Tuesday, August 25, 2015

On the Difference Between Abreaction and Feeling (Part 9/9)

 We Are Specialists of Joy, Not Pain

 Primal Therapy is no quick fix. We are attempting to redo someone’s entire life. It will be done in a slow methodical manner so as to never overwhelm the patient and make him suffer all over again, as happens with abreaction. If he can experience just enough to have a full experience that is enough for a session. We do not want him to suffer any more than necessary. He will suffer when the pain comes up arbitrarily, prematurely so that he cannot integrate it; the pain hangs there in an ego-dystonic fashion (Freud again), meaning alien and apart with pure pain that cannot be made ego-syntonic or integrated.

 So why do we have to trace back our evolution again? One reason is that we never sever anything permanently in our evolution; we suppress the old and add on the new. Sometimes the primal pain vestige is so powerful that it exerts a constant force that disrupts our functioning. In my patois, the first line erupts and surges higher. Then it has to be dealt with and relived. I call it “intrusion,” an imprint so strong that it interferes with our personal evolution and our current functioning. We see it in physical symptoms and deformation of organs and growth; we see it in diseases such as hypertension, cancer and heart failure that are actually offshoots of the central damaging memory, locked in as an imprint, out of reach and out of touch. This is also the case with Attention Deficit Disorder where forceful imprints constantly surge toward the top level to disrupt concentration and attention processes. Remember, earlier, I explained that evolution always moves the imprint higher so that first-line damage may be expressed on the upper levels of brain function, where attention and concentration are mustered. Training a person how to concentrate is not the answer; feeling the force that scatters thoughts is the answer.

 Once we lift the repressive lid (done in orderly fashion) there is no longer unconscious forces driving behavior and symptoms. And as repression lifts, the patient’s truth becomes self-revealing. Bit by bit his unconscious tells him what he needs to know, but not too much, just enough to integrate the pain and its information. His orderly descent into feelings eventually informs him of what it all means. Everything he needs to learn is already lying inside of him, waiting for discovery. It must come from inside, never outside, just as the feelings were laid down by the system and not by executive order.

 The aim is not insights; it is change in all aspects of the person: his behavior, biochemistry, neurology and feelings. We are after total change because there was total change at the time of the imprints. We want normalization of the whole person. We are not there to give love; we are there, paradoxically, to help patients feel unloved so that they recapture the ability to feel and then can feel love when it is there.

 If a therapist needs to be loved he will act out on the patient and give him what he, the therapist, never got. He has become a “pal” not his doctor. The patient feels loved, it feels good…and he loses! Or there are great discussions about music and art and politics, and the patient becomes an intellectual pal, and again he loses. He has been transformed from a patient who needs treatment into a good friend. Nice idea but very wrong. We are not there to give love; we offer kindness and caring but also science. We don’t replace science with pseudo caring. We adhere to key principles. The patient begins to suffer; we do not rush in to stop it and make him feel better. We don’t do him any favors suffocating the pain with “love.” His feelings are about real suffering. It must not be tampered with. That is the part he has kept hidden for years; it must come out and be experienced. Then we will be free; free of that pain which has made him depressed or anxious for so long. The patient is himself at last.

 It is dialectic; he has to feel unloved so as to unlock the feeling gates. He will never do that with therapeutic approval and warmth and understanding. He will get that after the feeling, not before. When he has made a breakthrough, we rejoice with him. It is not just about pain; it is about contentment, ease and relaxation. It is about joy. It is what we want too for them; why else do the therapy? I received over fifty letters on my birthday thanking me and my staff for saving their lives or improving them greatly. That is the reward and the meaning of our lives. We are not pain specialists; we are joy specialists who need pain to help joy along.
 There is a reason the patient has to feel unloved.  He needs to go back to the open sensory window when “unloved” dominated.  That is the essence of our therapy; travelling back in time and undoing the original damage. We cannot do any better than that.

Thursday, August 20, 2015

On the Difference Between Abreaction and Feeling (Part 8/9)

 The First Science of Psychotherapy

 The task of normalizing a patient’s entire system is a complex proposition because not all nervous systems are created equal. In the case of parasympaths – those low-energy types predominantly controlled by the parasympathetic nervous system due to re-shaping events in the womb and at birth – reactivity slows down. They remain passive and lethargic throughout life, permanently stuck in the energy conservation mode. That mode of operation becomes stamped in, imprinted as a life-saving device. This imprint is a memory of what the whole system did under threat in order, for example, to conserve oxygen, bind energy and slow down the metabolism to combat the deleterious effects of a mother taking drugs, drinking or a hundred other kinds of abuse. It differs from the revved-up sympath who is dominated by the sympathetic nervous system, the alerting, aggressive, fight (to get out) and battle system to save one’s life. For the patient who is a sympath, a typical session begins with higher vital signs, and tends to militate to lower levels as therapy goes on and feelings are experienced and connected. Not so with the parasympath whose body temperature often drops into the area of 96.0 degrees, steadily moving higher over months. It is the key distinguishing mark to differentiate the person with different kinds of nervous system dominance. And it is the marker for progress in Primal Therapy. Each nervous system tends to move toward normalization in our therapy; the parasympath toward higher levels, while the sympath, lower. This is what we expect to see over time in our patients. We cannot fool our biology. When we try to fool our nature, we put the patient in danger.

