Friday, July 29, 2016

On the Difference Between Abreaction and Feeling (Part 2/15)

The basis of Primal theory and practice is the concept of the three levels of consciousness, corresponding to an individual’s stages of development from gestation to adulthood. The first line is pre- verbal consciousness from the womb through birth and early infancy. The second line is laid down in childhood as the brain is still evolving. And the third line is current-day awareness, the top-level consciousness of adulthood. Those three levels of consciousness correspond to the structure of our triune brain – the primitive brainstem (first line), the limbic system (second line), and the neocortex, our thinking brain (third line). Pain is experienced and repressed at each stage, stamped into the brain as an imprint on the level where it occurs.

 The essence of Primal Therapy is unveiling the old events so we can live in the present. Those embedded memories contain painful and frightful feelings that needed to be repressed and kept from consciousness due to their overwhelming valence. But they are never forgotten. They leave biochemical traces serving as markers that say there was damage here and a hurtful event there. Through therapy, we can retrace our lives and our embedded memories and revisit them in orderly fashion, undoing the traces and (hopefully) reversing history by obeying evolutionary dictates. So we go back into those evolutionary stages methodically, feeling a bit at a time; beginning with the lightest pain in the recent past moving down to the deepest brain levels. In proper Primal Therapy, pain must be relived and resolved in the same evolutionary way it was created on all three levels, but in reverse. If we neglect evolution and do not deal with lesser pains first, we will again make a serious biologic error and force a feeling on a patient that he is not ready for.

 There is an adage in science: ontogeny recapitulates phylogeny. The history of the species is run again in our personal evolution. We can see our ancient history in how we evolve from the embryo on (fish fins, wings, tails, etc.). Each evolving individual re- runs the archaic life of the species. We get rid of our tail and are left with a vestige, a “tail-bone.” Similarly, we have vestiges of our old "ancient" personal life, which I call the first line. That is, we have traces of our lives from a time when only the brainstem was our predominant brain structure. And we can visit that ineffable life we lived before birth, and then eschew those traces though Primal Therapy, which can also be called undoing the imprints (or on a molecular level, de-methylation). Imprints mean precisely an event that was so powerful and so painful that it could not be experienced and integrated at the time. However, we are older now and can more safely experience them. But it takes years to be able to relive the past fully and make it part of us instead of a constant alien force.

 A well-ordered therapy begins in the present, anchoring feelings in the present-day life. Over time this will lead to deeper levels along that same feeling path through a process I call resonance. Once locked into the feeling, the neuro-biologic system will take charge enabling the patient to go deeper, traveling to more remote and archaic areas of the brain. Over months, as the patient follows that evolutionary path, different aspects of the feeling are gathered up at each level until reaching origins where very deep pain lies. This process cannot be forced or decided in advance by a therapist who dictates where the patient has to go. If feelings are forced out of sequence, no integration will take place.

 I stress this methodical step-by-step voyage as a warning, because in no other therapy that I know of can interference into the primal sequence by untrained people cause such lasting damage. They are meddling with the deep unconscious. It took us many decades to understand what to avoid, which is as important as what to pursue. We take great care to make sure that the patient descends the feeling chain in proper sequence so as to avoid abreaction, sliding off into pseudo feelings as a defense against the real pain.

 In essence, abreaction is the discharge of a feeling disconnected from its source, making it in fact a defense, or at least reinforcing an existing defense. It can be the release of a feeling from one level of consciousness into another level. For example, first line into third line. Or it can be first line disconnected from any other level, taking on a life of its own to the exclusion of any other levels. The defense system, in its crafty and brilliant way, can promote many forms of abreaction that may lead to strange ideations, crazy delusions and paranoia. Instead of leading to the undoing of neurosis, abreaction guarantees that neurosis will persist. This happens when the therapist allows the patient to skip evolutionary steps, going through the motions of feelings without feeling them.

 We must trust the feelings totally. But first we must recognize them and be able to differentiate them from abreaction, which is the discharge of the energy of a feeling without connection. Our job is to provide access to feelings, following evolution every step of the way, from the most recent aspect traveling down to the very origin of the pain in the most distant past. In this way, we go from an awareness of the feeling to its emotional content and then onto its preverbal base. We also go from the lowest valence of pain to the most devastating. It increases as we descend down the chain of pain in our ontology.

