Sunday, November 3, 2013

The Mystery Known as Depression, Part 1/12

This is the first of a series of articles I wrote on Depression. The whole article has been published by ANS: The Journal for NeuroCognitive Research in October 2013. To see the full text:

Depression has been considered a mysterious ‘monster,’ even in professional circles where it is still deemed an enigmatic illness.
The condition has proven so resistant to treatment that one therapeutic approach, based on cognitive-behavioral principles, calls itself “Taming the BEAST,” an anagram for “treatment modules” in Biology, Emotions, Activity, Situations and Thoughts. (Gilson & Freeman, 1999) Today, however, the most common treatment strategy is also the simplest. It involves the use of antidepressants, now the third most widely prescribed type of drug in the country, often administered by general practitioners untrained in psychology. (Mojtabai & Olfson, 2011) When neither drugs nor therapy are effective, some psychiatrists resort to that holdover from horror movies, electro-shock therapy, which is gaining renewed acceptance under a different moniker, electroconvulsive therapy (ECT).

Until recently, ECT was considered the last resort in the battle against the beast; it was used when psychiatrists concluded that the only option left was to blast the patient’s brain with electrical energy. Now, psychiatrists have gone beyond applying shocks from outside the skull and have opted for an even more radical alternative – brain surgery. (Mayberg et al., 2005) To say the least, it is a most drastic attempt at a solution. The procedure – known as deep brain stimulation (DBS) – involves drilling four holes in the brain with screws inserted into the skull. Surgeons then plant electrodes near the center of the brain in a region called Area 25, part of the subcallosal cingulate gyrus which has been identified as a having a key role in major depression. Activated by a pacemaker in the chest, the devices emit a steady stream of electric pulses to stimulate the area, thereby easing the otherwise entrenched symptoms.
Suppose, however, that we could access deep brain centers without any physical or chemical intervention and make alterations in the circuit – perhaps even rewire it – in a natural way. I submit that Primal Therapy does just that. It is possible to found a natural, non-invasive way to access the same deep brain structures that are affected by surgery and/or tranquilizers. And my opinion is that it is possible to successfully treat many deep depressions, and measure results through brainwaves and biochemistry. (For a detailed discussion, please see my book, Why You Get Sick and How You Get Well: The Healing Power of Feelings. [Janov, 1996]) By finding this psychotherapeutic avenue to the affected brain areas, we can avoid many misdirected approaches, especially the risky use of surgery and heavy drugs. Certainly, natural feeling methods are to be chosen over a serious brain surgery.

It is not that depression is refractory to psychotherapy. It is that psychotherapy is refractory to depression. In its current state, psychotherapy in many of its approaches is too superficial to change anything profoundly. It isn’t that depression cannot be touched by therapy because it is such a serious and unfathomable affliction; it is that conventional therapy is not designed to probe the depths of the unconscious where generating sources lie. And today it seems that the only way conventional therapists can get to those deep-lying imprints is through surgery or jolts of electricity. (The crucial concept of the imprint and its corollary, resonance, the gateway to deep brain levels, is explored in detail below.)

The reason we, as a profession, have had to resort to such drastic and dangerous measures is because most treatments thus far have addressed the neocortex; actually, the front left tip of the neo-cortex, the prefrontal area. Since clinical approaches such as talk therapy and behavior modification concentrate on the cognitive part of the brain, they may neglect the source and the site of the real problem. The success of the surgery itself, with some 80 percent of patients reporting their depression lifted, should tell psychotherapists that the site of the problem may lie deeper. The most serious cases are rightly referred to as “deep” depressions because the problem often emanates from the antipodes of the brain. To be clear, my opinion is that a psychotherapy for depression that fails to probe the depths of the brain, the depths of the unconscious, cannot be successful. The generating source remains untouched.
Diagnosis in psychotherapy too often is a matter of nomenclature, one that may not accord with neurology and the body that houses it.Conventional diagnosis is often symptom-based, focused on external signs – labored movements, lack of interest, and a bewildering array of other symptoms detailed below – while ignoring root causes. I propose a diagnosis, however, that encompasses the system as a whole – neurobiology, behavior and psychology as an ensemble, an integrated view.

