On Appearances and Essences

(Originally published September 4, 2008)

Another way of looking at the difference between awareness and consciousness is that of appearances versus essences—of phenotype (appearance) versus genotype (generating sources). An approach of appearances is always individual while that of essences is universal, generating universal laws. Essence is stable while appearances are transient. Essence is historic; appearances are ahistoric. Essences are few; appearances are multitudinous – meaning an endless therapeutic search down the most complex, labyrinthine behaviors. Essences lead to consciousness, the confluence of lower centers with frontal cortical structures. Appearances lead to awareness without consciousness. Essences necessarily mean the understanding of concrete contradictions between the forces of pain and those of repression because that is the essence of the problem of neurosis. Essences mean dealing with quantities of hurt leading to new qualities of being. It means dealing holistically and systemically. Appearances mean fragmentation of the patient, isolation of her symptom from herself; treating the apparent. Progress in psychotherapy is couched in terms of appearances instead of essences; and therein lies the rub.

The reason the Freudians and other insight theorists do not generate universal laws is because they focus on appearances and not essences, on fragments not systems. I should say that sometimes they do posit general hypotheses but invariably they cannot be tested and verified because they have no scientific base. It is very difficult to compose a universal psychologic law from individual, idiosyncratic behavior that applies to one person only, or from an id or dark forces that no one can see or verify. Cognitive approaches seem to superimpose psychologic laws on humans—on (their) nature. By contrast, we believe that through careful observation we can discover the laws of nature and apply them to humans; after all, they derive from humans. Biologic truths are of the essence.

In Primal Therapy, we make every attempt to meld our observations and our own research and current neuro-biologic research. We do this by not having too many preconceived ideas about the patient, and maintaining an empirical attitude. We do not treat each symptom as an isolated entity to be eradicated. Rather, we know that there is an ensemble of symptoms tied together by something that links them. That “something” is what we must get at in therapy; it is of the essence. Thus, we need to see the whole, not fragments of behavior. To see the whole we need to investigate history which is the context for its understanding. We need to look beyond a phobia of elevators and see historic events (put into an incubator at birth, perhaps) that gave rise to it. The minute we are bereft of history we are devoid of generating causes, and therefore essences. We remain in the dark.

The Freudians claim to have a deep dynamic therapy but they stop at plunging the patient into old, infantile brains where solutions lie. They too rely on the here-and-now, on current ideas about the past. Reliving the past and having an idea about the past are not the same thing. One is curative; the other is not. One involves awareness, the other, consciousness. Even tears in psychoanalysis are derivative. There is crying about in their therapy: the adult looking back on her life and crying. But it is not the baby crying as that baby, needing as that baby, something deep that is beyond description that can go on for an hour or more. In “crying about,” there is never the infant cries that we hear so often in our patients—a sign of a different brain at work, a different brain system solving its problems in its own way. The patient in the here-and-now, ego-oriented therapies is walking around in his history while the therapist is focusing on the present. He may be physically present but his emotions are in the past.

What we discover about the cognitive/insight therapists and especially the televangelist psychologists is that they embrace old homilies, morality, and religious ideals that are in the zeitgeist, mix them into some kind of psychological jargon, and deliver them with a folksy air of, “I know what you need.” Too often it all amounts to: Get Over It! And we all shout, Yeah! For we too think others should just get down to business and stop whining. That is the George S. Patton syndrome. Develop a positive attitude and you won’t feel like such a loser. But it’s hard to feel that you are capable and can succeed when you have spent a lifetime with parents who reminded of what a failure you are.

Every insight therapy has the implicit base that awareness causes improvement. It is founded on the notion that once we are aware, we can make necessary changes in our behavior. Awareness can make us aware, and that is a positive step. But it cannot change personality, which is organic, and it can never make us conscious. We can be aware that we are too critical of our spouse. Maybe with effort we can stop that behavior. But if we understand the concept of the imprint, then we know that anything that doesn’t directly attack the imprinted memory cannot make a permanent change. We can be aware that we are working too hard and neglecting our family, but when there is a motor inside driving us relentlessly, that awareness is useless. Ideas are never a match for the strength of the brainstem/limbic forces, which, I remind the reader, have everything to do with survival. There is always a rationale for our behavior: “I have to be gone and work hard to support my family properly.” We have applauded this kind of neurosis in our culture, which adores hard work, ambition, and relentless effort. Being driven is about the most widespread of neurotic forms. If only we knew how to finish the equation: being driven by . . . (Answer: need). Translation: I was not loved in my infancy and I am in pain, which drives me incessantly. And besides, I can’t stop because my imprint at birth was that to stop was to die. I have to keep going to keep from feeling helpless, that there is nothing I can do. Those are the truths we find when we feel our imprints—the truths that when felt will stop our drive and allow us finally to relax.

