Can Psychosis Be Treated with Primal Therapy?

In our Primal view, all mental illness arises from trauma and pain at different stages of development, starting in the womb. But since there are different degrees of pain in people, we also see different degrees in the severity of mental illness. In the broadest terms, insanity falls on a scale from bad to worse, from common neurosis to full-blown psychosis.

Which begs the question: Can Primal Therapy help with the most extreme cases of mental disturbance? Do we even treat psychosis? Is that so different from treating neurosis?        The answer is more complicated and nuanced than the question suggests. Please allow me to explain.    

Psychosis, is the result of massive first-line pain compounded by later devastating pain. For example, gestation events such as a smoking and drinking mother – which from the start overloads the baby’s ability to integrate the input – compounded by continuous trauma over the early months and years in the form of neglect, lack of touch, harsh parents who eventually divorce. In short, a life immersed in the complete absence of love. That is a prescription for psychosis.    

I treated two women who were psychotic, and both had experienced incest in childhood. One was the result of incest at the age of seven; the other was the daughter of a Nazi officer who also underwent incest. I find from clinical observation that the earlier the incest the more likely the psychosis. Obviously, incest is devastating, as the protector becomes the predator.    

The point is that one rarely gets over incest or a terrible birth. The imprint has a great force and it endures. Then when it is compounded by so many adverse events early in life, it becomes deeply embedded and endures as a lifelong force. Along the way at various stages, the system has a number of options for dealing with the trauma. If the traumas are early enough, the effects lie deep in the brain with major impact on the brainstem. Since the verbal system is not yet developed, we can expect the possibility of cancer or major biologic disease. The memory is deep in the brain as are its ramifications. Vascular problems, heart and kidney ailments, breathing impairment, are all part of the effects of the imprints. What happens is a serious crack in the defense system, leaving the person much more vulnerable to later trauma.        

There may be hallucinations and delusions that become possible, the latter as the verbal/cognitive system becomes functional. Hallucinations signal a very early, preverbal brain system at work, meaning the result of more primitive traumatic imprints. In the case of delusions, a later system is working to provide some sort of meaning to the experience. In one case, I was walking down the street with my patient who suddenly ducked, yelling that the ice cream vendor wanted to kill him. Notice here the content: death is approaching. Terror is involved. Someone wants to kill him. Yes, there is an imprint of impending death from early on, but the person has no idea that it comes from inside. He projects that terror and the related threat onto the ice cream vendor. Death from an imprinted memory is near, but he has no choice; he projects it outside. And now he can hide from the threat. He is no longer helpless.      

One of my patients, a boxer with many blows to the head, sealed up all his doors and windows to keep the “enemy” away.He still could concoct reasons and rationales for his terror, but it was totally irrational. Yet, his cognitive brain had to produce reasons for what was going on inside of him. This means that cognition was still in force, somewhat. When deep pain surges forward we see, “They are after me. They want to kill or poison me.” I saw one patient who, as a child, had the misfortune of witnessing his father shoot himself before his very eyes. The poor boy soon became delusional about the police, who he was sure wanted to kill him.      

So what is the central difference between neurosis and psychosis? Defenses. Neurotics can incorporate some of the input and hold the major force of the imprint below the gating system. Psychotics have a different defense structure with the inability to reconstitute a normal reaction. In their minds, there is now a permanent threat. That is why when there is a deep imprint there is a constant menace of the return of symptoms. With a small adversity we again may see psychotic ideation. Or later, the return of a catastrophic physical illness.    

So here is the problem for us lonely shrinks. In psychosis, we need to rebuild a dangerously damaged defense system. Patients need tranquilizers for many months or years. These drugs make up for a chemical system that was impaired early on in life. Those natural chemicals are part of the defense system which have been depleted due to the early trauma, a carrying mother who takes pain killers daily and smothers the baby’s ability to integrate. What is overcome and devastated is this ability to integrate input and make it part of the biological system. The neuro-biologic system can only take so much before it becomes a new kind of system: psychotic. In depressive psychosis there is a serious descent of blood pressure as depression grows deeper.Psychotic ideation is the last stand against the imprint of pain. The system seems to reach high up for help from the newly active ideational brain, which responds with concepts and rationales. That higher brain jumps in with weird ideas but to no avail. Because when I write “pain,” I mean a terrible pain that exists in force on lower brain levels. It is beyond description. Not like a broken arm. This is pure agony. And it informs us that a force exists in us that is truly ineffable.The reason that the verbal/cognitive system resides far above this kind of imprint is that the level of pain is far below and beyond verbal description. Patients often tell me about their deep pain: “It is something I do not even know how to describe. There are no words for it.” It has to be approached in therapy slowly and methodically, often with the added help of strong tranquilizers so that even a small part can be experienced. Once we see and observe that kind of pain, then psychosis is no longer a mystery.    

Let me add a warning about the danger of hallucinogens. These psychotropic agents can make matters much worse, because they open the gates even more to relieve the pressure of repression/ depression. It affects the person systemically, making them vulnerable to the heavy input of subsequent repressed pain that will be too much for him. This is particularly dangerous once it is set loose by the drugs. In the case of someone who uses pot and hash, we have a system enfeebled and more likely to have subtle paranoid ideas. It is not as irrational or abrupt as with hallucinogens, but still dangerous. In either case, the lesson is there: a fragile system can go psychotic when we open the gates abruptly. Or, over time, if we add so-called benign drugs to the mix until the system implodes.       It is very hard to reconstitute a broken system that was overwhelmed by deleterious input and then later aggravated by drugs that weaken the gates. Why are we fooling with one drug after the other? Because we do not understand what is going on in the neuro-biologic system. We are fiddling around with what seems obvious, but OH, it is not. If I told you that the average neurotic carries around an ineffable pain deep inside him all of the time, some may scoff. Alas, it is the ineluctable truth. We produce painkillers to meet terrible pain; even that is not often strong enough so we go to our personal pharmacy and take drugs that add to the mix. We do not buy them; we order them from our cerebral system. And still we may need more; then we buy what we need, and when that pain is agonizing and enduring we keep on buying until we are known as addicted. Then we are treated for addiction: with what? Pain killers.

So can psychosis be treated? In some ways, but that always requires a full knowledge of Primal Pain and Primal Therapy, which elicits traumas engraved deep in the brain. The doctor must be awareof the lurking menace that can spring forth and crash the system without warning. I have seen that force for decades. It is not guesswork. And it is certainly not banal. It is ineffable.