        The parasympathetic system, as the energy conserver, is dominant in feeling. We can see this dynamic played out in sports, especially at the end of games when athletes often show emotion. It happens to many tennis players, win or lose, after long, grueling matches. Some just collapse on the court in tears. In one famous case, Roger Federer was so crushed by defeat following a hard-fought, four-hour-plus tournament in 2009 that he could barely talk during a press conference. He cried so hard and for so long that observers at the Australian Open were shocked and felt uncomfortable. With a “torrent of tears” streaming down his face, as one writer described it, the only thing the defeated champion managed to say was, “It’s killing me.” What happens is that athletes gear up for battle and maintain an intense, fighting (sympathetic) stance during the game. When it’s over, the activation dials down and they are able to feel, so emotions overwhelm them. The neurological pendulum has swung to the parasympathetic side.

 The importance of the sympathetic/parasympathetic dominance is that it provides us with a biological basis for understanding personality development. At last we can leave abstraction and metaphor behind, and replace the vagaries of speculation with the precision of verifiable processes. We no longer need to talk about the "will to power" or the "will to meaning" or the "transcendent function." Instead, we can talk about the precise ways in which the brain and nervous system react to concrete events, and how those reactions become the physiological basis for the elaboration of personality. The precision of the theory and therapy leads to a precise knowledge of what is happening in sessions; we have a better fix on what may go wrong. If the theory is imprecise so will be the measures taken in therapy. It is why I call Primal Therapy the first science of psychotherapy. We don’t have to rely on patient reports to see if there is progress; there are many neurologic and biologic tools that can inform us.

 For example, when the sympath is reliving first line, we see high vital signs and accelerated brain wave frequency as well as higher amplitude waves. As we descend deeper we find the limbic system at work and then, further down, the brainstem and its cohorts. So one way we see evolution at work is by which nervous system dominates. If there is crying, chances are it is limbic and not brainstem. If there are grunts and no tears, we see a nervous system at work that predates limbic evolution. We cannot deceive the brain because it tells us in its own ineffable neurologic way what we are dealing with.

 What we have found is that very early events in life determine the settings of our nervous systems. What sways the two key nervous systems – both under the aegis of the hypothalamus – is the kind of biologic and neurologic reaction that is forced on us and our brains while under specific kinds of threats very early in life, during gestation and birth. There is the struggle-and-succeed syndrome, the sympath, and the struggle-and-fail syndrome, the parasympath. This latter gives up easily and smells failure. Not so the sympath who tries and tries and does not give up. And when a new patient struggles to feel even when he is not ready, we generally have a sympath on our hands. The parasympath comes in listless, down regulated, worn out, unmotivated and depressed. He sees no point in anything. This is where the therapist needs his full capacity to meet the challenge. Should he be encouraged? These are the questions we take up constantly in our staff meetings. We often bring the patient in and ask him what works. He sometimes knows and sometimes does not. With long-time patients I ask them if I made a mistake and what was it? I get good answers and I learn.

 One key problem in therapy is when the doctor tries to force the patient onto a nervous system that is not his. For example, the therapist may try to get the patient to act more aggressively with his boss when his whole system, the one that helped him survive, is in the energy conservative, passive unaggressive mode. So it is like deciding that someone should be right-handed and we force him not to use his left hand. We are confounding nervous systems (run by the hypothalamus) with terrible results later, such as stuttering and cross in reading and writing. In therapy, a comparable situation is created by abreaction: forcing the wrong nervous system into action.

Sunday, August 16, 2015

On the Difference between Abreaction and Feeling (Part 7/9)

 How Good Primal Therapy Should Work

 Now, let us look at how a Primal Therapy session is supposed to work.
 A patient comes in for his session feeling anxious and not knowing why. “What does it feel like?” we ask. He doesn’t know. It is all agitated and “jumpy” and cannot sit still. And here we do not make any effort to get him into a feeling. We spend a lot of time just on understanding the feeling: when it is worse, how it affects work and sleep, etc. What it feels like. He cries a bit and we let it happen; he is overwrought. We embed the current feelings solidly before we travel back in time and deeper in the brain. The present becomes the platform from which we work. We want to establish as much as we can in the present and embed the feeling in the present. No going back right away unless the patient leads us there. But we want to take easy steps with the feeling going back to childhood later on, and in each stage settle the feeling deeper. The patient begins to feel more deeply; this can go on for many months and then, after a year or more the feelings will take him down to first line if there is a traumatic first line, and if the feelings are very disturbing. It is not always necessary. Then the patient may alternate first- and second-line events for reliving which get deeper and more powerful over time. We keep the pace even and not too overwhelming; otherwise we get abreaction due to overload. It is an ordered process as much as that is possible. We help keep him on track when he diverts from the beginning feeling so he doesn’t get grooved into a new channel of feeling. That is our skill, knowing when and how to keep patients on track. We follow evolution in reverse at all times.