Why is cognitive therapy so widespread today? To a large extent because it is far easier and quicker (and cheaper) to change an idea than a feeling. Insight and cognitive approaches tend to appeal to those in their “head”; this applies to both patient and therapist. Neither the patient nor the therapist is likely to realize the amount of history we are carrying around and how that affects our thinking. How else could we possibly ignore the horrendous things that happen to our patients in their childhood? Nowhere in the cognitive literature have I seen a discussion of basic need as central to personality development, of why the person cannot put the brakes on impulsive behavior. As I have mentioned, the ascending fibers from down below, starting from the brainstem and the associated limbic networks, alert the cortex to danger; they are more numerous and stronger and faster acting than the descending inhibitory fibers, which as we know come later in evolution. Here in purely neurologic terms do we see how feelings are stronger than ideas.

An early lack of love means that there is an even further degradation of these descending inhibitory systems, not only because of cortical weakness, but also because the limbic-amygdala forces holding the imprint are enormously powerful and are importuning the cortex to accept the message. The engorged amygdala is figuratively bursting at the seams to unleash its load of feeling. The dominant direction it can go is determined by evolution—upward and outward, impacting the frontal cortex. There is only one direction that repression can travel—and that is downward, to hold those feelings back. Ideas can help in that job just as tranquilizers can. I suspect that therapists who practice therapies that deny history, and deny imprints and biology, are drawn to such therapies, ironically, as a function of their own history. So long as the connection is poor and access impaired, the therapist is open to any kind of ideas that appeal to him intellectually. And what appeals to him intellectually is what is dictated by his unconscious. And that means that he might choose a therapy that operates on denial, such as the cognitive, because he operates on denial. He makes therapeutic choices that obey this dictum.

If a therapist, unconsciously, has a need for power, he is apt to dictate to the patient; it may be directions for living, relationships, choices, and, above all, insights. He will impose his ideas, his interpretation of the patient’s behavior. What he says will become the most important in his therapy instead of what the patient feels.

If the therapist has the need to be helpful and get “love” from the patient, he can act this out in therapy. I remember feeling my need to become a therapist and be helpful, trying symbolically to help my mentally ill mother to get well and be a real mother. No one is exempt from symbolic behavior. And it is certainly more comfortable for a patient to act out his needs and get them fulfilled (symbolically) in therapy, and imagine he is getting somewhere, than to feel the pain of lack of fulfillment. It is understandable that the idea of lying on a matted floor crying and screaming doesn’t appeal to some. Pain is not always an enticing prospect. Thus, the cognitive/ insight therapist can be similarly deceived and entangled in the same delusion as his patient: both getting love for being smart. It is a mutually deceptive unconscious pact.

Any time we are not anchored in our feelings we are up for grabs; any idea will do. It is good that the left frontal cortex is malleable, but bad because it is too malleable. It is the difference between having an open mind, and a mind that is so open as to be a sieve. The difference is having a left frontal cortex open to the right brain versus a mind too open to others and their suggestions precisely because it is not open to its better half. That is why a scientist can understand a great deal about neurology but practice a therapy that has nothing to do with the brain, which I have seen time and again—the bifurcation of consciousness. What he or she knows scientifically does not translate to the other side of the head because of disconnection or dissociation. He/she may be utterly aware and utterly unconscious.

In appearances, the therapy remains pretty much the same no matter what is wrong. The Freudians have a certain take on development and pathology. They will follow that irrespective of what is wrong with the patient, and it all adds up to insights and more insights. Other therapies specialize in dream analysis. They go on doing that without any proof of its efficacy other than patient reports. There are no physiological measurements. They neglect the fact that experience is laid down neuro-physiologically, not just as an idea; they neglect essences.

Think of this as magic: Take a tranquilizer and we can sleep better, avoid sleep problems, hold down acting-out, stop feeling anxious, be less aggressive, less depressed, stop bedwetting and premature ejaculation, and stop using alcohol and taking drugs. One specific pain pill can accomplish this universal task. Why? Because the essence, pain, is behind all of those disparate symptoms.

Pain will always remain pain no matter what label we pin on it or how we choose to deny it. Whether we feel ignored or humiliated or unloved, the pain is the same and processed by the same structures. The frontal cortex gives it different labels and we act out differently, but the centers of hurt treat them the same. Isn’t it strange that we use the same tranquilizer to ameliorate depression and children’s bedwetting? Maybe it is all one disease with different manifestations, and when we attack the generating source with drugs, all of the manifestations disappear for a short time. We need to learn from Prozac the most obvious lesson: It blocks all manner of symptoms. Therefore, if we, too, in a feeling therapy attack orchestrating forces, we can block and eradicate all of those different symptoms. Notice also that it is a nonverbal medication that slows down ideational obsessions. It tells us about the relationship of lower centers where there are no ideas to higher level thought processes, which deal with ideas.

