Arthur Janov's Blog, page 30

The Mystery Known as Depression, Part 5/12

5. THE KEY ROLE OF EPIGENETICS

Although genetics may be partly responsible for depression in rare cases, by and large it is early life experience (including experience in the womb and birth trauma), that is the root cause. What we see at work is epigenetics, the altering of gene function without changes in the underlying DNA sequence (Booij et al., 2013). Those alterations, or deviations, if you will, often involve a biochemical process known as methylation. And it is through methylation that psychological trauma is imprinted. Thus the trauma – which can be as simple as a lack of caring and love by the mother – becomes “fixed” in the system and endures. It is the imprint, the linchpin of depression. The biochemistry, and ultimately the brain have been rerouted, sealing in depressive tendencies. It is this imprint that ultimately must be addressed and resolved.

What the scientific evidence shows more and more is that gestation and birth events are critical for later disease. In a 2010 study conducted at the Hannover Medical School in Germany,researchers concluded that “epigenetics is of considerable interest for the understanding of early life stress in depression.” The study, published in the journal Current Opinion in Psychiatry, found, among many other things, that unloved and untouched children had a predisposition to depression. (Schroeder, Krebs, Bleich, & Frieling, 2010). Recent work by a team of Canadian researchers also pointed to the critical role played by epigenetics. (Booij et al., 2013) 
The following passage is from their article:
“The functioning of the hypothalamic–pituitary–adrenal (HPA) axis and serotonergic (5-HT) system are known to be intertwined with mood. Alterations in these systems are often associated with depression. However, neither (is) sufficient to cause depression in and of themselves. It is now becoming increasingly clear that the environment plays a crucial role, particularly, the perinatal environment. In this review, we posit that early environmental stress triggers a series of epigenetic mechanisms that adapt the genome and program the HPA axis and 5-HT system for survival in a harsh environment. We focus on DNA methylation as it is the most stable epigenetic mark. Given that DNA methylation patterns are in large part set within the perinatal period, long- term gene expression programming by DNA methylation is especially vulnerable to environmental insults during this period. We discuss specific examples of genes in the 5-HT system (serotonin transporter) and HPA axis (glucocorticoid receptor and arginine vasopressin enhancer) whose DNA methylation state is associated with early life experience and may potentially lead to depression vulnerability. We conclude with a discussion on the relevance of studying epigenetic mechanisms in peripheral tissue as a proxy for those occurring in the human brain and suggest avenues for future research.”
It seems that the fastest changes in methylation occur early in our lives, at the very least in the neonatal period, though this thesis is subject to further study. What is important now is that certain genes which should not be silenced, are. Thus, certain means of expression are suppressed, which is often the case in depression. None of this means that methylation “causes” the affliction but rather, there are adverse events very early in life that increase its production.

Though the Canadian researchers emphasize the perinatal period, we have found the imprint to lie earlier, as well. If the neonate is especially sensitive to environment insults, it surely is possible that those insults can occur earlier and form the primordial imprint that later gives rise to depression. Methylation, in brief, offers the primordial event that sets the prototype for later inhibition and repression; thus, high methylation may be a predictor for later depression. It means that certain key genes which should find expression are silenced, especially due to modification of the genes promoter region. The tendencies for no or difficult expression are imprinted.

My opinion is that some of these changes in physiology occur during our life in the womb, when the set-points of so many hormones are being established, including thyroid hormone. Indeed if we give a small does of thyroid medication to depressive patients there is a transient improvement. One may think that such deficiencies are genetic but there are events that can cause them that are not always obvious. They are only obvious when the patient in therapy descends down to the far reaches of the unconscious where the crucial explanation of one’s depression lies. One again relives the birth experience, the suffocation, strangulation, the hopeless battle to get out – the unutterable and ineffable despair. Of course, it is not given a name until years later but the feeling is there engraved in the nervous system. We can feel hopeless without giving it a label. In the face of adult adversity, the old imprint – wanting to give up – appears and is now called depression.

We give it that name because we have not seen the generating sources of deep imprinted despair, something we have observed many times. We name it depression because we do not know the hopelessness inside that makes us miserable. We give depression the name of the defense instead of its cause – pain.

What is Primal Therapy?

I decided to write this because recently there has been an influx of patients from so-called primal therapists, and without exception they have been damaged. Patients have gone to professionals with all the credentials who have advertised primal and claim to know how to do it. Since it takes years to learn, they just borrow the term Primal and use it to deceive prospective patients. Sometimes it is former patients who think they know enough. Most often it is strangers who read the Primal Scream and decided to go into practice. In any case, we have spent some 47 years refining the theory and therapy, joining it with biochemistry and neurology to make it as scientific and efficient as possible. It is at least a complex matter that embodies science as its base.

There is a case this week that set my hair on fire. There are several primal centers in Europe who claim to be doing Primal Therapy. One Center took a woman who was feeling somewhat hopeless, plunged her into first line abruptly and drove her straight into parasympathetic overload and then deep depression. She left their place in pieces and no one there had any idea what was going on and or what to do about it. Then they say, “there is nothing more we can do for you.”

 It happens a lot that they open up the person to far too much pain, flood them and inundate them and then do not know what to do. There all manner of deviations possible and there all manner of unscrupulous individuals who use our term, Primal, to deceive others who are suffering. The proof lies before us every day in the wrecks who come to us from so-called primal therapists.


