Why We Need Safety

There is a confluence of two events, quite unlikely, that explain something about human nature.  The first is something that my colleague, neurologist Michael Holden and I wrote about over forty five years ago.  It was about amoeba that lived in dirty water with black ink poured in.  They absorbed the black ink, as an external  menace into a vacuole and then when the place has clean water they discharged this intruder.  Back  into the water.  The second event is something I see on TV all of the time.  Someone is discussing the loss of a friend or relative and they tear up and scrunch their face and then it shuts off and they say “Sorry.  Excuse me.” They do not seem to understand the mountain of tears lying below. It is those tears that need to be dredged up and experienced, otherwise  they stay locked up and continue to gnaw at the system. The person gets sick years later and no one knows that they have been sitting on all those unfelt emotions.

How do we know?  Because people come in and cry those itty-bitty tears only to discover weeks and months later in therapy what they have been sitting on.  Then the inundation begins.  And when that happens, there are major changes in many biologic measures, as well as alterations and normalization of many vital signs;  blood pressure and heart rate descend.  Also there are significant changes in brain wave functions.  In other words, tears can change all that. And because that is  true it may well be that repressing those tears plays a real role in a number of illnesses, not the least of which is hypertension and heart problems. Not just one day of holding back tears, but of years of it happening.  Because to hold them down takes effort and energy which is being used up all of the time.  It takes work to hide from ourselves.

So what does India ink have to do with it?  Amoeba, as a basic minute cell shows us a biological process; waiting for safety, a welcoming environment to allow us to rid of all the junk and pain inside.  And that is exactly what is missing in psychotherapy; first, a notion of all the tears inside that must be experienced, and secondly, the need to provide an environment where those tears can be let out in full force.    That is right; “full force,” because rarely does a therapist sees that force, neither in others, nor in himself or herself.  They see this as “too emotional” and, “out of control.” So the tears are “discussed” not felt.  We do not live in a culture where full emotionality is not only accepted but welcomed. There lies the rub, to quote an old pal of mine.  What is his name?  William something.

The problem is that psychotherapy that evades and avoids emotions makes the patient sicker.  All the emotions are entombed in the head and the body goes on suffering unconsciously.  So in helping a patient become mentally aware he is at the same time becoming more unconscious.  What a dilemma!  We can learn from that amoeba.  He is only doing what is actually human:  waiting for a loving, warm environment to show his feelings and unleash his pain.  Let me add:  crying about it is not enough.  It has to be crying in context.  Tears must emanate from felt pain, not as an intellectual exercise, not as directed by a well-meaning counselor but tears that arrive automatically when the actual early memory is evoked. And careful, it is not always words that express the feeling.  It is often in body language or non-verbal emotions.  We need to know how to read that language.  That is why it takes so long to do primal therapy correctly; that mysterious language that lies below verbosity and has so many hidden meanings.  Those means, “I am not loved, no one wants me or cares about me,“ drives so much of our behavior and later symptoms.  And why is that? Because those meanings derive from actual early experiences where we were not loved.  They are not inventions. They correspond to reality, and reality is what we must deal with.  It is the name of the game.  We are historical beings; we cannot avoid history and get well. Our own history.

Crying without specific context and memory is only abreaction, the discharge of feeling without feeling it. It cannot ever be healing.  We are going back to origins remember, and that means long, long ago.  Feeling is healing, to coin a phrase.

Suffering, Pain, What is the Difference? It All Hurts.

No, No, my friends, there is a big difference.  In my scheme most of us suffer but few feel pain.  Why is that?  It is a bit of a tale but pray let me clarify.  First of all they come from a difference play in the brain and play a very different role; and you better hope for pain cause it will take you out of your suffering.

If I kick you in the cojones you suffer but it can go away. If your father kicks you there you feel pain and you suffer because it has multi-determined meaning; as Freud said, it is over-determined.  How could my father do that?  Does he not love me? I feel hurt, wounded and unloved: I suffer.”  That suffering has implications that hurt and make us suffer.  A broken heart is suffering. A faulty heart valve is pain. Pain can be fixed; suffering is another matter.

There is a structure called the ACC  (anterior cingulate cortex).  When we are babies and mother disappears we send out a distress call; a specific call that demands, “Whaa, Come back now.  I need protection and care.”  We need love and protection at all times when we are young; we don’t often get it: stop crying and stop acting like a baby.  And so we do and we begin to lose that alarm signal that makes help and comfort rush to us.  The pure pain areas overlap with the emotional suffering part. When research subjects were make to feel isolated and rejected the ACC got busy but the higher ventral prefrontal cortex did not.  And from the research we begin to know why it hurts so much to lose a family member.  But the distress can be lessened with painkillers, as we all know.  What they were showing was the difference between emotional and physical pain. They were not identical and involved different areas of the brain.