 When we touch on our beginnings – gestation, birth and infancy – we see the deepest pain and the most danger to the system, which I call the first line. If we do not know brain evolution we can be easily fooled and will rush in to prod a patient’s nervous system to perform in ways it cannot; hence, abreaction. We will make the patient scream or pound the walls when the real feeling is elsewhere. Once a patient is channeled into abreaction it is almost impossible to pull him back. It forms a groove defense that becomes encased, allowing no other feeling in. It becomes a neurosis inside another neurosis. It is the patient who loses, though he may convince himself he is really feeling; or worse, he may be convinced by a therapist that he is feeling when he really isn’t. Sometimes, this may all seem like some kind of plot, but it is simply unconscious reactions to avoid deep pain. Remember, it takes great skill to produce a connected feeling and no skill to permit abreaction.

Tuesday, July 26, 2016

On the Difference Between Abreaction and Feeling (Part 1/15)

This is the first of a series of 15 articles I wrote on the difference between abreaction and feeling in therapy. It is a crucial point in Primal Therapy.

 The ability to distinguish between abreaction and a genuine feeling is an essential skill of good Primal Therapy. The difference between the two is stark, but in practice it still can be deceiving. Feeling is the key to cure, while with abreaction there is no chance of getting well. Yet, despite this crucial difference, the therapist is often unaware of what is going on, and certainly the patient is equally unaware. The insidious part is that abreaction feels like a primal, looks like a primal and smells like a primal, but is far from a genuine Primal. In clinical terms, abreaction is "the devil" because it doesn't allow patients to get better. They remain forever "prisoners of their pain" in an abominable, endless loop of hurt and hopelessness. Once abreaction sets in, it becomes a neurosis on top of another neurosis. And it is unshakeable. It takes months to even try to undo it. The danger cannot be overstated. We have now seen many patients who have gone to mock primal therapy and are stuck so badly in abreaction that it is almost impossible to extricate them from it. If left unchecked, abreaction can even lead to pre-psychosis and psychosis.

 It is the job of the therapist to distinguish between abreaction and real feeling. To some extent, that is a skill based on the instincts of a trained clinician and acquired by experience. For some patients who are mired in abreaction, that skill can mean the difference between successful therapy and staying stuck in mock primals that lead nowhere. The good news is that there are also scientific ways to know the difference. We can often tell how if a real feeling has been resolved by changes in cortisol levels, vital signs and other biochemical indicators.

 First, to avoid confusion, a definition is in order. Within Primal Therapy, the term “abreaction” means something quite different from its original meaning within Freudian psychoanalysis. In this psychoanalytic sense, abreaction is simply defined as the process of releasing repressed emotions by reliving an old traumatic experience(1). On the face of it, that classic definition is close to what we would call a Primal, although true “reliving” in our therapy is far beyond what Freud had imagined. In Primal terms, abreaction has nothing to do with any genuine reliving experience. On the contrary, for us abreaction is destructive to any feeling therapy because it becomes a defense against real feeling, as I shall explain in detail shortly.

 I must emphasize that abreaction is a non-feeling event. It looks like feeling, often to both the patient and therapist, but there is a qualitative difference. It produces awareness without consciousness, a difference I shall explore in detail in a moment. To a well-trained therapist there is a hollow ring to abreaction. It doesn’t “smell” right. A patient may unconsciously use abreaction as a defense against feeling, slipping into crying the minute she lies down, or simulating a birth primal. The key difference between abreaction and a true Primal, of course, is connection, which takes place in a Primal but never in abreaction.

 Before we delve into this, however, let me briefly review some of the basic principles of Primal Therapy. These theoretical cornerstones provide the framework needed to understand abreaction as a deviation from a successful coarse of treatment.

(1): Gordon Marshall. "abreaction." A Dictionary of Sociology. 1998. (July 2, 2015).

Monday, July 11, 2016

Ideas That Evolve Out of Feelings

  I was wondering how it came to be that psychotherapy became a thought therapy and that mental illness became a belief and perception disorder? So that psychosis became a thought affliction.  I was wondering how it came to be that psychotherapy became a thought therapy and that mental illness became a belief and perception disorder? So that psychosis became a thought affliction. So only a part of us seems to be going crazy. What about the rest?

So let me start at the beginning. There are levels of brain function which my friend Paul Maclean described fifty years ago in his Triune brain; and there are levels of the brain which I describe decades ago which largely coincide with Dr. Maclean. Only I learned about them through reliving those levels and the feelings, needs and pain that reside in them. It became the basis of my theory on the levels of consciousness and the neuronal chain of pain.