 Remember, each level of consciousness is an entity unto itself. If someone is reliving something emotional and then begins birth movements, it means to us that there is intrusion from another level; it may be that it is a defense against too strong emotions. And of course, if any words leak out we know it is not a preverbal imprint we are working with, another sign of abreaction. Similarly, if the patient doesn’t have her feet and arms in a specific position during a first-line Primal, we know it is abreaction. Defenses are tricky and we need a long training to pick them up correctly. In Primal Therapy we make it safe not to block pain. Since each higher brain level elaborates the same sensation/feeling/need differently, we can ride the top level down and it will eventually take us to the bottom—to origins. Once down there, the system on its own will move upward toward connection automatically, following the paths of evolution for connection. That is, we then move back up toward the right orbitofrontal cortex, around the orbits of the eyes, and then to the left prefrontal cortex for final connection.

 How do we go back in time? Good question and the answer is simple. We don’t deliberately decide to go back and visit our early lives; that is a recipe for abreaction. We cannot engage the higher-level cortex; we must disengage from it. Cede to feelings. And that is our scientific mission: to provide access to feelings and let the whole organism proceed in an ordered, slow descent into the deep unconscious. As odd as that seems, feelings are the vehicle that take us where we need to go. Deep feeling has little restraint and flows effortlessly. There is no such thing as trying to have a deep feeling; it flows and pours like the well-known salt.

 Again, it is not for the therapist to determine what the patient should feel. Our system has a biologic sensor that knows not only where we have to go in the past, but also how far, and above all, when. During therapy, when the body temp reaches a low of 96 degrees it often means that there is a first-line component. The patient has touched on the brainstem part of the feeling and therefore it drops inordinately. So the patient feels depressed and his vital signs indicate that he is close to the original imprint. Otherwise, we would not get such low readings early in therapy. This physiological reaction gives us a clue about the beginnings of depression. Some life-and-death threat during womb-life forced the system to a last-ditch defense to conserve energy. All systems slowed down and went into energy conservation mode. Worse, that mode gets stamped in. Then we spend a lifetime depressed and have no idea why. To end depression – notice, I did not say “to treat” depression – we must address those origins fully. It means going back a long way. In our therapy, we have patients reliving remote deep pains, those with no words nor tears, and we see it over decades.

 In Primal Therapy, we seek access to those deep recesses of the brain, where ultimate healing lies. First-line is always more powerful than later imprints; so the insights that flow from first-line feelings are widely encompassing because they are the basis for so much later behavior. There are fewer words in these insights to match the preverbal pains that give rise to the insights. But they have weight and importance. Reliving on the brainstem level means complete connection as the driving force of impulses are experienced at last. We connect, in short, on the level of the trauma and in that context only. Here we are dealing with the shark brain: no shouts, no words and no tears. Evolution has taken over. It means the patient has gone back in time and is living again what went on decades before. Then it was too overwhelming for a naïve and fragile brain to integrate. Now, perhaps, he is ready for it. This is the true meaning of facing yourself and accepting yourself; not in the booga-booga, new-age sense but in the biologic evolutionary meaning of it where the feeling is now integrated into the physical system. It is ego syntonic. (Excuse my use of old Dr. Freud for this contribution he made which expresses exactly what I mean to say.) As the reliving goes on, the feeling is fully integrated and there is a continued drop in vital signs, arriving below baseline. The body temperature lowers to real normal, rather than “average” normal. In this sense, “integration” is a new biologic state where the whole system can re-regulate itself. Blood pressure drops and heart rate slows.

 But a word of warning: vital signs are a symptom, not the problem. Treating the symptom alone is a mistake, one that can make matters worse. So when doctors see someone with very low vital signs, they look around for a good diagnosis. They work on his blood pressure, for example, in a medical effort to “normalize” it without understanding that the patient is already in his normal, life-saving mode. In Primal Therapy, we do nothing to address vital signs directly. We work to change the whole neurobiological system by addressing the repressed pain which vital signs only reflect. The difference is between a temporary effort, which has to be repeated into infinity, versus a basic biologic change which lasts.

Wednesday, August 12, 2015

On the Difference Between Abreaction and Feeling (Part 6/9)

 Awareness V. Consciousness

 The leitmotif of every intellectual therapy is that awareness helps us make progress. I’ll grant that awareness helps; but being conscious cures. Unless we are able to achieve consciousness in psychotherapy, the most we can do is tread water, having the illusion of progress without its essence. When it comes to measuring progress in psychotherapy, it matters whether one measures the whole system or only aspects of brain function. Awareness fits the latter. It has a specific seat in the brain.

