “no fulfillment”; that is what is driving us. And will continue to do so. The “no fulfillment” is always there no matter how much we eat because it is an ineluctable imprint. If we do not understand the imprint (explained by me in the blog…the mechanisms of methylation and acetylation) we can never understand what drives our compulsions and how to treat them. Understanding is primordial. Otherwise, we are forever prisoners of pain.

Psychology and Ideology. How Could Anyone (Except the Rich) Vote for George Bush? By Peter Prontzos (6/6)

Zimbardo investigates the forces that compel otherwise ordinary people to commit acts of extraordinary horror and brutality, such as torture and genocide (as well as eliciting heroic behaviour on the part of others).  He offers three fundamental explanations for human behavior.  The first and most common approach he terms dispositional.  This view focuses primarily on the individual and his or her personality, experiences, genetic inheritance, abilities, and beliefs.  It holds that, most of the time, the locus of control over actions is internal.  By this psychological explanation, individuals are held to be responsible for their actions – regardless of any other external explanations or forces.  Nelson Mandela, for example, is a hero primarily because of the type of person that he is (compassionate, intelligent, and principled), while Saddam Hussein was a villain because of his personal vices (sadism, hungry for power, vanity).  In the U.S., the dominant political culture focuses primarily on the individual as the responsible agent.

The problem with this focus is that most people who commit atrocities are not psychopaths, and individual variables alone can account for only a relatively small part of their actions.  For instance, after carrying out war crimes, most perpetrators return to their “normal” lives and never again exhibit such pathological behaviour.  Zimbardo therefore offers a second level of explanation, based on situational variables outside of individuals that usually provide more robust and comprehensive answers about the sources of (in)human behavior.  At this level of analysis, factors such as ideology, political culture, deindividuation, domination, socialization, and dehumanization contribute to producing irrational and cruel actions.  This focus on social dynamics does not deny the role of personal qualities, but it assumes that, on most occasions, there is an interaction between individual and their environment in which the latter is most salient for most people in most circumstances (Prontzos, pp. 170-76).

Fear, for instance, tends to bring out the worst in us, and it should not come as a surprise that,

people cling to their personal biases more tightly when feeling threatened. After thinking about their own inevitable death, they become more patriotic, more religious and less tolerant of outsiders…(Carey, 2009).

In other words, given the right “situational variables,” practically anyone will do terrible things to another human being.

Zimbardo stresses that horrors can be committed by “normal” people because human behavior is extremely malleable, producing contradictory behaviors by the same person in different situations.  The simplistic dualism of believing that “an unbridgeable chasm separates good people from bad people” ignores the reality that human behaviour is characterized by its variability, so that evil is “something of which we are all capable, depending on circumstances”.

In mainstream U.S. political culture, however, the idea that Washington’s foreign policies might be motivated – like other states - by selfish economic and political considerations, rather than by the wish to spread freedom and democracy, is “beyond the bounds of thinkable thought” (Chomsky).  “We” do not start wars of aggression, “they” do.  We might make honest mistakes, but we cannot be the villains.  We learn in schools and in the media that, “the United States is the greatest force for good the world has ever known” (Bob Dole).

Above all, Zimbardo places the blame for inhumanity primarily at a third level: systems of power which create situations, and which will do almost anything to maintain their domination.


It’s not just that “power corrupts,” but that power attracts the corruptible - hence Plato’s warning against those who seek to dominate.

From this perspective, the interaction between systems of power, situations and human nature may provide the broadest insights into our feelings, thoughts, and actions in general, and in particular for understanding humanity as the “zoon politikon” - the political animal.

CONCLUSION

There are multiple causes for the irrationalities that are all-too prevalent in political behaviour and ideology, from our “kluge” brain to the way we raise children and how we construct the societies in which we live.  This paper has focused on some of the most important, yet mostly unconscious, factors which can shape ideologies and behaviours in ways which are problematic and potentially dangerous.  Crises such as war, poverty, and global warming can never be solved if we continue to be at the mercy of such forces.

