Saturday, December 28, 2013

The Mystery Known as Depression, Part 12/12


There is scarcely a professional among us who believes in the absolute necessity of reliving old events and altering their imprints; yet it is that very process that is curative. It is curative because it deals uniquely with history and memory. This is not to be confused with recall. Recall is cerebral, neo-cortical. Reliving the imprint is neuro-physiologic, and is remembered in that way. While imprints are usually not in the therapist’s lexicon, I believe it will be the sine qua non for the future of psychotherapy.

There are now hundreds of studies in the scientific literature documenting the effects of pre-birth and birth traumas on later symptoms and behavior (and this is discussed in detail in Primal Healing.) There are research case studi es we did to verify my point. I have written about the UCLA experiment in my book (Janov, 1996) but I want to sum up the importance of it. This is research we did together with Dr. Donald Tashkin, former director of the Pulmonary Laboratory in 1992. Two patients were wired to many instruments while we helped them into a reliving session, a primal. Neither patient observed the other so we had a rather pure experience on the part of both men. They both relived severe oxygen deprivation during a birth trauma, something we had not planned at all. After being immersed in a memory of oxygen deprivation they began what I term "locomotive breathing," because that is what it sounds like and seems to emanate in part from the brainstem, in particular the medulla. This deep, raspy, rapid, compulsive breathing went on for over twenty minutes.

The heavy breathing was an attempt to compensate for the lack of oxygen they experienced during the memory event. This is never a voluntary effort. It seems “forced” on the person from low in the brain. It is as though the patient is making up for the deprivation event by gasping for air. Once begun it is very hard to stop until it has run its course.
Heavy breathing can go on for many minutes and it may take many sessions for the cause to be comprehensible. Though this heavy breathing goes on for up to twenty minutes there never is any hyperventilation. After the reliving, we did another experiment where each patient mimicked the primal in every way (same movements and heavy breathing) except for not being in the past. That is, it happens out of a deliberate action by the patient living in the present. Both got dizzy and almost fainted after 3 or 4 minutes in what was clearly a hyperventilation syndrome (clawed hands).

It happens systematically to those who attempt to go back to the past without being totally in the memory. In fact it is one of our controls on the veracity of the feeling. If they run out of air right away it is simple abreaction, and unconnected and not integrated event. The reason is rather simple; the subjects were breathing voluntarily, not automatically out of the memory. They were breathing from “on top,” not from the bottom. The memory offers us the truth of the experience.

What the researchers from the pulmonary laboratory found was that when the patient was back in the old feeling and its context of anoxia at birth the body needed oxygen; the patient was “back there” in every way, not the least of which was physiologically. They go back in a complete biologic state. What we found at UCLA was that despite the heavy prolonged breathing the acid-alkaline balance did not change. The conclusion of the UCLA investigators, who were not associated with Primal Therapy in any way, was that no other factor other than memory could account for the results. In short, the life-and-death memory was real. It was imprinted. Despite the fact that the oxygen was normal in the room the brain was sending signals of a great lack of oxygen, and the heavy breathing ensued. There was no hyperventilation syndrome because the whole system was back in history re-experiencing a key trauma and urgent need of oxygen. They were reliving not just in their heads or their thoughts but with every part of them. Patients are indeed in their past. They are living in their history, living in their personal past; and, I might add, living inside a brain from antiquity. Their lives are revolving around history with only a dim awareness of the present when they are reliving in a primal.

These experiments are the best supporting information for primal therapy , as the experience cannot be faked. The fact that his imprint endures and is immutable means that it constantly affects so much of our feelings, moods and behavior. It means that there is a profound origin for depression which began its life before we began life on the planet. In the case of one of our patients trying to get born against massive anesthetic the feeling was, "I just can't try any more. I have to give up. It is hopeless." Here was the deep preverbal forerunner for depression; the physiology of depression.

Once we establish that we are propelled by imprints embedded in an ancient brain we see that it has everything to do with our current behavior and symptoms, then we must acknowledge that the primitive brain affects not only our breathing but also most of our current life, our moods, values and attitudes. Those imprints must be considered when we want to understand depression. It is not just breathing that is affected but most of the brainstem functions; digestion, elimination and many mid-line events. We go to doctor after doctor to try to solve a stomach problem when the memory will give it all up as soon as we can access it. It will tell us all because it was there at the scene “of the crime.” It will tell us of the carrying mother’s anguish, her use of drugs and alcohol or her own depression. Therein lies the answer – history. It divulges all of its secrets when we descend to meet it. It won’t come up to confess its history verbally; we need to meet it half way. Then it may say in its own nonverbal way, my stomach aches, as we plunge into history; my stomach is not working well. Later on there is colic that speaks more of what is wrong. And still later a drug addiction. The point is that when life is not going well and one is unhappy for unknown reasons we need to look at generating sources. It is never a matter of thinking healthy thoughts; it is a matter of knowing what underlies unhealthy thoughts.

This is significant because it can open up a universe to us about the depths of man’s unconscious. It confirms that very early experience is impressed into us, not just as a memory but as a wound that needs healing. The corollary to this is that the early need for love endures, and does not change throughout our lifetime. We seek symbolic, substitute fulfillment but it is never fulfilling and compels us to go on seeking more and more, always in vain, because it is symbolic. The critical time when need must be fulfilled has passed. And we have found that we can only heal where we are wounded. This means a return to relive events deep imprints where breathing is organized. Thus, if the “wound”/trauma affected breathing at birth, due to a heavy dose of anesthesia, then it must be revisited and relived; a return to generating sources. This usually normalizes many functions, from cortisol levels to natural killer cells as well as blood pressure and body temperature. With reliving the system is allowed to function normally.

The marks that originally appeared during the birth trauma may again appear in a later session. (We have photographed these marks; they can be found in my books). The baby-cries during a session can never be repeated by the patient after it. It is clearly not a simulation. In other words, the past and its neurobiology remains encapsulated inside of us. This may account for a number of lingering diseases in adult life. What is remarkable is that it is impervious to later experience; no matter how much approval an actor gets he always needs more. It is why I maintain that only re-experiencing in the context of an old traumatic memory can be curative. Consider, in the session, despite the adequate oxygen in the room the brain is signaling a serious lack of it and the body responds accordingly-- gasping for air, living for the moment in the past. Engulfed by memory.

One would think that we learn from experience but those with heavy pain keep having the same experience over and over. That is why those who have one auto accident are likely to have another.

We have to ask the question, what is about reliving that is so important? Why is consciousness so critical? It means acknowledging the evolution of the brain. Although that seems evident, many current therapies treat the patient ahistorically, as if he/she had no history and there was no personal evolution. It is creationism in the guise of science. The universe was not created magically in seven days, and mental illness does not suddenly appear in people one day, without regard to their individual evolution. History must be the primary goal in psychotherapy if we want to get better. After all, what does it mean to “get better?” I believe it means getting our selves back, the self that hurts and feels. We must get our feelings back to become fully human.

Why relive? Because without access the agony portion of the memory has never been completely experienced. We carry that painful residue continuously inside of us. In Primal Therapy, we now react fully to the prototype. We no longer hold pain in storage where it has done its damage.

Depression is a terrible state. It feels devastating and never-ending, but fortunately, it no longer has to be. There is a way out; and that way out is the way in. But we have to have a map of the way; otherwise we are lost. The reason so many therapists believe it is untreatable except by drugs is that heretofore they have had no way to probe the inner depths of their patients. And that is where the problem lies. Depression seems like it is in the present, but actually, the person is walking around engulfed and ruminating in his/her past. In Primal Therapy, we help put the past back into history and thus bring the person into the present, now unencumbered. We cannot leave our past behind by any great amount of will or effort. In fact, trying to do so with will power only insures failure. We need to let go of that strong will and submerge ourselves into our feelings. In therapy, we provide access to ourselves, no more no less. But that is a lot, for it means an end to depression.