 Psychotherapy has been in the business of awareness for too long. Since the days of Freud, we have apotheosized insights. We are so used to appealing to the almighty frontal cortex, the structure that has made us the advanced human beings that we are, that we forgot our precious ancestors, their instincts and feelings. Thus, when the patient is uncomfortable during a conventional, talk-therapy session, therapists typically take the position that, “More insight is what we need; the patient is not aware enough.” Yet, what lies on low levels of brain function is impervious to the realm of any ideas, where insights lie. That is why we can be anxious and aware, but not anxious and conscious. Consciousness is the end of anxiety.

 Consciousness means connection to what is driving us – our disconnected feelings. Awareness means dealing with only the last evolutionary neuronal development: the pre-frontal cortex. It is the difference between separation on the top cerebral level versus the confluence of all three levels, which is consciousness. Once we are conscious, we have words to explain our feelings, but words do not eradicate them; they explain and elucidate. We are deeply wounded long before words make their appearance in our brains. Words are neither the problem nor the solution. They are the last evolutionary step in processing the feeling or sensation. They are the companions of feelings.
 We need a therapy of consciousness, not awareness. If we believe that we have an id stewing inside of us, there is no proper treatment because the cause is an apparition – a phantom that doesn’t exist. Or worse, it is a genetic force that is immutable and therefore cannot be treated. In any case, we are the losers. There is no powerlessness like being unconscious; running around in a quandary about what to do about this or that, about sexual problems, high blood pressure, depression, and temper outbursts. It all seems like such a mystery. The aware person, or he who seeks awareness, has to be told everything. He listens, obeys – and suffers. Awareness doesn’t make us sensitive, empathic, or loving. It makes us aware of why we can’t be. It’s like being aware of a virus. It’s good to know what the problem is, but nothing changes. The best awareness can do is create ideas that negate need and pain.

 Awareness is not healing; consciousness is. True conscious-awareness means feelings, and therefore humanity. The conscious person does not have to be told about his secret motivations. He feels them and they are no longer secret. Consciousness means thinking what we feel and feeling what we think; the end of a split, hypocritical existence. Awareness cannot do that because awareness has to change each and every time there is a new situation. That is why conventional cognitive/insight therapy is so complex. It has to follow each turn in the road. It has to battle the need for drugs and then battle the inability to hold down a job and then try to understand why relationships are falling apart. This also explains why conventional therapy takes so long; each avenue must be traversed independently. Consciousness is global; it applies to all situations, encompasses all those problems at once. The true power of consciousness is to lead a conscious life with all that that means: not being subject to uncontrolled behavior, being able to concentrate and learn, able to sit still and relax, being able to make choices that are healthy ones, to choose partners that are the healthy ones, and above all, to be able to love.

 A therapy of awareness versus one of consciousness has an important difference in terms of global impact. In science we are after the universal so that we can apply our knowledge to other patients. A therapy of needs can apply to many individuals, since we all have similar needs. A therapy of ideas usually can only apply to a specific patient. When we try to convince the patient of different ideas (e.g., “People actually do like you”), we generate no universal laws. It is all idiosyncratic. But if we address the feelings underneath, we can generate propositions that apply generally: for instance, pain when unleashed can produce paranoid ideas or compulsions. Or, the frontal cortex can change simple needs and feelings into complex unrealities, changing them into their opposites.

 One cannot be aware without an intact prefrontal cortex. By contrast, there is no seat of consciousness. As banal as it may seem, consciousness reflects our whole system – the whole brain as it interacts with the body.

 When there is awareness without connection during a session, that is what we call abreaction. Again, the vital signs rise and fall in sporadic fashion, rarely below baseline. We cannot make progress on the third-line cognitive level alone. We can become aware of why we act the way we do but nothing changes biologically; it is like being aware of a virus and expecting the awareness alone to kill it. Our biology has been left out of the therapeutic equation. What is missing is that we cannot produce feeling, empathic human beings from the top of the brain. Somehow feelings got the sobriquet of bad, out of control, negative, anti-thinking, unreflective and impulsive. All of which is true for suppressed feelings, which inject themselves without warning into our daily life and make us act irrationally. Not true if they are just part of a feeling person who lives his feelings and does not abreact.

Saturday, August 8, 2015

On the Difference Between Abreaction and Feeling (Part 5/9)

 Connection Is the Key

        So how do we guard against abreaction and produce genuine feelings? There are two important factors at play. First, the patient must arrive at a particular feeling/pain/need untrammeled by other feelings, which are often compounded by a history of unrelenting pain from childhood trauma and neglect. That is, the therapist must be acutely aware of the leitmotif in the session – which feelings are critical and which are peripheral. It takes much experience to know how to do it because often, there is a tendency to conflate feelings and go off on the wrong tangent. If the wrong feeling is addressed, we get abreaction. For example, if a patient is in a feeling and suddenly starts gagging and coughing as a result of first-line intrusion, the therapist should steer him back to the original feeling because the intrusion is a diversion, and that diversion itself is the abreaction. Or if the patient comes in bitching about his wife – “she is just suffocating me with her demands” – and then he begins gagging, we know that the origin of his complaints is deep in the brain, likely the part of the brainstem concerned with breathing. We do not push the patient into the birth trauma unless he is far along in therapy and ready for such an experience. Otherwise, he is steered back into the original feeling, to explore why he feels suffocated. It is indeed a thin line to know which level the patient is on and what level he can access without unbearable pain.