It is clear that these complex issues cannot be grasped without sufficient consideration of the psychological dynamics at work on individuals and in the culture at large.  Only a more complete understanding of the causes of human belief and behaviour provide real hope for a more genuine democracy, one that is less susceptible to the irrational, and which allows us to live up to our potentials for compassion, rationality, and freedom.

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Carey, Benedict.  “How Nonsense Sharpens the Intellect” in The New York Times.   5 October 2009.

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Kahneman, Daniel.  Thinking, Fast and Slow.  Farrar, Straus and Giroux (New York)  2011.

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-------  The Political Mind: Why You Can’t Understand 21st-Century American Politics with an 18th-Century Brain.  Viking.  (New York)  2008.  p 3.

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Prontzos, Peter.  Book Reviews.  Journal of Genocide Research 11:1.  March 2009.  http://dx.doi.org/10.1080/14623520902823199

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----------------.  “An Interpersonal Neurobiology Approach to Psychotherapy,” in The Embodied Mind: Integration of the Body, Brain, and Mind in Clinical Practice.  UCLA Extension and Lifetime Learning Institute  (Los Angeles) 2006.

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On Painkillers and Pregnancy

The more painkillers a woman takes during labor the more likely her child will be to abuse drugs or alcohol later on. Karin Nyberg of the University of Gothenburg, Sweden, looked at medication given to the mothers of 69 adult drug users and 33 of their siblings who did not take drugs (Nyberg, et al., 2000). Twenty-three percent of the drug abusers were exposed to multiple doses of barbiturates or opiates in the hours just before birth. Only three percent of their siblings were exposed to the same levels of drugs in utero. If the mother received three or more doses of drugs, her child was five times more likely to abuse drugs later on in life. Enough animal studies have been done to confirm the finding—exposure to drugs in the womb changes the individual's propensity for drugs later on.

There is some evidence that a mother taking downers during pregnancy will have an offspring who later will be addicted to amphetamines, known as “uppers” (speed) (Jacobson, et al., 1988); while a mother taking uppers during pregnancy—coffee, cocaine, caffeinated colas, may produce an offspring later addicted to downers—Quaaludes, for example. And the reason that the person can take inordinate doses, such as drinking two cups of coffee before bedtime and still be able to sleep easily, is that there exists a major deficiency of stimulating hormones—the catecholamines. In short, the original set points for activation or repression have been altered during womb-life and persist for a lifetime.

I have treated patients who have taken enormous doses of speed and yet have shown very little mania as a result. While other patients of mine have taken lethal doses of painkillers in previous suicide attempts, enough to kill anyone else, and yet still lie awake hours later, only feeling slightly drugged. The severe brain activation by imprinted pain resists any attempts to quell the system.


Jacobson, B., Nyberg, K., Eklund, G., Bygdeman, M., Rydberg, U. (1988) Obstetric pain medication and eventual adult amphetamine addiction in offspring. Acta Obstet Gynecol Scand 67:677-682.

Nyberg, K., Buka, S.L., and Lipsitt, L. (2000). Perinatal Medication as a Potential Risk Factor for Adult Drug Abuse in a North American Cohort. Epidemiology 11(6):715-716.

Psychology and Ideology. How Could Anyone (Except the Rich) Vote for George Bush? By Peter Prontzos (5/6)

III - THE POWER OF SITUATIONS

As a result of our evolution, human beings have the most “social” brain of any mammal.  As Frans de Waal, one of the world’s leading researchers on primate behaviour, wrote:

There was never a point at which we became social: descended from highly social ancestors – a long line of monkeys and apes – we have been group-living forever… life in groups is not an option, but a survival strategy (de Waal, 4).

The evolutionary advantages of being able to practice complex forms of social cooperation are the primary reasons for the growth of the neo-cortex, which is central to our “higher” mental functions, and which is most developed in the human species.

One foundation of our social nature involves mirror neurons.  This discovery illuminates the very profound way in which people are connected to each other and also provides a neurological foundation for empathy, which is so central to being human that whenever we even think about hurting someone else, our brain automatically generates a negative emotion.  The mirror neural system also illuminates the profoundly social nature of our brains (Siegel, 2006A).