I use the terms radical and revolutionary for my therapy with caution; yet I believe it is. It is revolutionary, in form and content. Primal Therapy is a radical departure from the face-a- face, insight-besotted discussion between two unequal partners; one with a worldly knowledge and an unerring moral stance, the other a willing neophyte genuflecting psychologically to learn what the worldly one dispenses, acquiescing to the outside instead of the inside. I speak from experience, having practiced insight therapy for many years. The majesty of it all is intoxicating for the therapist. The power of directing someone else’s life is seductive – and wrong!

Sadly, in the name of progress and being modern we have moved away from the past into a more present approach. There is an apotheosis of the present, of the here-and-now, and a move away from the one thing that is curative--history. More sadly, for one hundred years we have been talking to the wrong brain! It is that brain – the intellectual, unfeeling brain – that prevents any hope of a cure for emotional illness. Talking to the brain that talks was fine a century ago but now we know so much more about the brain and what it contains; we can speak to the brain that feels in its own language.

We need to learn a new language – that of the unconscious – a language without words that could help us make profound change in patients. After all, we call it “mental illness.” Yet, words often are the defense against feeling. Our goal is to produce feeling human beings, not mental giants. When one feels the prototypic trauma, one is on one's way to a solution for depression. That, plus feeling all of the harshness, the excessive discipline, the indifference and the lack of caring in one's family; and expressing all of the feelings and needs held back for those years. Expressing all that with the original feelings involved – that is why it is so forceful and terribly sad. The crucial, curative difference is that our therapy is not about the adult shedding a few tears – the adult crying about the past – but it is about becoming the baby and child with wrenching sobs and agonizing screams. "Be nice to me! Hold me! Cherish me. I'm your son! Let me be me. I'm your flesh and blood. Show that you want me. Let me express how I feel!" Those are the needs. When all that is physiologically re- experienced as what occurs during a Primal re-living, depression is no longer a mystery. And only when it is all felt, over months of reliving plus the birth trauma when appropriate, will the depression be resolved permanently. So the more one feels what caused the closure of the system, the more it becomes safe for the system to become open.
Finally, love can get in.

For References, see the full text at:

Tuesday, December 24, 2013

More on the Meaning of the Act-Out

I have written about how we, most of us, act out our unfulfilled needs and feelings. We act out because those needs remain active throughout our lives., and we still seek fulfillment even if we are not conscious of what we are doing. The act-out, in short, is as unconscious as the need/feeling. Since we cannot beg mother to love us when we are forty we try to get it in other ways, and those ways are known as act-outs. We can all choose our poison (how we do it), but too many of us never know we act out. But there is a hidden force in there that most of us do not understand. The drive, the compulsion has a biologic side; there is a churning of physiologic forces that wear down our organs because the act-out is, alas, unrequited and requires unrelenting effort for a lifetime. So it is not just behavior, it is what is going on inside of us, at the same time. That means tension, as all of us, is working overtime. And part of that work is dealing with the pain of unfulfilled need, which means repression.

The act-out is not benign. One might say, what does it matter that one has to keep active and unable to relax? It matters because the system is always on the alert to seek fulfillment. We become attached to authority figures tying to get approval, or attached to an aggressive man trying to feel protected. Or we gamble to try to feel like a winner. It seems so common that we think it is normal. But when the system breaks down later on it becomes the price we pay.

We need fulfillment early on. There is a critical period for fulfillment and it is rather short-lived and limited; it ends rather quickly. Any time after that our actions are symbolic; we can no longer be fulfilled; the critical period has passed. It is too late; sadly, it can never be made up for. So why is someone hooked on heavy drugs? Because he is not fulfilling old lacks that still need fulfilling. The drug is calming, perhaps, events during womb-life or at birth. But is never fulfilling. And here lies the enigma. For parents may be decent and loving, but they cannot make up for terrible lacks and traumas in the first few months of life. If love could do it then the problem could be solved, but it can’t. No matter how much a parent wants to, he cannot love neurosis away. Love cannot penetrate the barrier of the gates, which are busy blocking- out input from inside and out.

I used to think that it was the act-out that would be the death of us; but I now believe it is the underlying feeling that keeps the system activated and forces the act-out. The daredevil is constantly doing something death-defying. He is facing death and conquering it, a replay of his early life. But the imprint of approaching death is still imprinted and forces him to do it again and again. A counselor can insist that you stop this negative behavior but she doesn’t see the force below that drives it. Need forces unrelenting behavior. It is out of control because it is already controlled by unconscious forces, which are stronger than any act of will.

Monday, December 23, 2013

The Mystery Known as Depression, Part 11/12


The biggest argument about depression nowadays is how to subdue it and bring it under control. The opposing camps are the medication supporters versus conventional psychotherapy. The latter includes old-fashioned "talk therapies" like psychoanalysis, in which the patient "free associates," seeking to understand what in his past has caused the depression. But dominating the field are the cognitive-behavioral therapies, which focus on the present by attempting to help the patient change his thought and behavior patterns. It seems for the moment, however, that the group in favor of medication has won. Today, psychiatry has become an unwitting arm of the drug companies. Millions of Americans are on selective serotonin reuptake inhibitors (SSRI’s), like Prozac, Zoloft, and Paxil, the current gold standard in depression treatment, or a tricyclic antidepressant such as imipramine.

A psychologist investigating depression and its treatment, Ellen Frank, of the Pittsburgh School of Medicine, concludes that antidepressants are most effective when the dosage is sustained over time. "The dose of antidepressant that gets you well, keeps you well,” she told Science News in an article about the clash between proponents of psychotherapy versus drugs in the treatment of depression. (Bower, 1991) In the study, first published in the Archives of General Psychiatry, Frank and her colleagues tracked the treatment of 230 people who had experienced recurring periods of major depression for an average of 12.5 years. (Frank, et al., 1990) Of the 53 subjects who received and stayed on a full daily dose of imipramine, 41 remained free of depression for the entire three years. This study also found that psychotherapy plus drugs had no real advantage over the drugs alone -– not particularly convincing testimony to the efficacy of psychotherapy.

Similar results have been found with use of the SSRIs, drugs that are often prescribed indefinitely. Paradoxically, when one is given antidepressants, one may become suicidal; not because of the drugs but because the medication allows for more access to unconscious pain. The drugs, which are supposed to help in repression, actually lift the burden of total repression from the system, which has had to do it all on its own, so that feelings are now coming up. Tranquilizers, on the other hand, may dampen the imprint enough so that the pain does not intrude. The more pain, the greater the dose required. I have seen patients who attempted suicide by ingesting doses that would have been lethal for almost any human being, but who were only put to sleep for 12 hours. They had such massive amounts of pain activating the brain that the medication could not induce death. And deep depressives who had such high underlying activation that ordinary sleeping pills were ineffective.
Since the symptoms of anxiety and depression seem so different, one is tempted to label them as two different diseases. But the fact that repressive drugs can help with both depression and anxiety shows that they are simply different ways the body has of handling the same kind of pain. Drugs may help with both but for different reasons. In anxiety, they serve to plug the holes in the repressive system since the pain is leaking into conscious- awareness. In the depressive, as I noted, they function it is to take over some of the job of repression, so that the body is not so burdened. The body feels better because it doesn't have to do everything by itself.

Depression and anxiety are not necessarily separate "diseases"; they are reactions at different stages of neurologic evolution, both involving pain and fear and a stressed nervous system. Anxiety comes first where there is pure unadulterated terror with no possibility of defense; and depression second when repression is possible. If we examine animals it seems that they are anxious until placed into a situation with no behavioral opportunities, then they show symptoms of depression. Rats were kept on a slippery slope over a moat of water. When they were exhausted they would fall into the water. After a short time they could not move, were not curious or adventurous—they gave up and seemed depressed.

A depressed person who is not in therapy needs tranquilizers for the same reason that our patients might need them as they approach strong feelings: Repression is weak, so chemical help is needed to bolster it. The drugs help normalize our inner pain-killing pharmacy. We don’t want patients with weak defenses to have a free-fall down into remote and high- valence, first-line pain. Medication allows for a slow, methodical descent; it keeps the patient in the primal zone. When patients relive enough of their painful history, they no longer need alcohol, drugs, cigarettes, or painkillers. Less pain, less pain-killers. The difference is that in conventional therapy medication becomes the end-game, the sole ploy. In our therapy, medication is used to achieve our goal, not instead of it.