Some leaders in the field acknowledge that psychology as a profession is in need of a radical overhaul. The debate about the confounding state of psychotherapy seems to escalate with every new edition of the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), considered the bible of mental illness and treatment. This year, on the eve of the publication of the D.S.M.-5, the first revision in almost 20 years, the calls for a whole new way of thinking in psychology seem more urgent than ever. On both sides of the Atlantic, there have been recent calls for a complete paradigm shift in the way we understand and treat mental illness.
In a prepared statement on the eve of the D.S.M.-5’s release, the British Psychological Association stated it was unhelpful to see mental health issues as illnesses with biological causes. "On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse," stated Dr. Lucy Johnstone, a clinical psychologist who helped draft the association’s provocative statement. (Doward, 2013) Meanwhile in the U.S., Dr. Thomas Insel, director of the National Institute of Mental Health, based near Washington, D.C., states that there can be no progress in the field so long as we continue to use the D.S.M. as our guidebook. He claims it leaves out the complexities of neuroscience, biology and genetics. The manual is even counterproductive, he argues, because it is used to deny funding to researchers looking for the real causes behind afflictions such as psychosis and depression, simply because their research proposals cut across the D.S.M.’s outdated categories. “Dr. Insel is one of a growing number of scientists who think that the field needs an entirely new paradigm for understanding mental disorders,” concludes a recent New York Times article about the controversial manual, “though neither he nor anyone else knows exactly what it will look like.” (Belluck & Carey, 2013)

According to my view the last part of that statement is fully true, the paradigm already exists. I am not a lone voice in the wilderness, but my opinion based on my experience and four decades of work is that for example “Primal Therapy”, that was in focus of my work and experience is one of them that offers precisely the new paradigm that is needed in modern psychology. But as with all new revolutionary theories in science, the status quo is slow to recognize fundamental changes in any field, and loathe to adopt them. (See the article by Agustin Gurza on Primal Therapy and scientific revolutions, originally published in the Journal of Primal Therapy (Gurza, 1976) and more recently posted online as an appendix to my book, “Grand Delusions.”(Gurza, 2005) What this paper seeks to address is precisely that paradigm shift, probing for causes and generating sources that have been neglected in our work. I agree that we need to reorient our field and provide a new understanding of mental illness, which I take as my task. What I am proposing is a total paradigm shift not only in our view of this affliction but also its treatment. We need to reframe our thinking about it, and recognize that what is missing is the "why?" We need to ask: What is depression, and where does it come from? Why is the patient depressed?

Since I first published The Primal Scream: The Cure for Neurosis in 1970, the subtitle became the lightening rod for criticism because we used the term “cure.” Nobody dares speak of curing mental illness. Yet the issue seems to be a double-bind. We utilize therapies that cannot cure, and then look askance at those who claim to have found one. “Cure” is not an opprobrious term. What is opprobrious is that we have given up on proper therapy and made it an unacceptable word. “Cure” is not a term to be avoided in the interest of pure science; it is a state to be sought after assiduously. We owe it to the millions who suffer from depression with no real hope of finding their way out of the darkness.

Depression has been a mystery for a long time because we have ignored the connection between a patient’s current mental and physical health and long-ago imprinted traumas experienced in childhood but also in the womb and at birth. That left us with a narrow range of choices: either drug the patient or operate on him. Preferably, we need to help him plunge deep into that unconscious. We need to help the patient find the nexus between his current state of depression and its deep-lying sources. Only the patient can make that connection inside himself; our task is to help him gain access to those deeper levels of brain function.
History will provide us with the answer; history is the cause and history is the savior.