 The same is true of a patient who comes in crying on the third line and never goes beneath it, to older pains. That too is abreaction. He is discharging deeper feelings on a higher level of brain function, unable or unwilling to take it back further and deeper. The result is not a full feeling; rather it becomes a chronic discharge of the energy of the feeling with no final resolution. For example, a patient may come in and cry only about a film he just saw, but never connect it to his own life and his past experience. He is stuck on the third line, and abreacting. Screaming and yelling in and of itself always remains a simple discharge. Feeling ultimately means an experience in context. The problem is that yelling, crying and screaming with no context still feels good and can form a groove of relief.

 This is where it gets tricky because there are levels of contexts: the ideas (top level), the emotional experiences (limbic system) and the infantile (brainstem) level. The contexts deepen as the patient is able to go deeper in his therapy.  A complete primal experience means encompassing all three levels of brain function involved in a single feeling. That comes later in therapy when access allows the patient to travel to the beginnings of experience and of life. He is then allowed to complete the cycle of feeling and obtain resolution. In this kind of primal the patient feels the entire crucible of his behavior and symptoms. It is no longer a mystery, so long as we allow evolution to do its job. It is too tempting sometimes for a therapist to push the patient into something very dramatic so as to show his so-called skill.

 So we need to know on what line or level the patient is operating on, so that we help him and us to focus. This avoids a mélange of levels that also prevents proper connection. We see this with patients who wander over several feelings and disparate subjects during a single, scattershot session. Nearly always, the patient’s wandering over many subjects means there is a mélange of great underlying pain pushing him from one place to another. Needless to say, this is the patient who often suffers attention deficit for the same reason: too strong a primal force, preventing focus.

 Feelings must be felt on all levels but in an orderly sequence, not all at once. The therapist must get the patient back on track so the natural feeling can be allowed to unfold in tune with the natural resonance that links the levels of feeling together neurologically. Once the patient is on the right track, resonance will take its course, leading the patient naturally deeper and more remote over time. In abreaction, it’s often the therapist that is leading the patient in the wrong direction, creating all manner of bad outcomes.

 The idea is to remain in the feeling zone, the only zone where connection can take place. Outside of the Primal Zone, no integration is possible. This is why it helps for the therapist to have at least a modicum of brain science at his disposal. In some cases, for example, we know that the use of tranquilizers can help get the patient into the zone for a time. This is not in lieu of therapy but as an aid to it.

 Now why is the wrong feeling addressed? Because when a therapist has unresolved feelings of her own she will tend to drive the patient where she needs to go.[2] Or worse, she will avoid feelings of the patient that she is not ready for. As for example, anger. If the therapist is terrified of hostility, she will shut it down in the patient. She won’t let the patient go near it, and the feeling will remain unresolved. If the therapist cannot be criticized, she will dodge any blame and try to make any error the patient’s fault instead of hers. This is the most widespread of problems with therapists. Above all, we want to avoid confining the patient to his ideational cortex to the neglect of feeling. In other words, we want to avoid precisely the predominant therapeutic approach in contemporary psychotherapy, which is Cognitive Behavioral. The cognitivists really do believe it’s all in your head, that changing thoughts can change behavior. To me, Ideas signify something “disembodied.” When a therapist lives in the world of ideas there won’t be much feeling there; one reason is that feelings seem secondary to them. Ideas, they agree, are paramount and have value.

 By contrast, a full, feeling experience in the Primal sense means that that we are not confined to the neocortical level where ideas and intellect live. What we are after is to hook up the primitive, lower levels of the brain with higher levels so that there is a proper connection. This means that the historical need/feeling/pain has been fully experienced with all of our being.
 And how do we know when a real feeling has taken place? We can verify it, physiologically. Before and after every session, we systematically measure vital signs of each patient. During a real Primal, we expect to the vital signs move pretty much together – up at the start and back down towards the end of a session. Over months there is a constant normalization of vital signs so that the blood pressure, heart rate and body temp get reset to the normal range after some months of therapy. Over time, there is also a significant drop in cortisol levels and enhanced natural killer cells. (See my book “Primal Healing” for further discussion.) Measurable metabolic changes also include a permanent one-degree lowering of body temperature; since body temperature is a key factor in our longevity and the work of our bodies, it is an important index. In addition, our research found that after one year of our therapy there were systematic changes in brain function toward a more harmonized cerebral system. It all means that we are getting to the pain and undoing repression.

