Thursday, May 10, 2012

On More Therapeutic Nonsense




I don’t like writing about all the nonsense out there; I prefer to be positive and to concentrate on what can help people, but I have to make exceptions. Today in the NY Times (April 21, 2012, Sunday Review) is that exception. I cannot for the life of me figure out why I cannot get an article in the Times while those who write what I consider pure rubbish get a prominent place there.

I read the little rubric at the start of the piece, which said: “In Therapy Forever? Enough Already” and I thought, “My oh my, finally a bit of reality.” Disappointment soon set in. The piece is by a Mr. Alpert, a New York therapist. He is in dispute against long-term therapy, especially psychoanalysis. He begins with a bit of statistics: the longer you stay in therapy, the less you get out of it. Ergo: cut down on the time in therapy. The usual statistical logic. There is no “why” in all of this. Why is it that the longer you spend in therapy the worse it gets? Is it an addiction? Yes. The reason it goes on and on, says Alpert, is that therapists won’t admit defeat. Here is his key finding: “On the first visit to a therapist 88% felt they improved; after 12 sessions it was down to 62% improved. Yes but, say the long-term analysts, complicated cases require much longer time in therapy.

Alpert believes that the reason most people seek treatment is for something in the present that requires precise help; being stuck in bad relationships or a stultifying job. “It doesn’t take years of therapy to get to the bottom of those kinds of problems. For some of my patients, it doesn’t even take a whole session.” I think he is referring to counseling patients, not serious psychiatric problems such as deep depression and anxiety. And for YMCA counseling, he may be right. But it has been years since I have seen anyone who did not have deep, hidden emotional problems.

So let’s follow his logic: “Therapy can—and should—focus on goals and outcomes, and people should be able to graduate from it.” Whose goals are those? The doctor’s? The patient’s? It smacks of present attitudes about so many things: just get it done and be done with it, don’t whine and complain. He goes on: “In my practice, people who spent years in therapy before coming to me were able to face their fears, calm their anxieties, and reach life goals quickly—often within weeks.” Aside from its smug-self-satisfaction, the logic baffles me. He truly believes, “I’ve got the answer and you don’t.”

In case we missed something, this is pure cognitive/behavior therapy. We teach the patient to set a goal, work toward it and voila, in almost no time she is fine. I have been in practice for 60 years and I have never seen deep problems clear up in a matter of weeks; something that took decades to build up isn’t going away in 60 days. But you might think it will if you stay on the surface and think that what the patient thinks is the sole criterion for wellness; how about stress-hormone levels, immune functions, and all the rest? Do we just ignore the body and keep it cognitive? He has the answer for that: he believes “it’s a matter of approach. Many patients need an aggressive therapist who prods them to face what they find uncomfortable….They don’t need to talk endlessly about how they feel or their childhood memories.” There it is. Don’t delve into deep-lying causes, just get on with life. It is the anti-primal approach. Feelings, emotional pain, and childhood events—causes—don’t matter. Will power, strength, and determination do. It is his own modus operandi, his key neurosis elevated to the level of a principle. And he prefers his patients to listen to his advice, because they “need it.”

If you are willing to leave aside all causes and emotional anguish, and just focus on your future, maybe it can work for you—but surely there is no science there at all. Why is it that long-term stays in therapy do not work? The same reason short-terms stays don’t work. It just does not work. It is based on faulty science and a therapist’s own ways of dealing with things apotheosized into the realm of theory. Do we hear anything about what the person’s childhood was about? Not interested. Her emotional pain and anxiety? Not interested. So what are you interested in? Progress…progress according to my manufactured criteria. And what are those criteria? “Whatever I say it is.” And when the patient fulfills my criteria (when she says, I feel better), I pronounce her well. Unbeatable logic. Is she well when she has extremely high blood pressure, or high cortisol levels? Is it really all in your mind?

It is the modern day Charlie Chaplin brought into the machine age; results are all that matters. Jonathan Alpert has, forgive me, the Jewish disease (it takes one to know one)—explain everything, stay in the head, figure it out and then be rid of it. “How do you feel” becomes an anathema. It doesn’t matter in his approach, and yet in what we do it is all that matters. But you won’t know that when you live in your head. Neurosis is a disease of feeling, of repression and the inability to feel. That is why anyone should come to us. If they want something different—advice—they should see a counselor who gives it. I have seen or supervised thousands of patients from 26 countries and I have yet to see anyone who just needs a bit of advice. If that is what you need see a relative, a maven (a maven, the smart, all-knowing one in Jewish life, is usually the one with the most money). But wait, Alpert is not giving advice; he is telling people how to live, what to do, and how to do it. He is a cheerleader. No science there. He doesn’t ask how patients feel because “I already know.” Why bother inquiring.

I could go on, but what is the point. The real question is: How does that nonsense get such prominent placement in a world-renowned newspaper?
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Monday, May 7, 2012

The Meaning of Life

I lost a pal today;  eight years old.  He  died of a tumor around his brainstem.  His mother went everywhere in the world to save him; to no avail.   He was in New York but one day the family came out to join us for a day and I made tacos; not any tacos, mind you, but Janov specials.   And he loved them.  His mother wrote and told me he loved them and I thought: a few moments of pleasure in a very short life.   And so what did that life mean? Will he take that memory of the tacos to the grave?  No he won’t.  The only meaning the taco had was that day and his memories while he was alive.  After that, no meaning at all.  So what was the meaning of his life?  That day and many others that gave him pleasure.  No other meaning, sad as that seems.

Many of us try to get as much as we can out of life, and many people keep traveling and going here and there, off to the jungles or South America to get more out of it.  And secretly they still feel empty; they cannot feel their experience, cannot really experience it, because feeling is meaning and that lies out of reach of so many of us.  Without feeling centers what do sharks get out of life?   No a lot.  Not much meaning. We are feeling mammals; we need to be in contact with that in ourselves.  My pal got as much as he could but he spent most of his life going to Europe to doctors.  He was never told he was dying but he sensed it; and one day after a doctor visit, he asked his mother, “Do they speak English where I’m going?”  Whereupon I crashed, thinking of his agony and his dread. That tiny body riddled with foreboding that no one could take away.  That is what many of us have all of the time; foreboding of a crime foretold and a crime already passed.   And that crime is the pain that settles in so early in so many of us that leaves us with the same foreboding that my pal had; why? because death was in the offing so soon in our lives, at birth and before.  It happened even sooner than what happened to my little pal.  And it was imprinted and remained a force that dogged us. So we travel and go and go, and still that appointment in Summara catches up to us and rings our bell so loudly that we cannot even sleep.  It says “death is hurrying toward us,”  and there is no escape.  That memory is hurtling to our conscious/awareness at warp speed and no matter what we do and where we go, it is unrelenting.  This is a reality in our young innocent lives; death was approaching, strangled on the cord, too much anesthesia, etc.  There was no exit and still isn’t.  It never lets us rest.
  We keep on going very much like my pal, traveling all over Europe to find surcease: a cure.   Alas.  No.  For us the cure is to feel; to retrieve what we lost early on when death was coming toward us.  We can do it now. My pal can’t.
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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.
Editor