  1. Also holding psychology back is the fact that there are powers of influence that "use" psychology for their own agendas and interests. Big business applies it to how to sell to people or influence what they buy. Governments use it to mold citizens and change their views and attitudes, mold education to reshape the population. Then there are the black ops of the gov that have their classified uses of psychology to use and manipulate people. It is little wonder that we get little to no truth out of psychology, since big money and big power control its direction so tightly. And evidently, Primal therapy and theory do not fit in well with their plans.

    So these powers send “public” psychology down the wrong roads and dead ends so as to keep people unaware of how psychology is used to manipulate and control them. People could stand to be substantially more self- informed of what is going on around them so that they would not be so far in the dark and unaware. Real and true knowledge are powerful protectors to those who embrace that deeper knowledge that comes with a need for a little more effort to get at it.

    Most fans of PT found it because they were looking for something better than what had come along to them prior to finding PT. It works!

    1. Voko... they don't feel!

      That they are aware of what they do is quite clear... that they have a consciousness of it... there is no reason to believe!

      To be at healthy liquids and hurt their children falls on its own absurdity... that they are driven by repressed sentences... there is no doubt!

      If they have right to it? It is the question to crack as it is what progresses all over the world!

      They need help... how do we give them that? When they suffer so much that they kill anyone that comes close and tell them what it is that is going on?

      Maybe when the science is so clear that word means what content presents and then it's too late!?

      I want to " believe " otherwise... morality has its power!

      Your Frank

  2. What can one do? Families, besides big business, media, also use psychology in the wrong manner. They don't know what else to do to treat their child who might be going through a difficult time. The parents,use , what they think , is good psychology or good parenting. Forget the quality of the psychology used....just as long as it "shuts their children up", because the parent can't really handle having anymore than 2 children. Really this type of parent shouldn't even have children. The parent doesn't even know that he is really destroying his child in a way..... Parents , all parents, I think should take psychology lessons or something to that affect before bringing a child into this world. Of course , this is an impossible thing to ask; but if it were done, less people might be less depressed. Then the siblings, who are not as innocent as the parents when using psychology on another sibling....can actually destroy another sibling , mentally, if one allows it....happens all the time in families. Parents don't know what to do, so they use what they think is "good psychology" on possibly just the one child who is habitually being picked on; only because they might be "younger" than the other sibling. Parents are sometimes innocently blind to what goes on among siblings. Too bad; makes one wonder , many times, why parents have children. They , the parents , might be in a severe depression, themselves, so they only make it worse by using what they think is "good psychology" on their children "to straighten out their child's unhappiness, or to straighten out disputes among siblings. It is almost a vicious cycle. Sometimes a person, will have a family, maybe even a small family and boom "a depression" for years might be created for that person. Some people just don't think when they create families. I asked someone about their home life one time and all he said as he stared into space was: "tolerable". I never would have expected that answer from him, but then again, everyone has differerant levels of tolerance....maybe his was low because his parents seemed really to be nice people along with his brothers and sisters. Then again, some families don't show their "true colors" always, but this family seemed geniune. Of course, not all families are bad for one another, just like media, big businesses are not all corrupt and eager "to destroy; but in an innocent way". For many people (who don't bother anyone), the only hope is to have "strength" and plan on getting PT. Plan on getting "professional help" and not from families who really don't know what they are doing with their child , except "they just want the kid to "dummy up" (ha,ha). But like I said...there are definitely successful families out there; people with good hearts and good mental attitudes; people who want to do good, progress, and succeed; don't end up "individuallyl" finding themselves in a depression that they created either on purpose or the depression was created inadvertantly (by mistake through ignorance). Sometimes for family members not to feel the depression, they just have "to ignore" and then who knows what happens from there.

  3. An email comment:
    "The BEST Definition I EVER read about 'Neurosis' was when I first came across 'The Primal Scream' in 1982 !!.....That Book was a Lifesaver to me...Thankyou-- 'Aussie' Jay : }"


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.