In an anti-dialectic approach, which is that of appearances, there is no central motivating force. There is no struggle of opposite forces that move and direct us. It all remains on the surface—static. And because the approach does not contemplate the deep conflicting forces motivating us, there is no reason to delve into the patient’s history. It is all non-dynamic. Treatment based on dialectic principles means that there can be no ego or mystical forces that arise out of the blue, containing a mechanical, hereditary “given.” When the dynamics are left out, the therapy has no alternative but to be mechanical.

Because of an unloving, traumatic early childhood, a person cannot put the brakes on the amygdala or brainstem structures because he hasn’t the neurologic equipment; there is an impaired prefrontal cortex that does that. The cognitivist adds his frontal cortical weight to the patient so that their ideas, welded together, help control underlying forces. “You are strong. You can succeed. I will help you try. You just think you’re a loser but you are not. You are really a good person, not the evil one you think you are.” We see this in an experiment reported in a 2002 journal of Nature where electronic stimulation of the prefrontal cortex prevented rats from freezing up after they had been conditioned to do so at the sound of a tone (the one was paired with an electric shock). (FOOTNOTE: Nature (Nov. 7, 2002) When the therapist and the patient combine their thoughts in an insight session, it is no different from an electronic stimulation of that area. In short, it blocks the experience of terror and pain.

How is that psychologic notion different from the religious? The difference is that psychologists do not use the word evil; they call them negative forces. Shrunk to size, they are the same thing. And of course, the mass of current television psychologists are really televangelists in psychological clothing. They have wide appeal because they combine current religious precepts with psychologese (think Wayne Dyer). It doesn’t challenge anyone; it only confirms their prejudices. It offers cachet to them.

Then there are the drug therapies. Patients are given a variety of drugs for almost any condition. Talking to the patient is secondary. Patients are anxious—one type of drug. They are depressed—another type of drug. And, often the drugs have the same effect on the brain: killing pain. And if the drugs we give to patients do not work, we raise the dose. And if that doesn’t work we change drugs. Meanwhile there is no attempt to find out and address why they are depressed. Though we are trying desperately to find genetic causes, depression is not a necessary part of the human condition. 

A recent newspaper article described a woman who is suing her psychiatrist because her husband was suicidal and his doctor kept changing his medication. She said that it made him worse. The doctors were relying on appearances, not essences, and were possibly misled. She claims that no one talked to him. Here is a case where even a little talking and some sympathy would have helped. There is a place for it. Maybe drugs weren’t the answer. This approach saves the bother of having to deal with the patient’s history and his early life. It saves the troublesome effort of talking to the patient and feeling for his anguish. Just that, feeling something for the patient, can convey empathy and can be therapeutic.

Treatment that primarily involves giving drugs considers the patient as a “case.” There is no personal interaction after a few cursory questions. “Tell me about your symptom but not about your life. Tell me about it, not about you.” I have been in that position as a patient, seeing doctors who treat me as a “case.” It is not comforting. But then there are the economics. Seeing many patients every hour makes it difficult to empathize or to even know much about the patient. After filling out a long questionnaire, we find the doctor entering the treatment room scanning the file, unable to really take in the essentials about us. History is another victim in current therapy, both medical and psychological. Today, psychiatry has become an arm of the pharmaceutical industry. They tell us what drugs work and we use them. The insurance companies won’t pay for us to delve into the patient’s history, to take our time to find out about her. They pay for immediate results. The conclusion: We develop new therapeutic theories to accommodate the idolatry of the here-and-now intellectual, drug approach. We have ceded our integrity for pay. We don’t do it consciously, but we don’t feed our families if we don’t accommodate to the new reality.

Of course, cognitive approaches are ideal. Tell the patient, in essence, “get over it” and “thank you for coming.” In the new zeitgeist, the aim of cognitive therapy is to get the patient over it, not to understand basic dynamics. What is basic in man is his reservoir of pain and how it drives him to behave. Once we neglect basic need, we are thrust into awareness because it is the beginning and end of consciousness. We cannot see the reservoir when we focus solely on awareness. Therefore we cannot see the reason so many people on are drugs, both legal and illegal. We try to stamp out the need with words, but we will lose that war because need is stronger than anyone or anything. It will not remain suppressed. No one is stronger or brighter than her need because need is inextricably intermeshed with survival, and survival reigns. If we want to stop the demand for drugs we must attend to basic childhood needs, starting with the way we perform childbirth.