When it comes to exploring the subconscious roots of depression in most modalities today, the mantra seems to be: Don’t go there. There is still the idea that dealing with the deep unconscious is dangerous; and it certainly is, when done without proper knowledge. Within the cognitive school of psychotherapy it is believed that the depressive is locked into "self-defeating" thoughts. Thus, the patient must identify which of these thought patterns are "distorted" and, after that, by way of reason and logic, come up with another way of thinking, one which is "rational" and self-affirming rather than self-defeating. This kind of solution, or attempt at solution, is next to antidepressants on the front line of treatment today. It usually comes from those who assert that we can think our way out of problems; that is, we can literally think our way to health. This is part of the new “reframing” school where we turn something bad into something neutral and inoffensive. We reframe the situation so it won’t hurt; there is no notion of deep brain processes, nor of historical imprinted events. Another name for it is pure solipsism. To such therapists, pain is simply all in your mind.

The depressive often tells the conventional therapist, “I just can’t make it. I’m stuck.” And the therapist is warm and encouraging and insists, “Yes you can.” The therapist is unwittingly putting a gloss on the patient’s real feeling, which is the imprint. The imprint, which expresses itself as a feeling of “I’m stuck, I can’t make it,” is primary because the person is unable to change that imprint. Certainly not by talking to a therapist. It is not something thought-out. It is implicit in the birth experience. Optimism or Positive Behavior therapy ignores real feelings which must be dealt with. There is simply no recognition of imprinted memory, even though the process of methylation should inform us otherwise.
There are no such things as self-defeating thoughts, only self-defeating feelings: "I'm no good. I can't do anything." These are not just thoughts suspended in air that one must take back and exchange for new thoughts. They are anchored to physiochemical realities inside that must be addressed. They are evolved not just concocted. Do we actually think that the person makes up these thoughts out of whole cloth? Or do they reflect his life? Further, what and where is this "self" that one is defeating? And what self is doing the defeating? Are there, therefore, two selves?

The real self is the one who has undergone the terrible traumas and is suffering and feeling hopeless and unloved because of real-life early experience. It sends messages up to the thinking centers, which come up with the idea that one is unloved, even while there is a wife and children who are totally devoted to the victim. And a cognitive therapist is quick to point out all this: “After all, you are loved so why do you feel so unloved? You have to change your negative thoughts.”

If we ignore the exigencies of critical periods in the brain’s development during which its key systems require that certain needs – such as the need for touch – must be met, then we’ll never understand why present-day encouragement doesn’t work, even if it comes from a kindly and well-meaning psychotherapist. The depressive's "negative" and "self-defeating" thought patterns emanate directly from deep lying imprints and are in accord with the body’s internal, physiochemical reality. It is the deep-lying imprint wending its way to the top level that results in those defeatist ideas. Thus, the neo-cortex translates the feeling into the specialty of the cortical level – ideas. That cortex does not know that it is responding to something that lies in the depths of the mind. It thinks it is reacting independently. But its free-will has been robbed for a time by exigencies of the imprint. The problem is that the ideas are not in accord with current outside reality. The internal reality always takes precedence over the external one, and the so-called "distorted" thoughts – the ones that cognitive therapists say you have to struggle against – are only symbols for the underlying pain. The evolutionary extensions of the imprint have priority in the psychic economy. We do react to reality but which reality? If we have no notion of an internal one that takes precedence because it has to do with survival, then we must go astray.

That internal reality can represent decades of experience, reinforcing the same few prototypical feelings: "No one wants me. I'm in the way. They hate me." It is true that one can activate and motivate the depressive, encourage him and point to alternatives, and that strategy may help. But all of that is still just fighting against the prototype, which is much stronger and more powerful than words. Ultimately, the prototype will prevail. By and by, the person will fall back into depression. Trying to conquer the prototype means, in effect, conquering your own physiology – a vain task. So long as the imprint is left intact there can be no long-lasting therapy of depression. Without a theory of brain levels we are forced to remain on the last evolutionary level, talking the disease to death.

The notion of depression when unhinged from neurobiology becomes ephemeral and vague and lends itself solely to behavioral explanations. Once we understand that there are generating causes, deep imprints, in producing depression, we understand that cognitive procedures cannot be effective. Deep depression is by definition immune to talk therapy because the “disease” is non-verbal, involves deep-in-the-brain repression, which can’t be reached by new ways of thinking. Ideas and insight work on the upper front, left side of the brain – the cognitive part of the brain – while many of the actual feelings are registered and coded deep on the right side of the brain, leaving the traumatic imprint untouched below the repressive barriers. And that is why insight and talk therapy never reaches the basis of one’s depression. Medication, on the other hand, calms the pain bio-chemically. Both approaches disconnect thought from feeling. It also suppresses the one thing that can make us well -– our history.

Whether they are in favor of treating depression with medication or psychotherapy or a combination of both, most psychotherapists in the field adhere to the notion that suppressing depression is the same as curing it. It is certainly possible to suppress symptoms, to give the patient relief, and help him function better and enjoy life more. But the underlying problem remains, as reflected by the fact that the symptoms usually return when treatment ceases, and many chronic depressives elect to stay on the medication permanently in order to suppress their symptoms indefinitely. So long as we leave the imprint intact in dealing with the depressive there will be no cure and a vulnerability to more disease.

The dilemma in psychiatry and psychotherapy today is the focus on the level of presenting symptoms. This makes drugs necessary and makes treatment palliative and non- curative. The idea of repressing symptoms with drugs may work, but it ultimately goes astray because the symptoms are just that: symptoms of an underlying, unconscious pain. Without probing into history, all one can do is treat appearances (phenotypes) instead of causes (genotypes).
There are many new drugs on the market that are heralded as a “breakthrough.” I will discuss one recent one that makes that claim, and that is Ketamine. It is something that was used as a light anesthetic fifty years ago, and was called “twilight sleep.” But it is claimed to be effective in the treatment of depression. The question is why?

Ketamine was originally aimed at horses in veterinary medicine, then transferred to humans. It is not yet legal as a treatment for depression. In experimental studies it is reported as quite effective. It was first tried by scientists at the National Institute of Mental Health.
Thoughts of suicide diminished and depression eased for a time, though not over a long time period. So what happens once this drug is infused into the patient’s system? There is a feeling of dissociation and feeling drugged. Thoughts of suicide diminished and depression eased for a time, though not over the long term. So what happens once this drug is infused into the patient’s system? There is a feeling of dissociation and feeling drugged. What Ketamine does is fill up the space between neurons with the neurotransmitter glutamate, producing a flood of the drug in the prefrontal cortex. And that helps activate mental activity, making the person better able to handle feelings. Their conclusion was that depression is caused by an imbalance in the regulating action of glutamate. Ketamine does activate parts of the limbic system, including the anterior cingulate cortex. In this sense it is an “upper,” gathering up energy and activating the system against its basic repression/deadness, thus lifting depression. Remember, that anything that eases repression will help depression. Generally, then, any medication to combat depression must energize against repression. In short we need to soften the massive repression involved in depression if we are to help patients. Thus the biochemical GABA – gamma amino butyric acid, which works to inhibit the transmission of nerve impulses – is partially undone with ketamine, thus lessening some of the repressive work accomplished with GABA (Diazgranados et al., 2010; Vutskits et al., 2007).

The researchers believe that it is that imbalance that is responsible for depression. I believe we need to ask, what caused that imbalance in the first place? Since its effects are ephemeral I believe we need to first discover how to right the balance that endures. It seems to me that it might well be the early traumas that disrupt so much neurochemical balance in the brain. Depressives may be low on glutamate because excessive activity became dangerous; that is, during the trauma at birth shutting down was survival.

Every breakthrough has one key effect: easing repression and lifting its gates. Since I posit that depression is repression elevated to a higher level, it would make sense that easing repression would make a permanent difference. Otherwise we are obliged to work around the edges, tweaking symptoms and never reaching causes.