For my purposes it is the over-determination, the meaning of the pain that is repressed and remains unconscious so that we then walk around and not feel the suffering we are in.  “They don’t like me and there is nothing I can do.”  It happened to one of my patients who was born in error; neither parent wanted him and they made him pay throughout his life just for being alive.  The parents made up reasons for disliking him; but it was clear. He had “ruined” their life.  In suffering the ACC can mount while the pain centers remain aloof.  And what is our job? To make suffering into pain.  Why on earth would we do that? Because all of that suffering means unrelenting hurt.  That suffering must be made conscious, which means conscious/awareness/pain.  Then it can be dealt with, resolved and put and end to it.  So long as it hurts we cannot shake it.  In other words, according to the research we need to bring the limbic lower level suffering up the cortex.    It needs to be made consciously/aware.

Too often the patient demands help with her suffering so she is given tranqs and painkillers and the suffering is subdued for a time. But it will always return because it has not been made into pain.    And the suffering that is most troublesome and that cause serious addiction, is that from the brainstem. It is often horrendous and remains suffering because it is so deep and remote and inaccessible.  When we make that into pain we are on our way.  Pain is resolvable and suffering is not; it can only be suppressed.  Suffering is diffuse, amorphous, without shape, time or place.  It is an imprint often without words, but it endures for a lifetime.  Pain is a conscious, connected event which takes suffering makes it specific and we are done with it.  Pain, like the kick in the cojones, stops the vagueness; it is over and done.

It has been disconnected from its source, time and place and therefore remains a mystery.  When it becomes, “Oh my God. They hated me and blamed me for it.  And I thought it was my fault and that I was bad and unlovable. “  Or it can come from a traumatic birth and or a carrying mother drinking alcohol or smoking.  Many ways to suffer; only one way to feel pain.  Pain is connected and specific; you cannot be driven there by a therapist but you can be led there when the time is right.

So now we know that specific pain is held down by the gating system.  It was meant to be hidden so as not to be too disruptive.  But it continues to spray its agony all of the system, and we get high blood pressure, headaches, even epilepsy.
It is a mystery to everyone.  No one can see a carrying mother chain/smoking decades later but there it is and that is when it all began.  So what we need to do is wait till the patient is far along in her therapy and can safely descend
To lower levels;  we then using primal techniques to help dredge up those early pains from remote times, bring them up with the help of the right orbitofrontal cortex make them concrete and resolving.  That is  a different matter from suppressing pain. One is time consuming and evolutionary, and the other is always an emergency measure.  We should never do one without the other. We can kill pain with drugs while we are traveling to the lower depths.  But let us never fool ourselves; temporary measures, pain killing is not cure no longer how long it lasts.

So Why Are You Gay?

There are as many reasons to be gay as to be straight except one; and that is just a maybe.  Much recent research points out the fact that stress in the womb alters the stress hormone levels and that can change the testosterone levels and that can lead to homosexuality; if, certain conditions are there. First of all, we don’t always know if and how much sex hormones have been altered.  We don’t always know if changing hormones leads to being gay.  Except we know this”  if you give female animal male hormones they display “male” behavior including mounting males.
And they play more rough and tumble with their cohorts.

So why can’t it be that stress to a carrying mother can change her hormones and her baby’s?  Now for the second step—need.  A child needs parental care and loving.  If that is absent he will go elsewhere. Sometimes my patients, a number of them, will wear dresses and walk the streets that way.  That is the way he feels close to a mother who showed no love.  I have written about a mother who left early and came home late from work; a single mother.  The boy lacked a mother’s love, but he found a substitute, her clothes and her smell.  It became a lifelong ritual.  Something he was never aware of it.  He just thought it was a quirk, a neurotic act. But need drove and it and it should not be stopped because it is a signal of desperate need that was fulfilled in the only way possible.

Or the case of a stressed mother who, in the middle of pregnancy found herself bereft of her husband who found a young girlfriend.  That stress is transmitted to the fetus.  If the stress reaction goes on it gets stamped in, engraved as a memory that can change his hormones.  He may be feminine very early in life. Now add a missing father and a distraught mother who is devastated and unloving.  The boy can later gravitate to male love. Not always, but it is a factor in some of the gay men I have treated, over one hundred.  The boy, somewhat feminized, seeks out male love over female love partly due to his hormone shift.  No different from the young animals who seek out males to play with rather than someone of their own gender.  Their interest has been altered, and by hormones.  I am not setting down unalterable rules but rather elements to explain some behaviors.  In the cases of homosexuality I have treated there has nearly always been that first-line deep and early trauma.  Perhaps I am treating a selected group and my perspective is biased, but I could be right, as well. If we never posit these factors we will never know.

This change in testosterone is prevalent in all primate mothers; and it is largely due to the stress of the mother which becomes imprinted into the baby.  The patients come to me and say, “I don’t know why but I have been attracted to men nearly all of my life.  I knew at six years that something  was different.”  So one thing we need to do is a comparative study of stressed and unstressed mothers, and look at any differences.  Is it possible that being gay is epigenetic (due to experience) and not totally genetic?  We need to avoid political correctness and defensiveness and do what is correct scientifically.

Oddly, let’s look at one group of primates, the bonobos. They are gentle and loving and settle most problems with sex.  Not so with chimps, who organize groups to go on raids and kill other chimps.

