Tuesday, April 22, 2014

On the Rationale for a Diagnosis

There is an article on attention problems in the NY Times (April 13/2014. “Idea of a new attention disorder spurs research.”; http://www.nytimes.com/2014/04/12/health/idea-of-new-attention-disorder-spurs-research-and-debate.html) There is the claim of an entirely new diagnostic category: Cognitive, Sluggish Tempo (CST). The brain seems not to be active enough to focus and concentrate; another facet of ADD.
 So what is wrong with that? A new category? Everything is wrong with it. .

First of all the diagnosis should inform us, not simply describe. So OK the person’s mind works slowly, does that help tell us why? Which brain is sluggish and where? The same can be said for ADD. She can’t pay attention. OK. Anyone on the street can make that diagnosis: He muses; she seems too active, her mind is racing and she cannot sit still. So what? Is that indeed a separate category? In what way?

Description alone is not a proper diagnosis. The bacteria below infection is. So if I say, he sweats, has a high continuous fever, shakes and often seems to chill that is still a description; not a diagnsos…….no cause. If I say he is depressed, that is not a diagnosis; it is a description. What is depression? What is behind it? Oh, I see, he seems sad and down, has no energy and moves in labored fashion; is that any different from what the ice cream vendor could say about him? I doubt it. If we find that the vendor’s description parallels the doctor’s, throw them both out; no, save the vendor’s.

And there is then the other type of error in diagnosis. “His locus ceruleus is too active and there is an anomaly in his hippocampus”. In short, he is only a bunch of neurons and some seem deviated. No connection to his life, now or previously, no human touch; pure neurology. What’s wrong? It is a diagnosis in a vacuum. The same for biochemistry. We are not just cortisol; we are humans who respond to EVENTS with changes in biochemistry. No event, no real diagnosis. Unless we really do live in a vacuum.

And how about psychology?

Yes we have made all the diagnoses and see that the brain runs too fast and with far too high amplitude……he is therefore “”. And once we are certain of our diagnosis we rush to give drugs that are proven to slow down the brain? And they do achieve that and the person is far less anxious.
I forgot to ask, does he have a history? Traumas, lack of love, etc? Was there a key traumatic experience? Was there a trauma at birth or during gestation? When we have no frame of reference on the human level we are wandering in the dark, acting on half truths. …seeing only part of the brain and only part of the human.

We need a diagnosis, especially in psychology that is more encompassing; that goes below the obviously observable. That really explains and tries to find origins. It is not enough to find medicine to ease anxiety without ever knowing what it is and how to deactivate and decouple if from pushing our brain so hard. Until we do that we are forever in danger of recidivism; of it coming back again and again so long as the cause remains intact.

Worse, so long as the primal source remains intact there will be a need to drug the symptom and that is partially what this discussion is about: drugs for symptoms. Big Pharma at work. They have no incentive to find causes and put themselves out of business; so long as they dominate research and medication we become the losers. The source is what provokes the symptoms into life. The problem is that the source and origins are imprinted and can stay for a lifetime. And that is not just in the brain; the cells are found throughout the system, which is why cognitive therapy is lame against early imprints. It is not just ideas; it is in the lungs and kidneys, in the heart and blood vessels.

Let me tell you about a sluggish brain. In my earlier books I describe 2 kinds of birth; sympathetic nervous system dominance due to child successfully struggling to get out; and the parasympathetic birth where there was no possibility to move through the canal easily—a blockage. This describes the active person with an active brain versus a slugish person with a sluggish brain and that works more slowly….the sympath versus the parasympath. This is a complete systemic event and is not limited to brain function.

 There is more: a mother taking drugs or painkillers or tranquilizers while carrying can produce a down loaded baby who is very sluggish; I have seen it so many times during relivings. And that same mother drinking a lot of coffee or cokes can up load the baby and make him hyperactive. It becomes imprinted as a normal way of life, first for the mother and then the baby. The baby begins to adapt to his environment, which in this case means either too much stimulation or too little. It becomes “normal” and he adapts accordingly. So “sluggish” has very early effects. And a diagnosis needs to include that possibility.

 Oh my! Did I mention that this new diagnostic category is supported by Eli Lilly? That means financial support. They also pay him for speaking tours. It is good for them that a diagnosis requires drugs, but not so good for us. We need a real diagnosis not supported by drug companies.