Symptoms are signs of something wrong; we don’t want to drive the warning signal away. We want to heed its message. In conventional therapy we have extracted the symptom out of the person for treatment, instead of seeing how the symptom emanates out of a biologic history. We make the symptom well, not the person.

There is an interview in the British scientific journal, New Scientist with psychologist Joe Griffin, the co-creator of the therapeutic approach known as Human Givens, which has gained some acceptance in Great Britain. (Kiser, 2003) He states: “Research shows that any therapy or counseling that encourages people to introspect about their past will inevitably deepen depression.” With this advice, all one can do is focus on the here-and-now and never get better. It is the essence of historical solipsism. There is no past, nothing affecting us in our history. It is a turn on the Freudian notion of the dangers lurking when we meddle with the unconscious. When we ignore or don’t understand history we are confined to an ahistorical therapy. This can lead to a futility on the part of the doctor and patient; sitting by helplessly, infusing drug after drug into the patient to control her symptoms, or discussing them endlessly, in vain.

In order for psychotherapy to be effective, we need to take the heart of the feeling—“I can’t make it”—and trace it back to its origins in the brainstem, which is what Primal Therapy does. If we simply try and convince the patient through a talk-therapy session that yes, he/she can make it, we are widening the gap between his/her waking, thinking mind and his/her feelings. The feelings are real and are part of neurophysiology. In our therapy we take the phrase, “can’t make it,” and use it to allow the patient to feel it further; once locked into the feeling it will take him/her down the chain of pain in ordered fashion. In psychotherapy we have to be careful not to be a cheerleader for the patient and simply try and make her feel better through verbal comfort and consolation. He/She appreciates our encouragement, thrives on it, comes back for more, and each day therefore becomes more distant from herself. It will not make his/her better. And what is “better?” Being him/herself, being in alignment with feelings, there is nothing better than that. Our verbal encouragement makes him/her not herself, however, and if we rely on kinds words only, he/she will not be in accord with how he/she really feels. If the reality of inner feelings is, “I feel unloved,” then encouragement by a kindly therapist defies reality.

As psychotherapists, we want to be a good parent for the patient as much as he/she wants us to be. We know that parents should encourage and support their children. But feelings are engraved in the patient’s system, after that it is too late to make any easy changes through the use of kind words and verbal encouragement. The window of opportunity has passed. We cannot love neurosis away.

Saturday, December 21, 2013

More on Leaky Gates

Remember how I have been writing about leaky gates and what it does to us. Well, it looks as though the gates really are leaky, so writes Scientific American. They say that there are leaky receptors in the limbic system that play a role in pathology. Chronic stress damages neurons in parts of the limbic system (hippocampus) that interferes with cognitive function. (Nature Reviews Neuroscience. 2012).

When there is trauma it affects the ryanodine receptors and affects calcium balance. There is extracellular calcium which can damage neural cells. I imagine that key cells that control pain are also affected. In experiments with mice they found that stress resulted in cells becoming defective and “leaky,” their term. They conclude that chronic stress induces leakiness in hippocampal cells, resulting in impaired mental function. They liken this is post- traumatic-stress-disorder. Perhaps the same pathways are impaired.

 All this simply means that constant adversity gnaws away at key neural cells, which renders them defective; they cannot do their job. That job includes repression. When the body asks a certain system to function despite constant impact of neglect, abuse, indifference and lack of love, sooner or later it can no longer do what it is supposed to do—shut down pain. It is overwhelmed trying to carry out its job and then it falters; pain rushes through the barriers or gates and we begin to suffer. We don’t as yet feel; that comes when we experience the suffering for what it is and where it comes from; its site of origin. Feeling is making it concrete and connected; that is what transforms suffering into its opposite and finally relieves us. That is the secret of our therapy; and it is not so secret. Suffering is amorphous, shapeless, smell-less; it is as pervasive as the feelings underlying it. Once it is connected we know what to do about it; no different from a thorn in the foot. Once we pinpoint causes it leads inevitably to proper treatment. If we never know it is a thorn we are helpless and go on hurting; that thorn is an imprint, an old feeling stuck in place; we are unable to escape and change. It changes us and will go on doing so until we acknowledge it fully.

So leaky gates are helpful in one sense; they foretell of pain on the rise, bursting through the leaky barriers, showing us what we need to do. It is truly a “thorn in our side.” It is also our chance to get well; to take that rising anguish and turn it into what it is, a feeling, a history, something that constantly drives us. We help patients take their body off the accelerator; that seems like a simple metaphor but you would be surprised at how many patients feel that they are speeding along, driven, and do not know how to take their foot off the accelerator. We know how and it is not so difficult; figure out what has caused the drive or speed. It could be never being touched, or an anxious pregnant mother, or a severe unloving father. We don’ t find out; we find a way to help the patient go back in history and she will discover it all. And she finally will be free; no more constant drive, no more incessant compulsions; no more obsessive ideas and compulsive sex: liberation at last.

Wednesday, December 18, 2013

The Mystery Known as Depression, Part 10/12


The Centers for Disease Control and Prevention recently reported an alarming rise in the number of suicides among middle-aged Americans, especially men in their 50s who suffered a 50 percent increase between 1999 and 2010. (MMWR, 2013) Overall, suicide has now surpassed auto accidents as a cause of death in the United States. In developed countries, it now tops cancer and heart disease as the leading cause of death for people 15 to 49, according to the recently released report, “Global Burden of Diseases, Injuries, and Risk Factors Study 2010,” from researchers at the University of Washington. (IHME, 2010) Worldwide, suicide has come to claim more lives than war, murder and natural disasters combined, as detailed in an alarming Newsweek cover story aptly titled “The Suicide Epidemic.” (Dokoupil, 2013) Clearly, suicide has become a major public health concern. Yet, professionals struggle to explain the cause. In a New York Times article about the rising rates, (Parker-Pope, 2013) experts cited multiple possible factors, including the bad economy, increased availability of drugs, and even the unique world view of the Baby Boom generation. The real explanation escapes them because it is hidden in the victims’ remote past.

Suicidal depression is not a different disease but rather a breakthrough of feelings through the gating system. It is an agitated sensation where great and intolerable pain surges forth, having broken through the gates. The system does its best to hold it down but to no avail. Then the attitude arises – “the only way to stop the pain is kill myself.” The need is not to die but only to end the misery. The more severe the depression, the more likely there are to be thoughts of "what's the use of it all." There is a sense that there are no options and no alternatives, leading to a preoccupation with death and suicide. In the worst case scenario, the denouement of the infant’s original drama meant death at the very moment of birth. It meant death then and it means death now through the imprint — that is, the lingering sense of impending doom. The suicide attempt brings the sequence to its logical conclusion— death. In one way, pain establishes a marker for an unfinished sequence that was originally cut short due to its massive load of pain. Our system keeps returning there to finalize and integrate what could not be integrated early on.

It is difficult, perhaps, to believe that birth problems can give rise to suicidal tendencies years later. This is because we are not used to thinking about physiologic memory. Nor are we used to thinking that the most powerful memories we have are those without words; memories of events which predated our ability to understand what was happening to us. As we have seen, the despair during a birth trauma never goes away. It melds into later behavior and exacerbates it. Later in life, adversity provokes hopelessness and despair, a desire to give up, the direct run-off of the birth sequence. “Run-off” is a key concept here because once something in the present resonates with an old memory, we are forced to act out the entire sequence until its logical conclusion. That is why once into the feeling, there is obsessive rumination about death and suicide. The difference is that the newborn can only sense death in a vague way because it has no behavioral options, whereas the suicide case uses death as the behavioral option to end the agony.

Suicide typically involves the run off of the birth sequence in the same way that Pain insinuates itself into sex and carries the sex act out. We saw how, for the parasympath, the birth prototype ended in a near-death experience: death being the only way to end the agony. Being strangled by the umbilical cord or being deprived of oxygen by an overwhelming anesthetic makes the birth struggle agonizing and futile, a sequence with its own irrevocable logic: struggle, suffering, and failure leading toward death. Suicide finishes the evolutionary sequence. The imprinted preoccupation with death occurs in the present while immersed in the past. For those who think about dying as if it were about to happen now – that is, when the current agitation/agony reaches a certain level – it can set off the prototypic feeling. The body is indifferent to the current source of the agitation – the wrenching loss of a spouse. Once the valence of the present trauma is high enough, the old sequence will kick in and then begin its run-off. The result can be death by hanging. Many depressives insist that they could not wake up one more morning in pain. Because they had no idea what was happening or what to do about it, suicide became the logical option. There is rarely a preoccupation with death without resonance occurring, triggering off first-line pain.