Bonobos are high in testosterone, male and female, much higher than chimps, Chimps develop their levels later after puberty.  Up until them the bonobos are quite high.  And they play tough with their pals but rarely violent as chimps.  This is only to say that hormones matter, a lot.  And that hormones are radically affected by experience, especially very early experience when hormones are beginning their life and are vulnerable to trauma that can change levels.

Does that mean it is a neurosis? Could be but no more than a man who wears dresses every day. It means that early in life there were experiences that change things. Those experience for the mother can means she drinks, smokes, takes drugs, is anxious or depressed, and so on.

Now the important point: can we or should we treat the hormones?  Yes but only after we know if experience and early trauma changed them permanently. No different from those who have chronic hypothyroid.  Shouldn’t we see what may have caused it? I am of the view that most of us would be born normal if we were not made abnormal by early trauma and neglect.  Yes, we need to treat such afflictions as very low thyroid but let us never forget that for every symptom there can be an ultimate cause.  Why do we consistently neglect that fact?

So why am I not gay?  I had all the elements for it happening.  A psychotic/anxious mother and tyrannical unloving father.  But when I was sexually vulnerable at age thirteen, I was in the back of a car necking with a girl whose name I have preserved in memory. Those hugs and kisses sank in and changed everything.  It made me feel that I could get love from a female.  Having never been kissed she taught me how to kiss and hug. It was the first love I ever knew and it was critical.  So thank you, Liz.

A Past Without a Memory

If you have no memory, you have no past.  Wait a minute, could that be true?  No it is not.  Many of us wander around this earth with little memory of the past, especially if that past was very painful, and very early—predating conscious-awareness. Predating our verbal capacities.

So what do we do in our therapy?  Recapture our past; retrieve our history.  And why do we do that?  So we are no longer controlled and driven by it.  We are historic beings and need again to be historic; complete and full.  Why don’t we remember so much of our childhood and earlier? I assume it is due to pain which sets repression in motion so we do not remember; so we are not so troubled by it.  But it is there, nevertheless and it directs our symptoms and behavior later on.  So even if we don’t consciously remember we still have a past.

Why should we be whole and complete?  Because being unconscious is life-endangering.    We get involved with the wrong people, sometimes dangerous; we take chances we shouldn’t, gamble on things that are not possible for success, etc.  And being unconscious means we have forces gnawing away at our system, making us sick and shortening our lives.  Is that reason enough?

What we do is help patients retrieve key memories that open up the memory system and give us access to whom?  To ourselves so we can be whole beings, not partial entities.  And if we want to retrieve very early memories of gestation,  birth and infancy we need to understand the memory system; for our very earliest memories are of smells; so early that they bypass the usual routes, and travel directly to the limbic/feeling system,  directly to the memory centers.  Memory of odors are idea, concept and situation free; they are pure and unadulterated.  If we let the patient slip into them totally we often get remote pains that were hardly ever retrievable.

I visited a friend in a hospital recently and there was the scent of ether there.  It brought me back immediately to my own time in a hospital which was horrendous.  It was a pure, unadulterated memory that was attached to a specific time and place; it was a first-line memory from deep in the brain and from a primitive nervous system.  That is, smell lives in the deep brain associated with deep and remote memories, the ones that are difficult to access in normal everyday life.  It is one reason I think our patients might benefit for a trip to visit a hospital.  In the same way that we encourage patients to bring in photos of their early lives, and to bring in music that evokes old feelings and their memories.  Remember, there can be no effective psychotherapy without retrieval or our history.  Unless we only rely on cognitive memory; then we make progress on in  our top level and have neglected two-thirds of our brains and their memories.  To access preverbal events we need non-verbal techniques. Words will never do it.  We need to open up the memory bank to get rid of pain and put the system into a pain free state as much as possible.

So if I tell a patient, “tell me about your life in college,” it is a good idea but never ever deep enough to make a difference in what really drives our behavior.  Yes, we deal with college and school life but not to the neglect of very early memories.  The odors from infancy and before have an enduring quality; the reason?  It often has to do with life and death. Those memories could be of life-endangering events even before we had ideas to remember them with.  But they are there in full force all of the time.  They recede but never disappear. What pain drugs do is make them recede for a while, which feels fine but we pay a price for making our memories that could be liberating into deeply hidden events.  Drugs, obviously make them difficult to access and that means we cannot reach deep aspects of ourselves.  Those memories become the “untouchables.” They will certainly shorten our lives, both directly,  and indirectly through our smoking and drinking to keep them down and away.  We become addicted without knowing it to those memories and their suppression.  We are addicted to our unconscious memories; they hold us firmly in their grasp for a lifetime.  They demand more and more of us to keep them at bay.  And we think addiction centers will change that?    Never.

I should add that some preliminary research points to loss of sharp memory as possibly indicative of beginning dementia, and also signs of depression.  They do not necessarily cause them, but are compadres on the route.  Depression means deep often first line repression and that suppresses memory, as well.  Depressives are “down” in every sense of the word.  I think that one thing it means is that first-line deep in the brain trauma has an effect on deep reactions; hence loss of smell and memory.