I know that is often more convenient to go to someone nearby especially if they are in a foreign country but it is your life you are compromising. I have never known any one of these mock therapists to do research, to follow up on their work or to do vital sign research on patients. So here is what to watch out for.
The whole reason for Primal Therapy was to counter the 50 minute hour and let patients stay as long as the need to. So the first thing the mock therapists is to do one hour sessions. That defeats the whole idea of feelings guiding the therapy. There must be no timetable for it.
The mock therapists eliminate doing group therapy, which are essential to getting patients together, to learn about feelings and interact with others and see what feelings look like. Patients help each other in groups and then learn to buddy and carry on the therapy with each other.
 Because they do not follow evolution they often plunge the patient into deep feelings for which they are not ready. The result is overload and flooding of the brain with too many and too heavy feelings. Or, the patient is ready to go deeper but they are not taken there because the therapist has no idea how to do it.
Mock therapists always guide and control the patient. Telling him or her what to say, how to say it and even force them to speak words when the feelings have no words attached to them. Thus they produce a mélange which confuses the patient all the more.
They tell the patient when to come, how often and how long to stay, which should be the province of the patient not the doctor; oh yes, don’t be fooled many of these therapists can be licensed, are doctors, with all the accouterments of professionals. All they lack is knowledge and a bit of humility. They never know their limits and they figure since we do it why can’t they? The “we” in this case is me and my team who work relentlessly refining what we do.
The mock therapists do not have medical controls so they may treat something neurologic as something psychological; the patient suffers. They need a wide ranging background to sort out what is wrong with the patient before embarking on therapy. I wonder how many of them actually have the knowledge. We had a case recently of brain impairment which was previously treated as something psychological, and left a damaged individual in its wake. The human mind is not for dilettantes. Once derailed the patients may take years to make up for what was done to them.
The ways of detours and derailment is infinite. Often done by well meaning therapists, and just as often done by those who see commercial value in it. It has become the “flavor of the month.” I would very much to be democratic and leave the way open for other therapists but our experience up to now has been disappointing. There may be some who sit for patients and give them a good environment in which to feel but I have not seen it.
The danger lies in those who had a bit of training, left too early and hang out shingles saying, “Janov trained.” True, they had some training but Primal Therapy can be dangerous in those with insufficient training. This is especially true when there is no knowledge for how the brain works or should work. I often say that we cannot love neurosis away. No matter and good intentioned there is a precise science to learn.
To my knowledge, not one of those so-called Primal people write and publish in order to further the science of the therapy. Their interest is not the patient; it is commercial. It has become a business not a mental health approach. We have had several peer reviewed articles recently. One in the World Congress of Psychiatry, and another accepted by them for publication. And there are others. I do write books explaining the therapy (in 26 languages) and the science underlying it. Dr. France Janov is now about to finish legacy program detailing what we do, on disc. It is not a secret. We have no desire to keep it for ourselves but we do know that a high level of training is needed, and we do not want therapists to take short cuts that endangers patients’ lives. They would be taking short cuts on the patients’ health.
Primal Therapy should not be practiced alone. There are feelings in all of us that when they come up can derail judgment. We need others around to make sure we do not commit systematic errors on patients. Therapists control one another. There are constant staff meetings to make sure every patient is attended to. And training sessions where we advance the therapy and the theory. The whole focus is on bettering what we do for the benefit of the patient.

The Mystery Known as Depression, Part 4/12

4. WHAT IS DEPRESSION?
Throughout the ages, writers and thinkers have come up with poetic sobriquets to describe depression. Hippocrates called it the "black bile." Susan Sontag famously dubbed it "melancholy minus its charms." For Flaubert, it was simply “the eternal ‘what’s the use?’ ” And in his book The Noonday Demon, Andrew Solomon says “depression is grief out of proportion to circumstance.” (Solomon, 2002) Today, this ancient malady is poised to become the second leading cause of disability through the remainder of this decade, according to a report from the World Health Organization titled “The Global Burden of Disease.” (World Health Organization, 2004) By any name, depression has clearly become a plague among us. From a public health standpoint alone, it behooves us to understand precisely what it is and how to treat it humanely.

People often say they “feel” depressed, but depression is not a feeling. It is a defense against feeling,– against an accumulation of imprinted pain. As such, it is a protective device to keep us unconscious, or rather, to keep the unconscious from becoming conscious. It holds down, via its handmaiden repression, all of the catastrophic feelings and sensations from womb-life, infancy and childhood that, if unleashed from their safe, subconscious stronghold, would threaten the integrity of our conscious awareness. It is the ultimate survival strategy.

Depression is a system-wide state of repression that blankets many feelings. It is the history of the body’s traumatic experience exerting its force. And ultimately, it is the state of repression elevated to a higher level. For this reason, the depressive is chronically awash in suffering because he/she cannot feel those specific, early feelings. The organism seems to say, "Better to feel numb than feel what lies below and go crazy." Thus, the labored movements, feeling flat and unemotional, the lack of energy, and so on; all the feelings adumbrated by my patients at the beginning of my discussion. Any expression – anger, for example – can temporarily ease depression because it lifts repression a bit. But depression is certainly not, as Freud believed, anger turned inward. (Freud, 2005)

A normal person is rarely depressed; he has no backlog of feelings lying unresolved inside. He is open to feel and does not repress unpleasantness. He will be sad when it is appropriate. But sadness is a “now” event, a real feeling related to real situations. Depression is a “then” feeling, unrelated to now. If the young child could feel each and every original imprint, he would not be depressed in his life. The depressive, on the other hand, is stuck in time. He is stuck back in his past whether he is conscious of it or not, so that everything he does is a symbolic portrayal of that past. This means that we are all open to sadness when our defenses give way. To suddenly be out of work, left alone or excluded by one’s friends is most distressing, but depression is quite another matter. We should feel distressed, despairing, unhappy, sad; these are normal reactions. Not so with depression, which has as its kernel a deep hopelessness and helplessness. This is a basic imprint from long ago that can be triggered when one of those adversities occur. This imprint is often set down either during gestation or at birth when there was no escape from the traumatic input, such as a massive dose of anesthetics given to the mother during delivery which, as we shall see, effectively shuts down the baby as well. It is often this hopelessness that is triggered when seemingly not-so-serious events happen and depression occurs.