Another study demonstrated that empathy is a normal function of a healthy brain (de Waal believes that it developed out of maternal-infant bonding in mammals, op. cit).  It found that a person who has suffered an injury to their ventromedial prefrontal cortex (VMPC), were more willing to harm others than those whose brains were functioning normally.  As one researcher summed up: “Because of brain damage, they lack empathy and compassion” (ScienceDaily, 22 March 2007).

People are hard-wired for compassion and cooperation.  Not only is it natural to care for others, but nurturing relationships with family and friends are vital to our emotional and physical health.

Eric Fromm argued that we must consider how, in addition to the individual unconscious, cultures develop their own particular “social unconscious” in which political, economic, and cultural forces actively suppress certain “unacceptable” ideas and emotions, while promoting others (Fromm 1955).

There is wide agreement that the corporate media are a major factor in the construction of ideologies.  Kahneman notes that,

People tend to assess the relative importance of issues by the ease with which they are retrieved from memory – and this is largely determined by the extent of coverage in the media (op. cit.  p. 8).

This view that one’s social unconscious plays a significant role in determining one’s political views has been receiving support lately, as new research sheds light on how these unconscious forms develop.

For instance, “there is evidence that life experience as intangible as culture can also reorganize our neural pathways”.  Research shows that both younger Asians, and Westerners in general, view the world differently than older Asians, who grew up with less Western influence.  Psychologists using fMRI scans showed people 200 complex scenes, such as an elephant in a jungle or an airplane flying over a city…”  The lead researcher summarized the results: “An Asian would see a jungle that happened to have an elephant in it...Meanwhile a Westerner would see the elephant and might notice the jungle” (Binns, 2007).  The differences between younger and older Asians support the view that these results stem from cultural rather than genetic causes.

The fact that most people usually hold the same religious and political views as their parents is a reminder of how profound such early influences are.  Most children born to Muslims remained Muslim, and the same is true for Hindus, Christians, Jews, and so on.  By the same token, most children of liberal parents are liberal, while conservative parents generally produce children who lean to the right.

The effects of one’s environment can interact in a number of ways with one’s “nature” to affect attitudes towards other people.  For instance, a recent large-scale study (N = 15,874) in England,

found that lower general intelligence (g) in childhood predicts greater racism in adulthood, and this effect was largely mediated via conservative ideology. A secondary analysis of a U.S. data set confirmed a predictive effect of poor abstract-reasoning skills on antihomosexual prejudice, a relation partially mediated by both authoritarianism and low levels of intergroup contact. All analyses controlled for education and socioeconomic status. Our results suggest that cognitive abilities play a critical, albeit underappreciated, role in prejudice (Hodson, Busseri, 2012).

There are many ways, as noted above, in which natural empathy can be lost.  After all, biology is not destiny, except in the sense that it underlies the wide repertoire of human behaviour, which is more varied than in any other species.  Consider the immense variety of cultures that exist, and that have existed, and it is clear that our behavioural flexibility is vast.  The question of which of our potentials and behaviours are actualized depends on our past experiences as well as our current environment.  Phillip Zimbardo (who ran the [in]famous “Stanford Prison Experiment argues in The Lucifer Effect that:

we are born with a full range of capacities, each of which is activated and developed depending on the social and cultural circumstances that govern our lives…the potential for perversion is inherent in the very processes that make human beings do all the wonderful things that we do (Zimbardo, 2007).