  1. Hi,
    Isn't it difficult using language to 'de-scribe' actual situations?

    Am I being disingenuous to say most, ALL words are labels / symbols for something else?

    No I'm not and I'm not trying to make a case for 'categorization' etc etc. Except of course I am; how could I not? Anything I put into words can become a judgement can't it? (Particularly if I have a point I'm trying to make).

    I feel what rankles is the way these 'diagnostic labels' work as 'carriers' for commercial assumptions, which is the point you make Art. Without Primal Theory these labels can only be marketing props to satisfy a repressed audience (who will purchase 'cures' the same way they purchase the weeks groceries). But now that I know something of Primal Theory these labels mean so much more to me than they do to other people who have little or no comprehension of originating causes.
    I think it's going to be impossible to dispense with categories and labels because in communication with each other we will need a point of reference, a word, a starting point from which to extrapolate (in reverse evolution) the causes. Such is the nature of repression. . . very few, if any of us will 'know' until after the damage is done and then we are faced with 'presenting symptoms' and the need to put a word on them.
    Art, having been so immersed in Primal for so long it has become inevitable that commercial interest will be so irritating to you; and when I go to the Doctor it will be irritating to me that she is likely to be trying to categorise my symptoms and finding the correlating drug so that she can get me out of her surgery and back to work. Ding Ding ! Next Please!

    Paul G.

  2. An email question: "I keep asking this question yet no one replays to me. What about the actual damage to the brain in Fetal Alcohol Syndrome or FASD?? It's not JUST emotional…..the brain dysfunction is also physical."

  3. And my answer: Of course there is damage. Everything I have written points to it, and above all, you yourself know the answer. art

  4. Hi,
    recently in the news there was the story of Peaches Geldof who tragically died suddenly and without any obvious cause whilst actually caring for her small children. She was found dead with the little one close by. They've put her in the ground now, in the same cemetery as her mother Paula Yates.
    Somehow I feel this story relates to that of Mick Jaggers girlfriend.

    Peaches was a proponent for 'attachment parenting' and had recently spoken about her relationship with her mother. In particular she described how at 14 years old, when her mother Paula died, she had to just "carry on as before" going to school the next day as if nothing had happened. . .

    How very English is that?

    So, they are doing a toxicology report to see if she poisoned herself. . . But I can't believe it was suicide because she also regularly spoke about the joy her children had brought to her. . .

    "Sudden Death Syndrome". . . Straight away I am thinking this must have repressed trauma as the cause and what better family dynamic than 'showbiz' to demand on the child (or adult) the keeping up of appearances and the inevitable pushing down of real feelings?

    It's unresolved grief that killed Peaches and it could be unresolved grief that gets me or my son. . . or any one else for that matter.
    Don't keep your losses to yourself for the sake of appearances. . . Grief is better out than in.

    Paul G.

    1. Hi,
      It's beginning to look like Peaches overdosed on heroine. . . Just like her mother Paula Yates.
      History has this uncanny way of repeating itself.

      Paul G.

  5. "When we have no frame of reference on the human level we are wandering in the dark, acting on half truths. …seeing only part of the brain and only part of the human."

    Exactly. I myself seeked out a frame of reference from the beginning of my interest in psychology. But I'm a freak by today's standards, and that frame of reference is no longer the game, as it seems, in the modern psychology world. It's all just "chemistry" now. But is it? No!

    Andrew Atkin

  6. Dear Dr. Janov.

    If I remember correctly, the graph of a birth sequence is like a sine. At the beginning, there is a rise of the blood pressure and the body temperature. If a successful birth occurs at that point, we may have a sympath personality.
    If not, then the vital signs drop very low, leading to a parasympath person.

    My question is:
    …is there any chance that, in modern society, people are born with a straight line of their birth sequence, without those peaks (either max or min points)? Meaning no dominant nervous system?

    And one more thing. I am a parasympath and I know too well the lack of inner motive and sometimes the fact as if something invisible has drained all the energy from my muscles. But I assure you, that my brain is very active. Sometimes so active, I could assume I have ADD.

    - Yannis -


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.”
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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.”
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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.
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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

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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.
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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.