Feeling down and discouraged in response to losing a job, or breaking up with a mate, or after the death of a loved one, is different from a chronic, interminable depression. The former may be what is commonly known as "grieving" or "bereavement" which lasts for some weeks or a few months. The person has a normal response: gloominess, sadness, crying, feeling terrible, which stops after a time. What happens is that the person is reacting with real feelings. "Sad," for example, is a feeling; depression is not. Depression happens when you don't feel the real feelings. Those feelings agitate the deep brain levels and activate the imprint. The depressive feels all that; the imprint on the move toward conscious/awareness. It never makes it, however, as repression intercedes. But a deep despair and resignation set in, and a feeling of defeat and wanting to give up; and above all, that gloom and doom that is the hallmark of so many depressions. That is the original, precise, imprinted feeling that is trying to push its way into consciousness; it colors and dominates the present. We see the depths of the imprint in a syndrome known as endogenous depression, something that appears without apparent warning, leaving us helplessly deep into its maw. It has been labeled endogenous because until now we did not know where it came from or why. It is so deep that it seems to come from nowhere, but that nowhere/somewhere is deep in the brain.
When external defenses fail or are under attack, what the depressive experiences is the repression, not the feelings themselves. He feels the pressure against those feelings pushing down into his system. That pressure produces effortful speech and movement and total exhaustion so that the depressive has little energy and moves about in slow motion; “my feet are stuck in cement,” as one patient put it. In short he feels the weight of the repression, the ineffable force of keeping feelings down. He does not feel the feelings themselves. Once he does, the depression can begin to lift.

In depression there is the feeling of "heaviness," a lack of energy, which can be so great that even getting out of bed seems like a monumental chore. It makes everything a Herculean job, so that normal tasks such as talking or raising one's arm can become a great effort, even chewing on solid food. There is little or no energy left for enjoyment, pleasure, sexual drive, or any drive, for that matter, other than the wish to find a way to end the suffering.

So the depressive goes to a therapist for help; he/she usually has to be coaxed into it. What he/she gets is encouragement and hope that the therapist will make it all better – someone who will perform magic. He/she wants to be “pulled out” of her state; a symbolic feeling that was there when the original event – birth trauma – was taking place. Someone literally pulling his/her out, breathing life into him/her. The patient’s passivity requires an active, assertive therapist. The therapist becomes his/ her “friend” because he/she has rarely ventured out to make friends. And he/she will willingly take orders and obey his directions. But he/she has to offer hope and encouragement to combat that loss of hope deep down.

Give a depressive a new outlet – a new job, a party or a chance to go shopping – and all of the inner-directed pressure now pours out in manic activity. He will literally “throw himself” into his work. He will be “happy” for those moments when his work will make him happy. What has really happened is that he has found an outlet to release the primal force. Here we see the basis for bipolar or manic-depression. Not a different disease but a different kind of template – hopeless depths followed by manic energy. When repression fails, manic activity sets in. The imprint reflects the same cyclic event that occurred at birth. The person was stuck in what I call the trough and was blocked, then with great effort made it out. The template – down and then up – is played out in the cycle of giving up and trying manically to finish. It is the same energy source but a different way of handling it. So we can see that some of us shut down early in life and, lacking outlets, we become “dead,” globally and emotionally shut down. Others shut down and “act” alive. If being the “happy clown” pleases one’s parents, then the act will continue. Among the professional comedians I have treated this was never truer. I am treating a depressive now whose mother was chronically ill; he became funny to try to cheer her up. Though it never worked for long, it became a habitual pattern. His need? A happy mother who could love him. Take away the chances to please and the lurking sadness will begin to ascend. If one was disliked, suppressed, and rejected at every turn, then deadness and depression will be reinforced. How we develop depends on later life circumstance: Were the parents loving? Were they not tyrannical? Could they allow free expression? If there were free expression and lots of touch, then the imprint will be kept at bay because it was not compounded, but it will never go away until relived and connected.

The Mystery Known as Depression, Part 3/12

3. THE THREE LEVELS OF CONSCIOUSNESS

To understand how it is possible to trace the causes of a lifelong illness – and its cure – to the very beginning of a person’s life, I must explain my view of the three levels of consciousness.
We basically have three brains in one as MacLean (1985, 1990) already proposed in 1960s: the brainstem, the limbic system, and the neocortex, each representing different stages of evolution, from shark, chimp to human brain, respectively. These neurologic stages of brain growth correspond to three distinct levels of consciousness: the earliest, pre-verbal stage of infancy, followed by childhood and finally present-day awareness. At each level of brain development, we have specific needs that must be fulfilled uniquely. The earlier the needs the more lasting the consequences when they are not fulfilled, and the more grave the imprint. In infancy, we have a need to be touched and nurtured tenderly. On the second line, we seek fulfillment of emotional needs: to be listened to, to feel secure and supported, to get an empathetic response to our hurts and fears. And the third level involves intellectual stimulation, communication and understanding by the parents. Fulfillment on this level can lead to clear and logical thinking; to an accuracy of perceptions.

3.1. First Line – The Brainstem
The first level, the brainstem, is a primitive or reptilian brain, which is our oldest brain system (MacLean, 1990). The brainstem was the first to evolve, and the first part of the central nervous system to develop in human evolution. It seems that we never lost that part. We just added new brain tissue on top of it. The brainstem deals with instincts, basic needs, survival functions, sleep, and basic processes that keep us alive such as body temperature, blood pressure, heart rate and very deep breathing. At this level, we can store a carrying mother’s depression, anxiety, stress, drug-taking, smoking, or drinking. Mother can also communicate, through her changing hormones, her unconscious rejection of her coming baby, which then becomes stored in the baby’s brainstem. Such experience is not stored as ideas, obviously, since we don’t yet have a neocortex, the thinking, intellectual, comprehending mind. But what is important is that the imprints in this storehouse will later motivate certain thoughts and aberrations of thinking. The brainstem imprints the deepest levels of pain because it is developed during gestation and handles life-and-death matters before we see the light of day.