Not only does death linger on as a memory in the nervous system, but suicides will often choose a method that reflects the prototype of their birth experiences. So, those strangled on the umbilical cord may hang themselves, or an overdose of pills is chosen by someone who was drugged at birth. Why? Because of the prototype; for a neonate strangling on the cord, further strangling would have ended the agony. Those drowning in amniotic fluid at birth will opt for death by drowning. Case in point: the writer-actor Spalding Gray had a lifetime obsession with drowning. He used to swim in the ocean as far out as he possibly could until the point of exhaustion and then struggled to try and make it back. He killed himself by jumping off the Staten Island Ferry in the middle of the night. I hypothesize that he may have been drowning at birth and the end of the original sequence would be drowning. In other words, I think he died like he was born. This is never to minimize the pain in the present; sometimes it is most devastating and can reach suicidal levels. In Spalding Gray’s case, the actor had a terrible auto accident some time before his suicide and I believe that his high level of pain may have set off the original agony. The accident caused a skull fracture and damage to his frontal cortex, which may have further impaired his ability to repress pain. (Williams, 2004) The current trauma is just the trigger; it is the early pain add-on that is often what can push one into a suicide attempt.

Those who received a massive dose of anesthetic at birth may take an overdose of barbiturates, or they might gas themselves in their garage. And so on. I remember one patient who saved up dynamite; having experienced anoxia at birth, he was going to put a stick to his head and blow his head off so that he wouldn't have one second of pain and hopelessness. He laughs at that now, but at the time it spoke volumes of his desperation. Another patient was obsessed with jumping off a building. During her birth by Cesarean, this person had felt wrenched into space with nothing to hang onto. Another patient, battered and squeezed at birth, obsessed about jumping off a bridge head first.

It's not always the case that the suicide method mimics the birth trauma, of course, but it is often what we discover in talking to and observing our patients. If we want to get an idea about our birth, look at our imagined choice of suicide. Conversely, if we want to know the origins of depression, we might examine the birth epoch. Eventually, we will discover the secrets of our beginnings in life. I state this after treating, observing or supervising many hundreds of patients over decades.

I recently conducted an informal survey in which I asked my patients about their suicide attempts or their fantasies regarding the mode of suicide. Almost without exception the parasympaths chose the passive way out--sleeping pills. They preferred waiting for a slow, sure death. Also, without exception, they were the ones who were drugged at birth. The most drugged, incidentally, would prefer to lie down in the back seat of a car with the motor running and allow themselves to be gassed in death by the exhaust. Another patient, born at home in the freezing winter in Europe where there was little heat, preferred marching out into the snow and letting herself freeze to death. She heard that was the most peaceful way to go. By contrast, the sympaths chose the most active kinds of death: a bullet to the head. One said, "I can't imagine sitting around waiting for death like those who sit in a car." Another sympath said that drowning takes too long and there's too much fright in anticipation: "I prefer jumping in front of a train. It's quick and sure." He was all "smashed up" at birth – total body damage, as he was twisted and turned in order to get out. He knows there was external rotation as he was "presented" in the wrong position and had to be straightened out. Each of two sympaths wanted to blow their heads off with a shotgun, so there would be no wait but a big mess.

Most of my patients had fixed ideas about their suicide that was mirrored in their births, and they never considered alternate ways to die because there was no alternative at birth. (This has been studied at length by a team in Sweden, led by one of my students, Dr. Bertil Jacobson, director of medical engineering at the Karolinska Institute, a leading medical university and research center located in Stockholm.) (Jacobson & Bygdeman, 1998)
Dr. Lee Salk of Cornell University Medical Center undertook a study of adolescents who had attempted suicide. (Salk, Lipsitt, Sturner, Reilly & Levat, 1985) He found that 60 percent of them had three major risk factors occurring simultaneously around the time of birth: respiratory distress, chronic disease in the pregnant mother, and lack of prenatal care for the first 20 weeks of pregnancy. Incidentally, one of the ways we know about the relationship between imprinted pain and suicide is from brain research where several studies indicate that the suicide victim generally has a higher number of serotonin receptors in the brain, but less serotonin activity in the prefrontal cortex where key defensive maneuvers are located. This means less ability to suppress. An extraordinary amount of these receptors were discovered in the blood of those who had recently made suicide attempts; underscoring how the system automatically goes into inhibition in the face of pain. Instead of measuring pain, we measure the repressive forces it provokes. Our study of imipramine binding of blood platelets seem to mirror brain serotonin levels. Interestingly, the greatest risk of suicide is when serotonin levels are at a low ebb; when repression is at its weakest and when the feeling looms near the surface. That is why the depressive has a constant feeling of impending doom and thoughts of killing herself. So long as the gates hold there will unlikely be suicidal thoughts. There is danger when the gates weaken. Because what rises and obtrudes are those very same hopeless feelings hidden in the imprint.

The run-off of the birth sequence remains true to itself and usually does not deviate. When a present-day event is strong enough – such as the death of a spouse or loss of a business – it may trigger off the birth sequence, and then the action of the person is predictable. One might wonder how it is that the loss of a business, no matter how grave, could lead someone to try suicide. It is because the early trauma has infiltrated the adult's behavior so that he cannot distinguish between past and present. The person tries everything to keep the business going, even though logically it should have closed down long ago. Finally, it becomes a hopeless situation and great despair is felt. One of my patients continued pursuing a lawsuit although he was advised that loss was inevitable. He fought and fought and then lost everything, all the while accumulating debt for more lawyers’ fees than he could ever hope to pay, which provoked a deep depression. He had many sympathetic features – not recognizing defeat or obstacles when they were apparent – until he could no longer run from the truth. The original truth he ran from was death, which lurked just behind his continued struggles.

When confronted in adult life with no more options, when one has lost one's means of livelihood, a spouse or child, or when one's friends have turned away, one will tend to follow the prototype to its logical conclusion. When there is no one to help and give support, no one to understand and be encouraging, death seems the only way out. The great problem is that the person never knows where the agony comes from. "It is just such a comfort to know that I can end the pain whenever I want to," remarked one of my patients who was obsessed with death. She did not conceive of and could not adopt new approaches, such as moving to a new city, finding another mate or job, because the imprinted lack of alternatives confines one’s vision and imagination within its boundaries.

There are levels of futility that build with each trauma when we are young. Losing a mate at the age of 30 is simply the last straw if we suffered a similar trauma – the loss of a parent – as a young child. The force of this accumulated primal pain can reverse the most basic tendency of life – survival – and make anti-survival (suicide) seem logical. The survival instinct can only be defeated when one's psyche is so damaged that the instinct for life reverses itself, and death becomes the goal. Suicide is the option of an organism that has been defeated by life, by experience. It is the logical act of an unloved (ruined) organism, of a childhood so bereft of warmth, caring, kindness and, most of all, hope, as to be non- recoverable. It is saying: "Nothing that I can do now will work. Nothing will take me out of pain. Nothing will make me feel loved and wanted. There is nothing more to do, no more act- outs, no more hope." Then there is suicide, the ultimate act of self-destruction – destruction of the self that hurts.

So long as there is a flicker of hope, death can be avoided. But if the ex-spouse files for divorce and plans to marry someone else, the last vestige of hope is gone. It is shattering when a mother leaves home and deposits her child in the hands of a tyrannical, drunken father or an unfeeling stone of a man who has no emotional reactions to anything. If that child grows up and is again abandoned by his wife who runs off with someone else, the combined pain will be overwhelming, making the agony fatal. For the child there is no logic to it. He can't imagine life going on because, in his feelings, he is still the wretched young boy all alone, helpless, alienated -- hopeless. We can, as therapists, give hope to the adult, but the little boy inside the man is still there, hurting.