 That is not the case with abreaction. In a feeling without context, which is an abreaction, there is never this kind of organized, coordinated movement of vital functions. Instead, a random discharge of energy from the feeling/pain will produce a sporadic, disorganized movement of vital signs. There is no harmony to the system. Thus, when vital signs do not reflect integration, we can be sure that connection never took place. By these measures, “thinking” that we feel and actually having a real feeling are neurologic worlds apart.

 By definition, abreaction lacks connection, which is the sine qua non of Primal Therapy. Without connection there is neither healing nor cure. So, clearly it is crucial. If there is no connection to solidify the feeling there is no progress. So what is connection, after all? It means that while the patient is feeling and reliving she is connecting to the pain/fear/terror. Bit by bit as she relives and feels she is making a connection to something buried away for perhaps years. Connection means feeling something in context, comprising each different level or aspect of the feeling until the patient arrives where it all began. That is eventually where patients need to go. But a random scream or cry will not take you there. At each level, the feeling must connect with its context, which is different as we descend down the chain of pain. Each brain level contributes its specialty: ideas, feelings or instincts.

 On the other hand, abreaction is just a release of the energy of feeling without meaning and out of context. There is a great gap between reliving and relieving, and this is the mistake so-called mock therapists make all of the time. The mistake is easy to make because, again, abreaction looks like feeling but it is not. It should be noted that the patient is not deliberately faking a feeling. Abreaction can be a real feeling, but it is out of sequence, and therefore it is not curative because it does not allow for proper connection across all three levels in a natural, orderly way. The patient is pushed into the tributary feeling because the pain of the main feeling is too great. This heavy painful feeling does in therapy what it does in everyday life; it keeps us from focus and concentration. It pushes us away from the central feeling. So abreaction is going through the motions of feeling without its depth and history. And it requires that the person perform the sidetrack feeling over and over again—relieving not reliving.
 So again, connection means liberation of feelings in context. There are those who scream and writhe and cry out of context, as in an exercise. They make no profound change, but when the patient slowly descends to deep levels over time and reacts to the stimuli and events on that level with the neurological capabilities of that era, there is progress.

 The goal of our therapy is to retrieve memory, not only of the scene or the place but also of the feelings belonging to them; that is what has been repressed and held in storage, the pain and terror. When we primal, we are reaching deep down physiologically to a part of our history that has been sequestered for decades and will not give up its secrets easily. Sometimes, the patient is not yet ready for the experience so it remains a mystery, until the time is right. When patients finally experience those feelings in their totality, including physiological aspects, they become integrated. The neurotic split is healed and the person is no longer at war with himself. Now we can use the term “holistic.” The patient has become whole in every sense of the word. His feelings are integrated into awareness and into his neurophysiology.

Tuesday, August 4, 2015

On the Difference Between Abreaction and Feeling (Part 4/9)

 The Dangers of Mock Therapy

        In our four decades of experience, we have seen many ways the therapy can go wrong. A skilled therapist can take an upcoming feeling and channel it where it must not go. In the case of deep depression, it is an early death fore-told. But an ill-prepared therapist may take a near-death metric – such as very high heart rate – and refocus it into some other feeling that is not related to the cause but is decided on by the doctor. Whether aware or not, he is meddling with biology. The result is counter-productive because the patient begins to form a groove so that each time a deep feeling comes up with all of its power, it is rechanneled into a byway of unrelated feeling. And that is also an aspect of abreaction: taking a beginning, inchoate feeling and turning it into something else. The doctor thinks he understands the process and takes control, instead of the feeling controlling the session. The patient’s feelings, far from ready, are taken up prematurely, and the patient deals with an offshoot instead of the next feeling available. Those feelings seem to be in a queue, each waiting its turn, and each bringing relief when its turn comes. Primal sessions normally start with agonies up top of the brain; unhappy events in the present that can trigger more painful early associated memories. “My wife just suffocates me,” eventually connects to the basic imprint: “I am suffocating.” This is not thought out; it happens automatically through resonance where one pain high up can set off deeper lying pain, in a chain of events when the patient is ready to feel it. It seems like each feeling is classified as to its content and nature into separate compartments; one kind of feeling here and another kind of feeling there. Resonance in brain function connects the evolutionary links to each other to encompass most of our lives. Our biology decides, not a doctor or therapist, which feeling is on the rise and can be experienced. But when the unconscious of the doctor intercedes into this still untrammeled, pristine sequence of feelings, the result is an emotional detour – abreaction.

 We do harm in therapy when we think we know where it all comes from, and we don’t. It is our guess against the reality inside the patient. So we have an internal battle: the patient’s system struggles to maintain his neurotic equilibrium, which is the body’s natural adaptation to early trauma and pain, while the misguided therapist struggles to change the neurotic’s life-saving ploy by tinkering with his thoughts and attitudes. The cognitive therapist, in particular, wants to change neurotic normal into abnormal by turning depression into a more positive, optimistic outlook. They don’t understand that depression is normal for the patient because his life experience drove him there and his biology is doing its best to maintain the equilibrium – the neurotic normal – established when trauma disrupted and rerouted his system’s natural state. The primal therapist also seeks to dismantle the neurotic normal but by resolving its origins, not by futilely trying to manipulate its present-day manifestations. Neurotic normal is what patients have to do to adapt to serious imprints, while abnormal is an attempt to enter into this equilibrium and alter its careful balance.