3.2. Second Line: The Limbic/Feeling System
The second level of consciousness is basically the limbic system of the brain (and its affiliates), which is responsible for feelings and their memory (MacLean, 1990). It provides images and artistic output, processes certain aspects of sexuality, and is partly responsible for anger and fear. The limbic system possesses some key structures which affect brain function. They are the hypothalamus and thalamus; the hippocampus, which is the guardian of emotional memory; and the amygdala.
The hippocampus contains the archives of early experience, particularly trauma, and also puts a damper on amygdala activation so that our reactions themselves do not become a danger; after all, continually high blood pressure and heart rate will threaten our existence. The hippocampus has a high density of stress hormone receptors and is therefore quite sensitive to stress. The context of a feeling is predominantly organized by the hippocampus. It gives us an anchor for our feelings—a time and place—and allows us to connect to our feelings.

The amygdala is one of the most ancient structures of the brain and the oldest structure of the limbic system. It is the hub of the emotional system; the gateway to feelings. It gives us the sensation behind feeling, while the later developing hippocampus registers those feelings as facts. Early traumatic memory is consolidated by the amygdala. Luckily, when the going gets rough, it can help manufacture its own opium to hold back pain. In this way it helps us remain unconscious. It is truly a wonder that this small brain structure “knows” when to stop pain and can release a poppy derivative to help. More, it tells other brain structures about how much to release and when to stop.

The hypothalamus works with the lower structure, the pituitary, to govern the release of key hormones, not the least of which are the stress hormones. When we have strong emotions, it is the hypothalamus that organizes our response. (Within the hypothalamus lie two different kinds of nervous systems, the sympathetic and parasympathetic, which are key to understanding depression and are discussed in detail below.)

The thalamus is the central switchboard of the brain, relaying certain aspects of feeling to the frontal cortex. It can decide a feeling is too powerful to be felt and orders that the message not be relayed, and thus kept from awareness. The thalamus talks straight neurochemical talk, a language that expresses itself wordlessly. Yet it can translate painful messages into something understandable by the frontal cortex. If the pain is too much, the message that arrives is garbled. If it is acceptable, the gates open and the message is clearly understood – we know what we feel.

3.3. The Third Line: The Neocortex
The third line is the neocortex, the part of our brain that was the last to evolve and the one responsible for intellectual functioning, generating ideas and thinking (MacLean, 1990). The left pre-frontal area deals with the external world, helps us repress and, when able, to integrate feelings. It comes online at about the third year of life. The frontal cortex is part of the feeling system to the degree that it gives meaning and understanding to our physiologic- emotional reactions. The neocortex serves as a portal for entry into the suffering component of memory, a portal that cannot operate by itself. It’s the first door we walk through toward retracing our history and understanding our pain.

We can be fulfilled or deprived on any of these levels; when deprivation occurs so does pain, as the lack of fulfillment means that the integrity of the system is threatened. And pain is most often accompanied by its counterpart, repression. Fulfillment is more serious and urgent as we descend down the neuraxis on what I call the chain-of-pain. Indeed our biology dictates that deep pain elicits strong repression, to keep the pain at manageable levels. Heavy repression on the first line can mean a deadness of affect, a lack of good interconnection to bodily function so that sex is problematic and appetite is dulled; there is a lack of energy and passion. Symptoms on the first line include ulcers, colitis, and breathing problems. Symptoms on higher levels have different manifestations; the inability to make a decision, to be independent and forthright and to be aggressive.

This is simply a brief overview of the three levels in order to better understand the origins of depression and its therapy. If we consider that those ancient brains are still active in our head, the nature of the problem becomes clearer. All three brains should work in harmony throughout our lives. How they all get along is paramount. We need clear channels among the levels; otherwise there is distortion. Early trauma, however, creates a lifelong disharmony and disconnection among brain levels, resulting in many forms of mental illness. Essentially, neurosis is driven by lower brain centers that are trying to communicate to higher ones but are unable because a disconnection has occurred, a disconnection caused by the imprint of an early lack of love that spells hopelessness and helplessness. The goal of therapy is to restore that harmony, neurologically and psychologically, because consciousness (not to be confused with awareness) means all three levels working fluidly.

How Womb Life Shapes Us

 There is a recent experiment that throws light on this subject. Babies can learn a musical melody while still in the womb.  They recognize it after they are born.  They took two groups of babies, testing them at birth and again at four months.  The tests were of brain responses. They were greater in those who recognized the tune.  And it was equally true at four months of age.  One key conclusion by the authors was that, “ a baby can be relaxed and soothed by melodies it hears before birth.” Obvious.  But the neurotic mother’s metabolism also plays a tune, a fast or erratic one.  And that baby is not longer soothed; rather, she is galvanized.  Or confused, or dazed. And this state is imprinted in the same way that she is soothed with nursery rhymes.  (twinkle twinkle little star).  (see Eino Partanen, University of Helsinki,  Finland).

Here is what makes early life so important; experiences can be engraved for life.  They stick and they guide behavior thereafter. They make us open as individuals or closed as personality traits.

 The point is that we start learning long before we think we start learning.  Yes, it is a nursery rhyme, but any key experience affects us for a very long time.  Long before we can say, “Oh yes, I remember when my daddy came home drunk and beat us!”  These are things of instincts, primordial memories that have no words, yet shape us ineluctably as any later trauma; more-so, because very early experience is stamped in with a force that is often powerful because it is stamped in to a vulnerable, naïve soul that has little previous experience to fall back on.  There is no reservoir of perceptions that help establish a frame of reference to make sense of things.