Even a glimmer of hope can make the difference between life and death. Look at movie stars such as Marilyn Monroe who seem to have had everything, including adoring fans, and still felt completely unloved and miserable. They don't need more love; after all, the love of a million people isn’t lacking. Although this may seem counter-intuitive, what they need is to feel the people who counted in their lives – their parents. This is key, because re- experiencing that feeling unblocks the system and is liberating. If we bring the mother of a suicidal patient into a session and she hugs and kisses him all the way through, it will make no difference. But if he lets himself feel completely unloved by her it will make a great difference. Feeling unloved unlocks the defenses that can let love in. And the result of this reliving is a lowering of cortisol levels and a normalizing of vital signs.
People who attempt suicide just don't know what to do anymore to live. They want to end the suffering; but since it is the self who is suffering, the choice is to end life. If they could be promised an end to the suffering, they would not want to die. What hurts is not feeling. The hurt is the clash between upcoming pain and the defenses pushing it down. Once into a feeling there is no more hurt; it is now a feeling.

In order for the person to continue to believe that there is a reason to stay alive, to not revert back to suicidal thoughts and planning, she must eventually feel, in a proper therapeutic setting, the original feelings which underlie her hopelessness. The patient must separate current feelings of loss and sadness from old feelings of despair. Giving hope alone without the patient feeling the hopelessness is not curative. It’s only superficially helpful. But in the experience of hopelessness lies the ability of the person to end depression and suicidal tendencies. "Well," one might say, "I've been feeling completely hopeless about losing my girlfriend. That should be enough." Not so; the hopelessness must be felt in its original context, otherwise it is not curative. It is only palliative. It is the original feeling that is stored away and must be brought to consciousness so that it won't be triggered off anymore.
Hope lies in the original hopelessness—felt in a safe, warm atmosphere. After a person has felt the complete hopelessness from early on, it becomes automatically transmuted into hope. No one needs to offer any more hope to her. The person is on the road to health where it is less difficult to live than to kill oneself. The hope she now has is reality, not some fantasy.

Monday, December 16, 2013

Does Plenty of Infancy and Childhood Love Undo Early Trauma?

I have written about the irreversibility of early trauma, gestation and birth. I stand by that but there are mitigating factors, namely plenty of early love. It never erases those traumatic imprints, but it does hold them at bay. They are never altered or diluted by later love, never mitigated by hugs and kisses, but they do not have the reach, the upper level access, they would have had without all that infancy love.

There is no way out of the biologic fact of the critical period, the time space where love must be received or forever more becomes an imprint. It has been found in many animal studies where rats not allowed to see for several weeks after birth can never see again. Damage to the kidneys during gestation will not be reversed by later love but it may not flower into serious symptoms. I was discussing this with a friend who is gay. We both had the same family configuration with a cold, tyrannical or absent father; both of us needed male love. I think that the difference was that my gay friend had a serious trauma while being carried, a trauma that I think changed his hormone balance and perhaps altered his sex hormones. This is an assumption, not a fact. But with the cold father it was enough to produce homosexual leanings in him. I did not have that. I had no love from either parent so I could “choose” when I got older not to be gay. Not really a choice but the sum of unconscious factors which led to unconscious behavior, and then a chance encounter with a loving girl at age fourteen that turned me into totally heterosexual.

 We cannot change personality so long as the imprint remains to drive us; and the little love we get later on may not be enough to allow us to change direction. And more, the shutoff that occurs with gestation and birth trauma may be so great that we are helpless before it. We no longer can let love in; we first have to feel agonizingly unloved by our parents. We cannot purposefully open up because we are then open to great pain. They have to be out of the way first. Why do we have to feel unloved first? Because it is a memory sealed in and engraved thanks to the process of methylation. That chemical helps to make sure the memory lives on in our memory bank. Once we attack the imprinted memory and help to undo the methylation process, the system opens up all on its own. We need to undo repression so that we can feel again. When we "feel" unloved we begin to feel once again. If we open up first to any feeling we will be overwhelmed with pain. If we gain access slowly over time to lesser hurts we will not. We will be on the road to fully feeling.

 I think that part of a good childhood can block the effects of first line early pain. But a bad childhood plus unloving later life creates insurmountable emotional problems. That compounding undoes us and creates damaged individuals. But having said that there is some hope. An article in the Journal of Epidemiology and Community Health (July 27, 2010) has studied this problem in a research project studying over 400 people. It was a long-term study where at the age of eight months the interactions between mother and child was noted. And then decades later the children were studied again as adults. The early study classified the interactions as high or low loving interactions. The mothers who were judged most loving produced offspring who were low on anxiety, hostility and general distress.

 There was more than a 7 point difference in anxiety scores between love and unloved children. And a three point differential in hostility scores. Unloved offspring are more hostile. In brief, the higher the mother’s warmth the lower the score in distress. Doesn't that tell us a great deal? And it means that very early love is so, so important. Without it we have a damaged soul, someone more likely to fall ill and who has poor social skills. That lack of love makes us unable to interact lovingly with other adults … decades later. Those imprints endure perhaps for a lifetime. Affection is all, even if we had first line pain. You cannot as a parent say, “My children know I love them. I just can’t show it.” Sorry, that is not good enough. It is like saying I know my child is hungry but I cannot feed him. There is that need for warmth that cannot be abrogated. Love is love and there is no compromise. You cannot be sort of pregnant; you either are or aren't’. There is no compromise for love. Either you love or you don’t and it will show up decades later in the feelings and behavior of the person. We can “smell” a loved person; they exude it in every pore, in every word and every movement.

Friday, December 13, 2013

The Mystery Known as Depression, Part 9/12


“Repression” of pain on various levels can begin in the womb at any point during the nine months of gestation, when the neuroinhibitors in the fetal brain work to quell pain. It is mostly established in the last trimester of pregnancy. At that point, the fetus can feel pain and can repress. The deepest most severe repression occurs during fetal life and at birth because it is nearly always a matter of life and death (Anand & Scalzo, 2000). These dangerous situations call for extreme responses from the fetus. Repression during this time then becomes global, or system-wide, and affects every aspect of the fetus’ body and development. It’s easy to sense that kind of early global inhibition in someone because they have a flattened emotionality, having not developed an emotional life before repression set in; and the cause of it happened before they even took their first breath in the world. Incidentally, it can also determine how he functions sexually. He doesn’t have the biochemical equipment to be tenacious, aggressive, assertive, optimistic, or future oriented, or sexually erect. This is because the prototype has a global affect on his entire physiological system and the impotence he felt at birth is an impotence that may assert itself in later years sexually. His whole system veers toward less testosterone, dopamine, glutamate, and noradrenaline, lower serotonin and higher cortisol. This is the material of impotence; it is not just an attitude that we can change in order to be more assertive. We are impotent on the deepest levels of brain function.

Evidence is mounting that those with depression are more likely to develop heart disease. (Freedland & Carney, 2013) Considering that deep depression means deep repression and that means deep pain, the conclusion is not surprising. There are two schools of thought as to why. The first is that the biochemical changes – the release of stress hormones – and autonomic changes occurring during depression affect the heart. The second view is that depression makes people sad and they then neglect their health. I’d opt for the first, only let's go further and say that the very early imprint that makes people depressed also ultimately affects their heart; stress hormones play a role in both conditions. Those who are depressed/repressed may have sporadically higher blood pressure in some cases and if one neglects one's medication a heart attack can ensue. This article notes that one in six adults suffer from depression from time to time. Those who have suffered heart attacks and who were also depressed were four times more likely to die of a heart attack in the following six months. Researchers have found that some depressed patients are in a state of hyper-arousal, and that means more pressure and activation of the heart. Stress hormones speed up the heart. What causes chronic high levels of stress hormones? Largely, it is due to the imprints of trauma.