  So why didn’t Freud and his pals discover that? Because there were not the scientific tools we now have at our disposal.  Brain science in his time was in its infancy; that is how brain lobotomy could gain acceptance.  There was no “point de repère”, no scientific frame of reference to not accept it.    And it killed many.  So good old Dr. Freud did the best he could and he did want to target feelings but he believed the way to do it was to have patients talk their way into it.  Eventually they would run out of words and get into feelings. It could not happen neurologically but he did not know it.  And words and insights became “de rigueur”.  And the whole idea of psychoanalysis, which I practiced for 17 years, was to offer insights to the patient.  Knowledge would make him well, we thought.  All it did was have the patient internalize what we thought was inside of him.  And we had to be wrong because we were guessing.

  But the die was cast and we all thought mental affairs were only a matter of the verbal, conceptual brain. We now know that cancer can be a psychosis of the body with the exact same origins as the later development of cancer. We now know there is a body attached to that brain that must be accounted for. It is not mental illness; it is illness, period. That illness takes different forms as we mount the evolutionary ladder.  We cannot have mental psychosis until we are fully mental but our bodies can express all kinds of symptoms.  And when we get to attention deficit syndrome, we know that internal agitation has reached the thinking mind and disturbed it so that concentration and focus become impossible.  And in 1920 we did not know about imprinted and embedded memory, nor of how the three levels of the brain worked. So how could  they know where ADD came from?  Sadly, it is very true today where most therapists have no idea that inner cerebral agitation perturbs concentration and focus. I have read volumes on the subject and it nearly all avoids inner imprints.

And what do we get instead?  Behavioral therapy which avoids feelings altogether.  And all other cerebral approaches which are feelingless.  We want a therapy of feeling not only because it is nice to have but because it means the cure of  mental illness.  I mean, the cure of so much illness.

Saturday, July 2, 2016

The Difference Between Being Sad and Being Depressed

We must not confuse the two as the treatment needs to be different as does the diagnosis.  Let us return to the brain and its three levels.  There is a big difference between sad and depressed. Sad is strictly limbic, second line emanating from amygdala, hippocampus and other key limbic structures.  Depression  lies deeper in the antipodes of the brain, out of reach, part of the shark/dinosaur legacy.  It makes me think that utter hopelessness can derive from an ancient brain,  the same brain that harbors rage and fury.  It can only be described in global notions of heaviness, no energy,  no ambition, no future, etc.  There are no words on this level which makes it difficult to treat; and certainly a cognitive, word-laden approach will not touch it.  That is why in desperation some doctors insist on electroshock therapy. Blasting the brain because they simply do not know what to do.  Pretty clumsy and massive.  The opposite of delicate and targeted.  What else can they do?  Talk to the shark brain and convince it of the ineffectiveness of its ways?  It doesn’t talk and won’t respond.  Doctors want to blast the brain because it seems so unyielding.  The station of last resort are pills; they help kill pain. But not forever; therein lies the rub.  We are mollifying, not curing.  We are adding  sop to the process hoping for the best.

Can we offer hope? Maybe, but against what?  Hope to get out and be free.  Who knows that is the problem?

Depression seems to come out of nowhere; it comes out of the non-verbal brain.  Herein lies one key difference.  Sadness can be described as to how it feels.  Depression cannot. Sadness is often situational/existential.  There might be a reason for it;  lost a lover, failed a class, did not get the promotion, lost a job.  It seems to come from outside.  And psychological counseling can help.  Depression can only be described by its internal effects, a heaviness,  cannot get out of bed.  What is being described are first line brainstem effects.  The problem is that deep hopelessness can be life endangering and can lead to impulsive suicidal acts.  The act comes out of an impulse laden brain that can act but not reason and cannot rationalize.  It cannot delay act-outs because that brain is what is behind act-outs; a brain with no great cerebral cortex to hold back action. And those who cut themselves sense this when they cut into themselves; they understand it is inside and deep and that they must reach it even in their crude ways.  They do not know there is a deep imprint there but it is all they can do.  It is what deep depression is.  I see it often when the depressed patient comes in immersed that state and begins to relive  the birth trauma or even before when the mother was  drugged during pregnancy and the child has no way to escape. It is indeed hopeless, there is no exit, no way out, to quote Sartre.

That all encompassing lassitude is what animals do when all is hopeless, locked in cages and unable to escape. The system gives up. It is just awful but it is treatable; no easily but possible.  The whole system accommodates to this state with  drop in vital signs.  The voyage to the deep brain has to be slow because we must travel deep into the brain that is millions of years old, and it must be done methodically and carefully.  In no other way can we become close to our archaic history.  I believe that in some of us the imprint may lie in the period when the system was on the verge of giving up; passivity and lifelessness were imprinted and drove our personal evolution.
 Those deep unconscious pleas to live must see the light of day so we know exactly what it is and what we are dealing with; only then can we say, “Cure.”

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.