The experience joins in the a-perceptive mass which helps form an orientation to life that ultimately shapes one’s attitudes, interests and perceptions.  Later when we are asked what made you think that,? there are childhood experiences we can evoke but also many pre-birth experiences of which we are unaware.  These join into the ensemble of experience that form us. And these are the experiences that psychotherapy ignores systematically.  How can we know what drives us when we ignore life in the womb there the mother is severely depressed or takes heavy duty painkillers?  How can we know about terror and anxiety in a patient when we ignore a father who left home when the fetus was seven months? Or neglect to take into account a severe auto accident where the mother was pinned against the seat and the baby petrified?  We ignore this because we do not know about the imprint of experience and how it endures perhaps for lifetime.  We do not “grow out” of experience; we grow into them.

If we do not understand our malleability early on or how the brain changes all along the nine months of pregnancy we can’t hope to figure out endogenous depression at age thirty.  Those early experiences are still part of us and guide behavior.  So when a therapist says “I focus on behavior and try to make the patient take a healthier more wholesome attitude,” we know she is missing out.  She is missing out on causative factors that are alive and well inside of us.  And when we address the imprint we make real profound changes in the patient as he relives those central imprints.  It is supporting evidence that the traumatic event lives on. Otherwise, obviously there would be no change.

Now we see why some of us suffer endogenous depression.  Children whose mothers were depressed while carrying are more likely to have depressed offspring. (major work done at Bristol University, England who studied 8000 depressed mothers. Also see the work and comments of prof. Carmine Pariante of King’s College, London Institute of Psychiatry, Published in JAMA Psychiatry 2013,).
These studies are part of current science that should affect our practices.  We need to investigate birth weight in our patients because recent studies point to birth weight as affecting how long we live and the rapidity of aging.  (International J. of Epidemiology. 2013).

I don’t want to drown the fish but I do want to underline what we as therapists must do to be effective and help patients:  read the scientific literature.  That is our key responsibility.    We don’t want to rely on the writings of Freud or Jung from one hundred years ago. There is a new science out that we must adhere to.

What is uplifting about this research is that those nursery rhymes can still play in our minds as we mature.  We carry around that relaxation as an imprinted memory, maybe for all of our lives.

The Mystery Known as Depression, Part 2/12

2. DEPRESSION AND THE PRIMAL PARADIGM

Let me begin by proffering my definition of depression, and how it is understood within the paradigm of Primal Therapy. One caveat before proceeding: Our understanding of depression arises from an observational, not statistical, perspective. Ours is basically an empirical science; wanting to know rather than knowing what we want. What I describe has been seen in hundreds of our patients over 45 years. It is a new paradigm, a departure from the conventional notions of depression. If we try to understand it within the old frame of reference we will fail. Depression has its roots in the earliest moments of a patient’s life, during gestation and birth. Since first espousing these theories more than four decades ago, advancements in brain research have offered mounting evidence to support our theory about the role of early trauma in causing mental illness. What is still difficult to accept by some is our assertion that reliving those traumatic experiences, including birth, is the way to reverse depression. In this sense, exploring the mind has been a little like exploring the world to prove it is round; it often can’t be believed until somebody actually makes the journey. In the development of our therapy, we have made no a priori assumptions in our observations. From the beginning, we have always let ourselves be guided by one unassailable truth – the experience of our patients.
Not long ago, a group of my depressive patients met to discuss their problems and the overwhelming pain that surrounds them. As they talked it became apparent that there were numerous things they had in common. Looking back at the experience of their lives, they identified certain symptoms and tendencies in their feelings and behavior, including:


. A feeling of constant suffering
· Difficulty concentrating
· Extreme fatigue
· Immobilized and paralyzed
· Feeling helpless to change a situation
· An inability to talk
· Lack of energy
· Can’t move, enclosed, stuck in a dark abyss
· Not being able to find anything to live for
· A monotonous, inner deadness
· Feeling that nothing is going to change
· Something wants out
· An inability to feel pleasure.
· Unable to make a decision, or make something stop
· Numbness and ponderous, labored movements
· Recurrence of a wish to die
· Sense of isolation
· Falling into a black hole
· Not getting anywhere
· An overall heaviness or deadness
· An effort to breathe or even lift an arm
· Not interested in anything
. No sexual interest
· Despair, resignation and wanting to give up
· What’s the use of living? Don’t want to go onlike this

This group of “symptoms” is based on my experience with my depressives describing their own general condition. But in addition, what these patients have come to realize, however, is that they were describing the sensations of a birth trauma, the common denominator of their communal experience. No one suggested this in any way because we would not have known what to suggest.
If we were to overlay a transparency illustrating the characteristics of depression over one showing the effects of the birth trauma, we would find that they match perfectly. Everything a person felt during the birth trauma back then is reflected in the description of her current depression. Clear examples are contained in the list of depressive symptoms enumerated by my group of patients; they are expressing exactly what they felt as infants being born. The traumas set down in the womb, at birth and during infancy are coded, registered and stored in the nervous system. They become a template for what happens later.

Stress in the Womb and How it Lasts Forever

There is current research so important that all I can do is bow down and genuflect before it. It is research that supports my theories developed over forty years ago; but there is more. There are two studies , one from Germany (Hans Berger, Clinic for Neurology at the University Hospital), and the other is from the Netherlands, (Tiburg University).

In the Berger study; it was done on sheep because their pregnancy development is very close to humans. The parent animals were injected with a stress hormone, an analogue of cortisol. In premature fetuses it offers a better chance at life, helping the development of the lungs. This also increased the development of the brain, as well. One offshoot of this research was the finding that this alone, stress, alters sleep patterns perhaps for a lifetime. So if we want to know why we cannot sleep we need to look to the gestation period, but let us not look to shots of cortisol given to the mother; let’s look to the stress the carrying mother undergoes that operates just as if she were given a shot of cortisol. So if we have trouble sleeping now because the mother was stressed while pregnant. And by the way, if she drank many cokes, or coffee, or if she injected or snorted cocaine we have the same result; her system acts if stressed.

The researchers called this fragmentation of sleep patterns which also occurs in depression; and no surprise, there are serious sleep disturbances in depression. In other words, during gestation the mother may stamp in tendencies to depression in the offspring. This can last a lifetime.