In this context, researchers have implicated that hormones play a significant role in depression. A 1998 report in Scientific American, titled “The Neurobiology of Depression.” (Nemeroff, 1998) notes that the monoamine norepinephrine (noradrenaline) is low in depression, some thirty percent less than in a normal population. It leads some professionals to think of depression as a “brain disease.” Norepinephrine (a monoamine), by and large, is a stimulating neuronal activator. It is manufactured mainly in circuits that emanate from the locus ceruleus, a brainstem structure. There are projections elsewhere in the brain, particularly, to the limbic system. Because there is not enough of this in depression it may lead to the false conclusion that this deficiency causes depression.

Sunday, December 8, 2013

The Mystery Known as Depression, Part 8/12


There is an understanding within the psychological profession that pain killers help suppress depression. This means that somewhere there is the recognition that pain may be a factor in causing the disorder. And there is also ample research that points to the fact that some depressions are activated states; stress hormone levels are high, often just as high in anxiety states.

Early alterations in hormones and neurotransmitters are part of the way memory is inscribed. There is a danger: lack of fulfillment. And that danger – of needs not being met – is accompanied by an inordinate secretion of stress hormones. Trauma to the fetus and infant causes the sympathetic system to gear up, producing more adrenaline, dopamine, cortisol, noradrenaline. Once need remains unfulfilled, we are activated...toward fulfillment. When the critical period for fulfillment has passed then these attempts at fulfillment are always symbolic. Needing applause, for example, or constant approval. Or, on the flip side, avoiding criticism (“Say I am good. Please. Don’t criticize me. I can’t take any more.”) Once the imprint is embedded by methylation, there is very little that can change it. A person’s personality is fixed very early on, and future experience no longer makes a great and radical difference. (It is a study of methylation that we plan for the fall).
Being vigilant is a matter of survival. The whole system is on alert, and stays alert as long as needs are not met and the imprint remains is fixed in the system. It is not that we have a memory and then there are hormone changes; those changes are part of the experience, entwined with the memory. And in turn, it is the changes in biochemistry that influence our ideas and attitudes and behavior.

For instance, feelings affect the hypothalamus, which governs the output of oxytocin and vasopressin, the “love hormones.” These hormones help us establish loving relationships, and they also function as partial painkillers. Love can do that. Love is the major painkiller for a young child, so it is not an accident that with early love our "love hormones" are more in abundance. But if no one came to love us early in life when we were lonely or felt neglected, chances are we will suffer from chronically low output of these hormones. The underlying feeling will be “No one wants me,” or “No one loves me.” It was, and is, hopeless. “No one wants me” governs our life. It is engraved not as an idea but as an ineffable feeling. It makes us shy in social situations, gives us a hangdog look, and compels a defeated posture. All ingredients of depression. In short, depression exists everywhere within us, not just in the brain. It constitutes the subtext we respond to in a therapy. Eventually we will need tranquilizers to hold down the feelings that are pushing from below.

Deficiencies in hormones or neurotransmitters can establish systemic vulnerabilities so that later trauma creates full-blown afflictions. We do not see any apparent disease when the child is five, but the seeds have already been sown. We may say later on, "Anorexia is caused by too much noradrenaline," too little of this or that. However, these are not causes, they are accompaniments to the original trauma, one which we can no longer see and cannot imagine in a person who is 40 years old. The imprint produces deviations in personality and physiology, which ultimately ends in specific symptoms. Thus, the aggressive sympath may have an excess of noradrenaline. It doesn’t cause anorexia; it is part of the ensemble of reactions to the original event. Interestingly, Canadian researchers recently reported success in combatting chronic, severe anorexia by using the same deep brain stimulation technique in the same area of the brain that worked to treat depression. (Involved in both cases was Dr. Andres Lozano, a neurosurgeon at the Krembil Neuroscience Centre of Toronto Western Hospital and professor of neurosurgery at the University of Toronto.) The results, originally reported in the medical journal The Lancet, showed that the patients not only gained weight but also saw changes in their mood and their ability to control emotional responses. (Lipsman et al., 2013) "By pinpointing and correcting the precise circuits in the brain associated with the symptoms of some of these conditions, we are finding additional options to treat these illnesses," stated Dr. Lozano. (ScienceDaily 2013)

I do not share the enthusiasm. Indeed, I find this both dangerous – it is experimental brain surgery, after all – and unnecessary. What the researchers claim is that they moderate the activity of dysfunctional brain circuits. So why are those circuits dysfunctional? I submit that it is due to imprints that distort them. In reality, they are not dysfunctional, that have been deviated as a defense against traumatic input. And instead of correcting the deviation of circuits, one must attack the origins of those dysfunctions. Otherwise the vicious cycle in all of psychology and psychiatry continues to repeat; something goes wrong and exudes symptoms, but instead of seeking generating sources one is constantly beating back the symptoms. The surgeons claim they are heralding a new way to treat these illnesses. They claim that they are correcting the precise brain circuits associated with the symptoms. And they are: correcting symptoms and their neural circuits but I submit those circuits are secondary to the imprint. They want to help those who suffer, as we all do, but in attacking the suffering we sometimes forget why that suffering occurs.

If we don't get to the primal imprint we are left with radical therapies such as brain surgery, which is finding a recrudescence in the field. This approach to anorexia is becoming popular and joining brain surgery for deep depression. These brain surgeons are stimulating the area just below the corpus callosum around the cingulate, which has a lot to do with feelings, whereas we do the same without surgery. Not exactly the same; we connect the imprint so that there is no longer brain activation where it should not be. When patients relive early traumas there is cascade of changes back to normal. It shows us unmistakably how early traumas spread their tentacles throughout the system. If we don’t get to the primal trauma, then we have to treat each symptom de novo, and each separately with a different drug or a different psychotherapeutic mode.

We may think of the imprint as a conductor of an orchestra. Since experience affects almost every one of our systems, from the muscles to blood to brain cells, the imprint is bound to cause effects everywhere. The same imprint can, and does, affect the central nervous system, heart, and blood sugar levels. It can alter all of the survival functions because survival was at stake. That means effects on the deep brainstem level where so many survival ploys are organized. Compounding our early pain with later experience makes symptoms manifest, giving rise to high blood pressure, diabetes, migraine headaches, hypothyroidism. The simple fact of chronically high cortisol set up by the imprint can impact memory later in life, not to mention making us more vulnerable to cardiovascular disease.

Let’s take a look at some of the physio-chemical effects of an imprint. Suppose there was diminished oxygen at birth and during gestation, which may be caused by a carrying mother who smoked cigarettes during her pregnancy or had anesthesia to kill her pain during labor. These two factors establish a physiologic record in her baby’s system. This record orchestrates a large variety of reactions in the baby; each reaction is an adaptation to the original threat against survival. Thus, there is lowered oxygen demands brought about by alterations in breathing, such as shallow and short breaths, then there is lowered thyroid output, lowered blood pressure and body temperature, exhaustion, such as chronic fatigue syndrome; and many phenomena governed by brainstem functions, such as butterflies in the stomach, dizziness, spaciness, and a vague terror. When terror is set down early, the fetus or newborn has no cortical capacity to dilute its impact. The nature of deep terror is so profound that in the reliving decades later it is only possible to feel for moments at a time. And it is dangerous to push a patient deeper into the feeling.

Hopelessness, helplessness, despair, and resignation can be imprinted through this diminished oxygen; all of the true sensations which accompany the memory. These pains elicit its equal and opposite reaction—repression. The pain is “suffocated” in its tracks and the result can be depression, a state that could be compounded by an unfeeling, dictatorial home environment where the child had nowhere to go with her feelings. It is not that parents necessarily suppressed the child’s feelings but that they may not have been present emotionally. The result is the same: no one to tell one’s feelings to. We are again helpless and hopeless. What is worse, the parasympathetic child makes no effort toward the parent to get love; she gives up and doesn’t try.