Treating the Patient With Respect

Why can’t any therapy help patients with their feelings? One good reason is that they are talking to the wrong brain—the brain that thinks rather than the one that feels. Unfortunately the correct brain, the right brain and lower brain, doesn’t talk much, doesn’t understand English and, as a matter of fact, doesn’t understand words. It doesn’t understand in the way we think of understanding. The correct brain is one that contains our history, our pain and our feelings; the brain that processes our deep feelings that can finally liberate us. It does understand feelings; we need to speak that language—one without words. We have to convince the brain that spouts words and ideas that it is necessary to go back to early life and a world devoid of intellectuality (kids are not intellectual as yet), and relive feelings—that lack of love—that were too much to feel at the time. We have to convince that thinking brain to let go, let the lower brain systems emerge and breathe the air of freedom. It can be done; cure can be accomplished. But only by stealth, not by deliberation. Feelings have to creep up on us, not be sought out. It has to be a therapy of nuance, of subtleties, of flexibilities and lack of domination; that is, it cannot be a therapy of experts because the only expert is the patient. The doctor has to let go of any notion of superiority. Even keeping the patient waiting for a session is a sign of superiority, which I do not tolerate in our therapy: it says “I am more important than you and my time is more valuable”. And while you are trying to get back some self-esteem, the doctor lowers it by keeping you waiting. It is subtle but there. And above all, we need to get rid of any time constraints that force a crying patient in the midst of her feelings to leave and wait until the next session.

We do not touch the patient when she needs to feel unloved; we touch her when the pain is so excruciating that we need to lower its force so it can be experienced and integrated. It is one means of keeping the patient in the primal/feeling zone. If the therapist cannot feel he cannot distinguish the difference and will touch at the wrong time or in the wrong way. Patients can sense when they are being touched out of the needs of the therapist and not their own needs.

When a therapist cannot tolerate the patient's suffering she may touch to ease the pain, and thereby ruin the session because it kept the patient from feeling all of his pain. The therapist may be acting out her own need for touch and caress in her own early life. Watching the patient writhing may bring up great pain in herself, setting off her own feelings, forcing her to stop the patient from feeling.

So the therapy can go wrong when the therapist has not resolved a good piece of her own pain. And none of that can be taught: when trainees take notes all of the time it usually means that they cannot feel what is right and need intellectual signs of what to do. This is a therapy that cannot be done by the numbers. It is a matter of sensing, intuition, and instinct…plus a soupcon of training…a lot of training.


ON PAINKILLERS AND PREGNANCY

The more painkillers a woman takes during labor the more likely her child will be to abuse drugs or alcohol later on. Karin Nyberg of the University of Gothenburg, Sweden, looked at medication given to the mothers of 69 adult drug users and 33 of their siblings who did not take drugs (Nyberg, et al., 2000). Twenty-three percent of the drug abusers were exposed to multiple doses of barbiturates or opiates in the hours just before birth. Only three percent of their siblings were exposed to the same levels of drugs in utero. If the mother received three or more doses of drugs, her child was five times more likely to abuse drugs later on in life. Enough animal studies have been done to confirm the finding—exposure to drugs in the womb changes the individual's propensity for drugs later on.

There is some evidence that a mother taking downers during pregnancy will have an offspring who later will be addicted to amphetamines, known as “uppers” (speed) (Jacobson, et al., 1988); while a mother taking uppers during pregnancy—coffee, cocaine, caffeinated colas, may produce an offspring later addicted to downers—Quaaludes, for example. And the reason that the person can take inordinate doses, such as drinking two cups of coffee before bedtime and still be able to sleep easily, is that there exists a major deficiency of stimulating hormones—the catecholamines. In short, the original set points for activation or repression have been altered during womb-life and persist for a lifetime.

I have treated patients who have taken enormous doses of speed and yet have shown very little mania as a result. While other patients of mine have taken lethal doses of painkillers in previous suicide attempts, enough to kill anyone else, and yet still lie awake hours later, only feeling slightly drugged. The severe brain activation by imprinted pain resists any attempts to quell the system.


Jacobson, B., Nyberg, K., Eklund, G., Bygdeman, M., Rydberg, U. (1988) Obstetric pain medication and eventual adult amphetamine addiction in offspring. Acta Obstet Gynecol Scand 67:677-682.

Nyberg, K., Buka, S.L., and Lipsitt, L. (2000). Perinatal Medication as a Potential Risk Factor for Adult Drug Abuse in a North American Cohort. Epidemiology 11(6):715-716.