In an unpublished but reported study it was found that in research on 40 eight year old children who were given cortisol-like medication during womb-life, they did much worse on key indices of behavior than normals. Their IQ was lower and so was their concentration and attention span. Again, when we look at ADD in children we must look at this research. Attention Deficit is above all, a distraction in brain processes that may come from major input very early in life. That input from a hyper, revved up mother, is far too much for the baby who is over-activated. The hyper-activation is impressed in the brain of the offspring, and so keeps the baby’s brain over-stimulated. He can no longer easily focus on one thing when so much is going on in his brain. Those early experiences form an indelible imprint for life. That imprint is never inert. It activates and re-activates and keeps us unable to relax, which was the case with the children. Investigators say they were programmed in the womb to release more stress hormones throughout their lives.

In the Tilburg Study they found that maternal stress between the 12th and 22nd week affected the later emotional and cognitive functions for twenty years later. So to reiterate, as if it needed reiterating, womb-life is critical for all later life, not the least of which is the advent of depression. They go on to say, “increased levels of stress hormones in the baby in the womb …play a larger role in the (later) development of disease than previously thought.”

It is not only about obvious physical afflictions but also about serious emotional problems, depression and anxiety. This again adds support to what I have written about. These scientists found the residue of stress hormones in the brains of the unborn. These means: 1. They could be under stress during womb-life, and 2. That the stress endures for a very long time. 3. This stress foretells of impaired functioning later on and possibly the beginnings of mental illness. 4. The damage can be permanent so that high blood pressure, heart disease, and in my opinion, Alzheimer’s disease can result.

It took a while for this research to appear, but how nice to see it.

The Mystery Known as Depression, Part 1/12

This is the first of a series of articles I wrote on Depression. The whole article has been published by ANS: The Journal for NeuroCognitive Research in October 2013. To see the full text: http://www.activitas.org/index.php/nervosa/article/view/157


1. INTRODUCTION
Depression has been considered a mysterious ‘monster,’ even in professional circles where it is still deemed an enigmatic illness.
The condition has proven so resistant to treatment that one therapeutic approach, based on cognitive-behavioral principles, calls itself “Taming the BEAST,” an anagram for “treatment modules” in Biology, Emotions, Activity, Situations and Thoughts. (Gilson & Freeman, 1999) Today, however, the most common treatment strategy is also the simplest. It involves the use of antidepressants, now the third most widely prescribed type of drug in the country, often administered by general practitioners untrained in psychology. (Mojtabai & Olfson, 2011) When neither drugs nor therapy are effective, some psychiatrists resort to that holdover from horror movies, electro-shock therapy, which is gaining renewed acceptance under a different moniker, electroconvulsive therapy (ECT).

Until recently, ECT was considered the last resort in the battle against the beast; it was used when psychiatrists concluded that the only option left was to blast the patient’s brain with electrical energy. Now, psychiatrists have gone beyond applying shocks from outside the skull and have opted for an even more radical alternative – brain surgery. (Mayberg et al., 2005) To say the least, it is a most drastic attempt at a solution. The procedure – known as deep brain stimulation (DBS) – involves drilling four holes in the brain with screws inserted into the skull. Surgeons then plant electrodes near the center of the brain in a region called Area 25, part of the subcallosal cingulate gyrus which has been identified as a having a key role in major depression. Activated by a pacemaker in the chest, the devices emit a steady stream of electric pulses to stimulate the area, thereby easing the otherwise entrenched symptoms.
Suppose, however, that we could access deep brain centers without any physical or chemical intervention and make alterations in the circuit – perhaps even rewire it – in a natural way. I submit that Primal Therapy does just that. It is possible to found a natural, non-invasive way to access the same deep brain structures that are affected by surgery and/or tranquilizers. And my opinion is that it is possible to successfully treat many deep depressions, and measure results through brainwaves and biochemistry. (For a detailed discussion, please see my book, Why You Get Sick and How You Get Well: The Healing Power of Feelings. [Janov, 1996]) By finding this psychotherapeutic avenue to the affected brain areas, we can avoid many misdirected approaches, especially the risky use of surgery and heavy drugs. Certainly, natural feeling methods are to be chosen over a serious brain surgery.

It is not that depression is refractory to psychotherapy. It is that psychotherapy is refractory to depression. In its current state, psychotherapy in many of its approaches is too superficial to change anything profoundly. It isn’t that depression cannot be touched by therapy because it is such a serious and unfathomable affliction; it is that conventional therapy is not designed to probe the depths of the unconscious where generating sources lie. And today it seems that the only way conventional therapists can get to those deep-lying imprints is through surgery or jolts of electricity. (The crucial concept of the imprint and its corollary, resonance, the gateway to deep brain levels, is explored in detail below.)

The reason we, as a profession, have had to resort to such drastic and dangerous measures is because most treatments thus far have addressed the neocortex; actually, the front left tip of the neo-cortex, the prefrontal area. Since clinical approaches such as talk therapy and behavior modification concentrate on the cognitive part of the brain, they may neglect the source and the site of the real problem. The success of the surgery itself, with some 80 percent of patients reporting their depression lifted, should tell psychotherapists that the site of the problem may lie deeper. The most serious cases are rightly referred to as “deep” depressions because the problem often emanates from the antipodes of the brain. To be clear, my opinion is that a psychotherapy for depression that fails to probe the depths of the brain, the depths of the unconscious, cannot be successful. The generating source remains untouched.
Diagnosis in psychotherapy too often is a matter of nomenclature, one that may not accord with neurology and the body that houses it.Conventional diagnosis is often symptom-based, focused on external signs – labored movements, lack of interest, and a bewildering array of other symptoms detailed below – while ignoring root causes. I propose a diagnosis, however, that encompasses the system as a whole – neurobiology, behavior and psychology as an ensemble, an integrated view.