Research by A. R. Hollenbeck, another specialist in fetal life, documents how any drug given to a carrying mother will alter the neurotransmitter systems of the offspring, especially during the critical period when these neurotransmitter systems are forming in the womb. (Hollenbeck, Grout, Smith, & Scanlon, 1986) He states that administration of local anesthetics, such as lidocaine (to aid the birth process), during sensitive (critical) periods in gestation is capable of producing enduring changes in the offspring's behavior. Brain chemicals such as serotonin and dopamine can be changed permanently when an animal undergoes birth even with a local anesthetic. This again affects the gating system.
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. 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 mothers received three or more doses of drugs, their child was five times more likely to abuse drugs later on. (Nyberg, Buka, & Lipsitt, 2000) Enough animal studies have been done to confirm this finding—that 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), while a mother taking uppers during pregnancy – coffee, cocaine, caffeinated colas, will 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 and well, 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 have shown very little mania as a result. While other of my patients have taken lethal doses of painkillers in previous suicide attempts, enough to kill anyone else, and still lie awake hours later, only feeling slightly drugged. The severe brain activation by imprinted pain resists any attempts to quell the system.

Psychotherapists must ask the question, “Why does a tranquilizer or painkiller that works on lower centers of the brain calm the patient and change his or her ideas?” We know that it often does. We know that someone suffering an acute heart attack can feel terrible, yet when given a shot of a painkiller, it changes his ideas and attitudes about the experience. This alone should inform us that feelings drive ideas and not vice versa.

Wednesday, December 4, 2013

On the Importance of the Primal Frame of Reference

There is a recent survey of coffee consumption (Read Rebecca Coffey—no joke, in Discover Magazine, April 2013 ). There were many conclusions including heavy consumption and smaller breasts in women. But another caught my eye: university students who drank three cups daily were three times more likely to hear voices and have out-of-body experiences. Now why is that? It is pretty much the same with long- term usage of marijuana. Both approaches speed up internal pressure on the neo-cortex. Coffee agitates against the neocortical repressive function, which then has to manufacture booga booga notions to cope with the additional input—out-of-body feelings. This is almost literal in the sense that one has been driven beyond one’s repressive capacity….out of one’s body. “I am no longer the usual me.” It should read, “out of brain” experience because that is in a sense what is happening.

Long term marijuana use works a little differently, like a functional lobotomy over time. Bit by bit the gates are weakened, the lower forces are liberated and again force the neo-cortex to manufacture paranoid ideas. The real feeling—death is approach due to loss of oxygen at birth, “becomes someone wants to kill me”. Bizarre notions are not capricious; they derive from real experience, real imprints that are filtered through the gating system. It is the weakening of the defense/gating system that permits breakthrough of feeling which then impels and compels the cortex to go into action manufacturing booga booga.

It is not the coffee that does it; it is the activating ingredient caffeine that soups up brain activity. As usual, it compels the last evolutionary defense, ideas, into action. So one can activate the brain inordinately or diminish the gating system to achieve the same result. Notice, it is when feeling are artificially thrust into action that the cortex enters the fray and tries to capture and bind those feelings with ideas.

Here we get a picture of psychosis; the same processes are at work but the internal thrust is not artificial. It is internal; something causes hurt and pain, some feeling that is too much to feel to accept and integrate, so the cortex begins its job of protection and survival. It is in charge of repression, of holding back those feelings so that we are not overwhelmed and lose our bearings. It is essential that we don’t lose our cognitive skills so that we no longer can navigate through life to protect ourselves. It has all to do with survival; that was always the function of defenses. They just became more sophisticated as we evolved. And the last defense is cognitive. The cognitive therapists, however, forgot the other two key brain systems and focused only on cognitive functions; in this way they cannot possibly understand what defense systems are about and how they evolved. In short, they cannot see that they are survival functions, not to be analyzed to death but to be liberated so we can live.

Tuesday, December 3, 2013

The Mystery Known as Depression, Part 7/12


Elizabeth Blackburn and Elissa Apel in Nature (11 Oct. 2012). (Blackburn & Epel, 2012) reported on a number of studies of telomeres: in 2004 a study compared white blood cells of mothers with chronically ill children with those mothers with healthy children. Mothers of ill children had shorter telomeres. It is likely that stress is a factor. And that means increased cortisol levels with possible shorter telomeres. It is not short term stress that is the culprit but enduring stress; what could be more enduring than the imprint?
What cortisol may do, inter alia, is increase the enzymatic action of telomerase which affects the function of telomeres. To be clear: what that enzyme may do is get busy fighting deterioration taking place with the input of primal pain. This, it seems, increased telomerase happens to prevent further neuro-biologic damage to the system. A research team led by Owen Wolkowitz of the University of California, San Francisco, has been studying telomeres and depression. (Wolkowitz, Reus, & Mellon, 2011) What telomerase does ordinarily is help maintain the length of the telomeres, even lengthen them. They are protective. And they go up when depressives take antidepressants; they also go up in animals where it is associated with increased nerve cells in the hippocampus. It appears that the hippocampus deals with the facts of feeling and the memory of it. It is seriously affected by depression. The longer the depression the shorter the telomeres, and it becomes a life-or-death matter. They have found, for example, the very serious pancreatic cancer, is associated with shorter telomeres in blood cells. These people were also studied before the onset of cancer so we cannot say that telomeres shortened because of the onset of cancer. Telomeres maintain the stability of genes; it may be that unstable individuals equal unstable telomeres. There are other cancers associated with shorter telomeres, as well. (There is a book soon to be published by Ed Park, M.D on telomeres). Imprinted pain has a lot to do with depression and with later serious illness. We will study this among our patient population.

Telomeres are shorter in chronic depressives, and that fact is crucial. Why? We can to assume that there is an imprint of early trauma to set up the depression, in the first place. That means pain. There may be a great amount of imprinted pain in depressives. This seems to be also true with immune disorders, as depression affects the immune system adversely. Chronic depressives have shorter telomeres. That can mean imminent serious illness and early death. I believe that a feeling therapy that attacks the imprint is life-saving. We are beginning to see why. One problem we have is that when patients get to earlier brainstem
imprints the pain is serious; but if they stay with it, it does not last, and makes for great changes throughout the system. I often tell patients, I didn’t put the pain there, I am charged with taking it out.
When cortisol is chronically high and telomeres short there is a much greater chance of suffering from certain cancers, including the deadly pancreatic cancer. What causes this cancer? Likely also, early trauma that is imprinted and endures may play a role. Thus a brainstem imprint means a brainstem reaction, and that may mean deep physiological responses, including such afflictions as colitis. Another effect is the appearance of dementia in those with shorter telomeres. Again, we need to look at very early trauma, even in gestation, to find the answer to the questions, what causes cancer? What causes dementia?
When you have a constant pressure and tension on the organs due to the imprint it makes sense that they will give in and break down. The organs are saying, “I can’t hold on any more. It is more than I can handle, all too much.” It is surprising to me that they do continue to hold their integrity as long as they do.

There is an article in PloS One that underlines the importance of anxiety to damaging the telomeres. It is an important study in which the researchers took blood samples from 5200 women ages 42-69 enrolled in the Women’s Health Study. (Okereke, et al. 2012) They analyzed telomere length among them. Those who reported frequent anxiety attacks (phobias) had significantly shorter telomeres. They implied that it would deduct six years from their lives. They conclude that chronic anxiety in childhood leads to premature aging and, of course, a shorter life. Anxiety will kill us; which is why it is so important not to leave the imprint untouched in psychotherapy. Telomeres may soon be the key marker for not only how long we live but how many years a feeling psychotherapy can add to our lives. If we leave it untouched and unchanged the therapy can be a failure.

Stress erodes telomeres very early on, according to late research. So children who spent time in orphanages from birth on had shorter telomeres. I think the evidence is there in so many dimensions; early trauma damages the system in every way possible. We need to pay attention when we carry a baby in the womb and we need to pay real attention to our birth practices which are too often deleterious.
The research emphasizes that the early stress carries on into adulthood. It follows us everywhere and anywhere until we acknowledge it, face it fully, and relive the damage. Paradoxically, as we experience the imprinted damage it goes away, and with it there is a normalizing of many vital signs. Here is supporting evidence for the imprint even if not stated. Why else does it endure and shorten telomeres? Why cannot they make the equation that early trauma stays fixed in the system and drives behavior while shortening our lives? I believe that the earlier the stress, the carrying mother smoking early in pregnancy, the more harmful it will be later on. Lets teach about pregnancy in school so that adolescents understand what pregnancy means for a human life.

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.