        This is a state where the vitals betray the patient. It literally can be a death foretold because constant abreaction weakens the system and can lead to premature death due to the load of unresolved feelings weighing in, stealthily adding pressure on the biologic system. We don’t see the pressure that repression is exerting constantly on the heart, liver, lungs and other organs.  We don’t see what chronically high heart rate does to the whole cardiovascular system.

  In short, what is killing us is exactly what we don’t see. And why don’t we see it? It is just too much to face and experience all at once, because it is life endangering in and of itself.
 We can watch the descent into lower depths of the brain as the patient sometimes will touch on the first line, brainstem part (the base and/or lower part of the limbic system) during a higher-level Primal.  At that point, he may show vital signs down into unimaginable depths – body temp at 96.0 and heart rate down into the fifties. We know what part of the brain is activated as the brain systems unveil and indicate unmistakably what level of the brain is at work; defending against what trauma and at what period of ontogeny. When there is suddenly a breakthrough – an abrupt trespass – we see intrusion at work; the ripping away momentarily of the defense system, giving way briefly to deeper feelings.

 This tells us that deep material is now just below the surface and may be ready to be addressed and relived, or Primalled. It is not guess work as the body signals its readiness. If we do not recognize intrusion we may wait too long to allow deep imprints to mount; the body is ready but the doctor is not. Again, the feeling may be changed into something else by the doctor because personal evolution of the patient, his ontogeny, has been ignored. The therapist has led the feeling elsewhere. A neophyte therapist, anxious to show his skill and dramatic effects, will force the patient far too deep too soon. As a result, the patient develops far-out ideation as the top-level brain is doing its best to handle the doctor-induced overload. It is the same effect we see with the ingestion of LSD.

 I remember during the LSD craze of the sixties when some doctors experimented with hallucinogens for patients. Many went into transient psychosis as out-of-sequence pains were thrown up and could not be integrated. The result: overload of the neo-cortex and delusions. In our early research, we saw the residue of all this: aside from universal sleep problems, the neo-cortex was in a constant flooded state and the brainwave amplitude came way down, which meant to us, after many of the same readings among other LSD patients, that the repressive defenses were faltering and crashing. When patients are pushed too fast in therapy we often get the same kind of profile.

 One clear example of dangerous feeling therapy is rebirthing – driving patients way too deep way too soon. Reliving birth in the first weeks of therapy is defying evolution and leads to disaster. It is arriving at deep levels of consciousness prematurely, skipping evolutionary steps and going through the motions of feelings without feeling. It overwhelms the integrating capacity of the brain and there is flooding with far-out ideas and bizarre notions. We have seen pre-psychotics who come to us and slide immediately down to some kind of birth trauma, way off a proper evolutionary voyage. They are often deeply disturbed and start therapy with a severely damaged gating system. They usually need help in gating so we may recommend medication for a time to control the upsurge of brainstem imprints. The medication temporarily enhances gating so that a proper descent is now possible. Without that there is no integration and therefore no getting well. Even worse, when the doctor buys into the ideas and beliefs the patient is in danger. Suddenly, he “merged with the Almighty.” And in booga-booga land, the doctor may nod agreement. It is now a folie a deux. If the therapist is mystical he may not find all this so strange, because those into mysticism never think that their beliefs are odd.

  The problem with rebirthing is that it defies the fundamental evolutionary law. Never challenge evolution; respect and follow it. It will unerringly take you where you need to go, and only when you need to go. I have seen the psychosis that this mistake engenders; and we see the inherent danger in rebirthing because feelings are directed by someone else, the therapist, on his timetable and they are reached prematurely violating history’s careful steps. Don’t fool with history. No one is smarter than that and no one has any idea what lies in the unconscious; only the patient knows. And it takes time for him to know. His body knows but he needs a higher brain to inform him. His body is screaming the message through its asthma and migraine and high blood pressure but it is a silent scream that only his system can feel. It says, “I hurt” and he says “I hurt” but he does not know from what. The decorticate message has gotten through but it lacks key information that cannot be imparted when we are too young and fragile to understand and accept it.

 When the whole brain is forced into a state for which it is not ready, it galvanizes itself and moves up the evolutionary scale abruptly searching for a handle, some way to deal with the pressure. When the ineffable feeling reaches the top-level neocortex, it concocts ideas and beliefs that are basically psychotic –  “at one with the cosmos.”  And this is the precise mechanism in a true psychosis (rather than induced) where the gating system has been trashed by the continuous onslaught of compounded pain over the years until it collapses. Notice that the pressure of the feeling moves up the evolutionary scale searching for some way to turn off the pain. It is a biologic rule for all therapists to understand. Crazy ideas are not single entities; they are the result of a long evolutionary voyage that ultimately results in a belief. When a therapist meddles with an idea, she is interfering with this evolutionary process. And I include behavior in all this and the anti-evolutionary behavior therapy. How simplistic to strip behavior of its roots and then to keep on manipulating the effluvia.