Some leaders in the field acknowledge that psychology as a profession is in need of a radical overhaul. The debate about the confounding state of psychotherapy seems to escalate with every new edition of the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), considered the bible of mental illness and treatment. This year, on the eve of the publication of the D.S.M.-5, the first revision in almost 20 years, the calls for a whole new way of thinking in psychology seem more urgent than ever. On both sides of the Atlantic, there have been recent calls for a complete paradigm shift in the way we understand and treat mental illness.
In a prepared statement on the eve of the D.S.M.-5’s release, the British Psychological Association stated it was unhelpful to see mental health issues as illnesses with biological causes. "On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse," stated Dr. Lucy Johnstone, a clinical psychologist who helped draft the association’s provocative statement. (Doward, 2013) Meanwhile in the U.S., Dr. Thomas Insel, director of the National Institute of Mental Health, based near Washington, D.C., states that there can be no progress in the field so long as we continue to use the D.S.M. as our guidebook. He claims it leaves out the complexities of neuroscience, biology and genetics. The manual is even counterproductive, he argues, because it is used to deny funding to researchers looking for the real causes behind afflictions such as psychosis and depression, simply because their research proposals cut across the D.S.M.’s outdated categories. “Dr. Insel is one of a growing number of scientists who think that the field needs an entirely new paradigm for understanding mental disorders,” concludes a recent New York Times article about the controversial manual, “though neither he nor anyone else knows exactly what it will look like.” (Belluck & Carey, 2013)

According to my view the last part of that statement is fully true, the paradigm already exists. I am not a lone voice in the wilderness, but my opinion based on my experience and four decades of work is that for example “Primal Therapy”, that was in focus of my work and experience is one of them that offers precisely the new paradigm that is needed in modern psychology. But as with all new revolutionary theories in science, the status quo is slow to recognize fundamental changes in any field, and loathe to adopt them. (See the article by Agustin Gurza on Primal Therapy and scientific revolutions, originally published in the Journal of Primal Therapy (Gurza, 1976) and more recently posted online as an appendix to my book, “Grand Delusions.”(Gurza, 2005) What this paper seeks to address is precisely that paradigm shift, probing for causes and generating sources that have been neglected in our work. I agree that we need to reorient our field and provide a new understanding of mental illness, which I take as my task. What I am proposing is a total paradigm shift not only in our view of this affliction but also its treatment. We need to reframe our thinking about it, and recognize that what is missing is the "why?" We need to ask: What is depression, and where does it come from? Why is the patient depressed?

Since I first published The Primal Scream: The Cure for Neurosis in 1970, the subtitle became the lightening rod for criticism because we used the term “cure.” Nobody dares speak of curing mental illness. Yet the issue seems to be a double-bind. We utilize therapies that cannot cure, and then look askance at those who claim to have found one. “Cure” is not an opprobrious term. What is opprobrious is that we have given up on proper therapy and made it an unacceptable word. “Cure” is not a term to be avoided in the interest of pure science; it is a state to be sought after assiduously. We owe it to the millions who suffer from depression with no real hope of finding their way out of the darkness.

Depression has been a mystery for a long time because we have ignored the connection between a patient’s current mental and physical health and long-ago imprinted traumas experienced in childhood but also in the womb and at birth. That left us with a narrow range of choices: either drug the patient or operate on him. Preferably, we need to help him plunge deep into that unconscious. We need to help the patient find the nexus between his current state of depression and its deep-lying sources. Only the patient can make that connection inside himself; our task is to help him gain access to those deeper levels of brain function.
History will provide us with the answer; history is the cause and history is the savior.

Alzheimer’s Disease: What Causes It And How Do We Treat It?

There is some new work by the Rush University Medical Center (October 2013) that begins to inform us about Alzheimer’s disease. They say that experiencing traumatic events in mid life can lead to later Alzheimer’s. They recruited 800 middle aged women and followed them for 40 years, checking in to see if they had a trauma and when and what kind. This would include the death of spouse, caring for a sick relative or unemployment. For each of these events there was an increased risk of later Alzheimer’s disease By 20%. This was despite how well they seemed to cope with it. (see http://www.nydailynews.com/life-style/health/mid-life-stress-linked-alzheimer-study-article-1.1475610)

The researches claim that this is the best evidence by far to date linking psychological stressors with dementia. They go on to state that previous studies showed that stress hormones could help increase the build-up of proteins that are found in the brains of people with dementia. This means that serious disease such as dementia is related to stress. Not surprising. But wait! They have not touched the critical source of stress; the traumas during gestation and birth. In our clinical work we have found that as patients start to relive these early events the vital signs skyrocket, brain waves are increased in amplitude and frequency and other signs of severe stress.

We need to imagine what happens to a fetus fighting for her life because of lack of oxygen or of the carrying mother ingesting alcohol or serious pain medication.
There is terror and panic; her life is at stake, not the same as losing a job later on. The fetus cannot scream or talk or explain her agony but we see it in her biologic signs. And unlike the current research, the scientists, when discussing what to do about all this, believe the person needs stress reduction techniques to help eliminate the problem. I am not sure. I am very not sure.

The point is that these very early traumas are imprinted and are locked into the system for a lifetime. They form the basis for how later stress will be reacted to. That should be the next study; to see how the imprint plays into all this. I think it does in a big way; that primal stress is important in the later advent of Alzheimer’s disease. So if middle age stress can lead to disease think about how traumas on a naïve and vulnerable being can affect later illness. Just because the fetus cannot scream does not mean that she is not suffering. And that suffering continues on and on.

What we are planning to do soon is study the imprint and how to reverse it; that is the ultimate reduction of stress. We want to see if we can reverse history through reliving traumas. For if we can do that we may well help patients to avoid serious disease later on. We will measure the methylation process by which traumas are stamped into the brain. If we reverse methylation we may stop historical traumas from going on to do damage later on. We will reverse history. Think of that; stopping an imprint from going on to cause damage. That is mind-blowing.

