On the Science of Psychotherapy

Sometimes I realize I am getting science heavy but what is happening today is so exciting, especially since it supports what I have been writing about for almost 50 years.  (See the following:  T.J. Rebello, et al., “Postnatal day 2  to 11 constitutes a 5HT sensitive period.”    G. Perna: “Panic and the brainstem: clues from neuroimaging studies.”  2014 1996 Betham Science Publishers (see an abstract at http://www.ncbi.nlm.nih.gov/pubmed/24923341).    Justin Feinstein (my colleague) with E.G. Velez and D. Tranel  “Feeling without memory in Alzheimer Disease.” see http://journals.lww.com/cogbehavneurol/Fulltext/2014/09000/Feelings_Without_Memory_in_Alzheimer_Disease.1.aspx)

I will try to sum up the implications of their research without all the scientific lingo.  Let’s start out with the urgency of early love.  Eric Nestler, (Mt. Sinai Hospital, N.Y.)  writing on epigenetics states the following:
“There are epigenetics effects that last a lifetime.  Rat pups that are rarely licked are more susceptible to later stress.” (see the full article at: http://211.144.68.84:9998/91keshi/Public/File/34/490-7419/pdf/490171a.pdf) And of course rat pups licked and love do much better later in life.  They are more adventurous and curious.  What is important is that we can begin to zoom in on why, and the answer seems to be that damage means heavier methylation.  And what is that great damage?  Early lack of love.  It takes many forms in humans, but poor nutrition, a mother drinking, smoking and taking drugs and later abuse found in neglect and lack of touch (licking).

Methylation seems to be an important marker for lack of early love, both in animals and in humans.  What new research is finding is that so many diseases are methylation dependent, including MS, Diabetes and heart disease.  Again, these are stress related, and the great stressor seems to be a simple lack of love.  And lack of love means ignoring and denying the baby’s basic primal needs.  Not surprising in the rat study was the fact that heavy methylation occurred in the limbic/feeling structures such as the hippocampus which has to do with memory.  It doesn’t take an Einstein to see the possible later relationship with Alzheimer’s disease.    Above all, we need doctors to stop asking “Have you been in any unusual stress recently?”  They need to ask the right questions if they want the right answers.  And that includes research scientists who must delve into the marks of damage to key cells that will provide answers.  Since we cannot ask the fetus about his stress we need to do the next best thing and sniff out biologic damage.

Remember when there is very early stress (womb-life) the genes can be up or down regulated, and here starts the origins of depression and anxiety. It becomes the crucible for later disease.  When we add abuse in infancy in childhood, given away to foster parents, a  mother too sick to care for the child, etc., we can almost be sure that neurotic behavior and disease will follow.  That almost surely will involve ADD, lack of concentration and learning disorders.  The DNA has been chemically modified and it reroutes normal reactions for behavior and disease.  These changes are not neurotic; they are often normal to the noxious intrusion of things like a mother’s smoking or drinking.  The fetus is trying to adapt as best she can.  Neurosis is an adaptive reaction to threat.  It is in that sense, normal.  Behaviorists are trying to change a normal adaptation into something else that is not organic nor adaptive.  They are basically moralists, trying to get patients to adopt healthy behaviors when they are already in normal behaviors depending on their early experience.  Or they concoct exercises for relaxation when the only proper relaxation is to deal directly with the imprint.  Otherwise, they are still behaviorists trying to find ways to change our response to early damage without acknowledging that damage.  My patients do not need special relaxation ploys because when we take the pain out, they are very relaxed and that state endures.

Now the important part:  they are finding where all this begins, and like my mother used to say, “Columbus discovered America”, early damage, the primordial primal imprint involves the brainstem.  Phylogenetically this is an ancient brain system that we share with sharks.  It makes us hyperaware and hyper-reactive. It is the source of basic biological impulses, fight or flight.  And research points to this key structure as where anxiety emanates from.  Something I have seen and written about for many decades.  Somehow,  “objective” research has credibility.  What imprints here do is adversely affect the serotonin system which should help dampen panic but it cannot.  So what do we do years later for panic? We offer serotonin pills in the form of SSRI’s.  And what does that do? Make up for what was affected during brainstem dominance.

What the Perna group did was do a complete literature search of many databases for panic disorders.  Yes the brainstem was involved. The brainstem, which registers very early trauma and sets the tone for how we respond to it later in life.  So  mother’s drug taking and later birth anesthesia sets up a panic reaction to lack of oxygen.  Later in life, closed doors or windows become a threat and can set up a panic attack.  Their summary was as follows: “Panic patients tend to have abnormal brainstem activation to emotional stimuli when compared with healthy controls.”

Here is my question for them but it cannot be answered by research alone?  Where does that come from?  What causes that brainstem reaction?  Or does the brainstem just go off and do its own special thing?  What is the exact relationship between certain experiences and brainstem activation? Those are the answers that will lead to proper therapies.  Above all, why is the brainstem so involved?  Maybe the damage is registered there because it dominates during the first weeks or days of life in the womb.  And the brainstem becomes methylated early on.  And as I say, it is the earliest imprints that are the most damaging; there is where therapy needs to begin.