        This is exactly what happens with mock primal therapy. The correct roots have been evaded while driving the patient into false byways. The result? Abreaction. A false root can mean leading the patient into first line, brainstem level where highly charged imprints await. So what does the doctor see as the first line intrudes? Gagging, shortness of breath, squirming, coughing. And what does he do? He encourages the patient to go into it when he is not nearly ready for such a deep experience. What does he get? Abreaction – temporary release plus a residue of feelings that could not be experienced, which push against defenses to make the patient feel bad. More often such great reactions produce fear in the therapist and he avoids dealing with it at all. It is left hanging and unresolved.

 But beware: there is also danger when the therapist is too passive. Those who do not recognize first line on the rise will keep the feeling down and only let it come up for experience when it is far too late. It is too late due to the lack of experience of the therapist who has no idea how to handle pretty strenuous feelings on the rise. So what happens? Abreaction again: feeling different memories from the ones at hand. Again a groove is formed and instead of deep resolving feelings, there are little by-ways that are not resolving. For this timid and reluctant therapist, Freud’s dictum about the unconscious still holds true: don’t go too deep. Freud decided almost one hundred years ago that digging deep into the unconscious was dangerous for the patient and would disturb his equilibrium irrevocably. We have seen the unconscious at work and it is simply not true.

 We therapists need to abjure being omniscient. We don’t know enough, and I cannot even guess how it happened that we became experts in the human condition. Whenever a therapist tells the patient what to feel we know he is already on the wrong path. We must sense feelings and follow the patient, not lead him. We take him by the hand and follow where he leads, not vice versa. We doctors must avoid the temptation to act smart. We spent years in college learning to be smart, and now we must elude it. How ironic!  Yet the history of psychotherapy was intellectual and provided a therapy of the intellect, exactly what we don’t need. We don’t let the patient act “smart;” we allow her to act intelligent, to recognize her feelings and how they drive her and cause her to act out. When she tries to act smart we help her get to the feeling; of how to please momma or father. Finally it is a great relief just to be yourself and not have to act this way or that to get love.

 It seems banal and harmless that a therapist supplies insights for the patient, but it is far from that because the patient is given a guess about his feeling from the professional which may be accurate but most often is not because it does not emanate from the patient’s feelings, but from someone else’s. It is a subtle way of channeling the patient into a groove because the therapist is insecure and wants to make sure that the patient is really feeling. And a facile groove is what most people suffer from in abreaction; they find a release to direct their feeling and it becomes comfortable to stay in it. It becomes embedded until they cannot get out of it and they don’t even know they are in it. The force of the feeling, the actual content, finds its groove, and it takes months of proper therapy to help patients out of it. Abreaction has compounded the neurosis rather than eliminating it. Worse, the person is convinced he is better, and he is not. Much worse, the doctor is convinced that all is right, yet nothing is right. The whole process has become a charade; a delusion of wellness. It feels good for the patient because he can release the pressure of the upcoming feeling and that feels like progress: ergo he is getting better.

 When we try to insert ourselves into the feeling process we get a reflection of ourselves, not the patient. And that reflection relies on a host of theories concocted by doctors to explain that which needs no explanation. The mistakes in theory are as myriad as the unconscious of the doctor. He may see a need for power or of meaning or of sex and on and on. He often sees what is not there and refuses to see what is right there. His vision is limited by his openness. And that depends on how much he has felt and experienced of his own pain. You cannot be more open than your repression. That blocks so much: vision, insight, empathy compassion and understanding. If you live in your head you will never consider plunging to the depths of feeling; it is then all about explaining feelings, discussing them or writing about them. There is a form of therapy today where patients believe they can get well by keeping a journal about their feelings. Again, it is too obvious for comment but it is the top level that is embraced when we need to push far below it. The same is true for mindfulness therapy, which enhances attention and asks the patient to concentrate on details such as rate of breathing. This keeps that top level super-attentive when it should lie quietly. In these therapeutic schemes, there is no way to go deeper when every move that is made in therapy militates against feeling. They cannot go deeper because they are locked into kind of abreaction themselves. There is no larger, encompassing frame of reference that can guide them. They are as diverted from feelings as the patient who abreacts.

 These cognitive theories are based on a basic distrust of feelings in favor of intellect; the opposite of one needs to produce a feeling cure. When a doctor defines his therapy as cognitive, he has already lost. It means he will deal with half the brain to the neglect of the other parts; above all the feeling parts; those parts that are healing.
 Feeling is healing. No feeling, no healing.

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.