The Role of the Placenta in Neurosis and Normality

I have been writing about gestational life for decades but I have never discussed the baby’s home, the placenta, in detail. We never seem to consider the placenta an organ but this is what it is,  secreting hormones and other chemicals just like other key organs. It is affected by trauma and reacts to it in its own peculiar way. Its home is against the wall of the uterus. It merges with the mother yet remains apart. It therefore seems foreign to the mother and yet is not rejected by her. The placenta is a kind of monitoring device mediating the all communications between fetus and mother. There is a constant “conversation” taking place between those two, mostly by chemical means. The first order of business for the placental is defense; keeping out all sorts of pathogens and harmful chemicals.  Thus it is both a communicator and a barrier preventing and allowing cells to migrate between one another. And indeed, fetal cells have been found in the mother for a long time after birth.



The placenta manufactures products that help keep the pregnancy ongoing and normal. Although it would be logical to expect a 50-50 split between the contributions of each parent to the placenta, such is not the case. Rather there seems to be a battle for whose contribution will dominate. So it is the father’s genes that help provide the growth of the placenta even while it is the mother’s genes that help impede its growth. When her genes do not do their job there will be runaway growth and serious disease. Runaway growth is often associated with cancer. But with no paternal genes here isn’t any growth at all. (Please see. Life’s Vital Link. By Y.W Loke, for a through discussion of this subject.).

While being carried about sixty percent of all nutrients are dedicated to the growth of the fetal brain; that is why slight changes in oxygen during fetal development can affect the evolution of the fetal brain.,  not the case with other mammals. The first step towards the formation of the placenta is “Taken soon after the egg is fertilized by the sperm.” (Loke). The placenta is a living organ that can go on living even if the embryo dies. It has a primitive nervous system that can sense danger and mount defenses including such neuro-chemicals as serotonin to fight invasion. It is from the embryo that one can harvest stem cells. And those cells are capable of healing diseases and extending life. But think of these implications for the placenta: it is the paternal genes that promote growth, and the maternal ones that impede it. If there is a faulty pregnancy those tendencies get disrupted, and we can get a too large placenta or a too small one. And changes in the biochemistry can alter how the genes will or will not be expressed.  If there is a trauma to the mother it is possible that part of the methyl group will be recruited to alter gene expression in the baby. The methyl can attach itself to the outside of the gene to either switch on or off the gene— epigenetics.


I have discussed the critical period in terms of when the baby must be hugged and loved; this is also the case for implantation. There is a period of receptivity for the implantation which is about one week after fertilization. That critical period is crucial if we want to make sure that the baby is properly attached to the mother. So the notion of critical period must apply to the placenta as well because it is, as I have stated, a living independent organ. The embryo must behave and abide by the rules of the critical period. It is no different from other aspects of evolution. Trying to be loved at the age of six years is a bit later for it to matter greatly.   Luckily, outside the critical window implantation will not happen.  Meanwhile, events in the womb are crucial for the later development of the baby. The placenta lives in an environment and that environment must be salubrious for the child’s health.  So we must not just focus on the placenta/uterus after so many weeks of gestation; rather, we need to be aware of it from the very start.



At birth something lives and something dies; the placenta is gone and the baby is alive in this world where the blood is then diverted from the placenta to the lungs, and a viable life begins.  The baby has left its home, so to speak, and strikes out alone, on its own without help from the mother to live. The conversation between fetus and mother has ended, and takes on a new role. There are now words and above all, emotions; the need to be hugged and caressed. And the relationship goes on from there.


And then serious evolution begins; the immune system and its natural killer cells proliferate and help keep cancer away. And those cells reflect how placental life has gone, as well. Has it prepared us properly for the menace and dangers in life? NK cells which protect us again serious disease are quite primitive and exist before many of the other cells have developed in the immune system. When those are inadequate at the start then we are not well prepared for the onslaught of trauma later on. We need to ask a new question: not only how has gestation gone? But also how has implantation and life at the beginning of placental life gone?  This is even before we can see a viable being.


Natural Killer cells are found in all mammals. And we do enhance those cells after one year of therapy. It may be because we go back with the patient into the beginnings of life. If those cells are deficient at the start of therapy they are not deficient after a year of therapy. We need to refine our research to make note of first line primals in those patients who greatly increased their NK cells. There seems to be enhanced NK development around the time of the critical period of the placental receptivity. The uterus has the greatest stockpile of NK cells, and it may be that early trauma impedes its proliferation making us more susceptible to disease later on.

The placenta is a powerhouse of chemistry, and adds to the hormones normally produced elsewhere such as the pituitary, and this includes the stress hormone., cortisol. Our “home” environment is not what we are used to thinking about when it comes to womb-life.  But a bad home life creates serious problems later on; and this home is far more important than later home life in childhood in terms of what diseases will befall us. Serious traumas, a mother depressed or anxious at the start can change the stress hormone output in the placenta and eventually that may translate to such diseases as Alzheimer's, decades later. We have to wonder why there is such a great amount of cortisol produced, and the key reason I think is to combat the intrusion of trauma.

In some ways the placenta acts like the relationship between the thalamus and the cortex, allowing certain input and rejecting others. The placenta is pretty much like a switchboard careful to monitor the amount and quality of nutrients and rejecting certain pathogens. It tries to keep a healthy environment for the fetus at all times. It keeps out infections in the mother and most often it blocks cancer developing cells. It is strange that each of them, mother and child exchange cells so the part of each is part of the other.

Finally, what is exciting about the placental cells is that they are also life-saving stem cells. They are saying, “I will become anything you want so long as you love me and take care of me. If you keep me healthy you will be rewarded with cells that can help give life and attack disease. And how does one do that? No smoking while pregnant. Live in a non-polluted milieu. And eat properly for both of you.