Arthur Janov's Blog, page 35

How I Know About Psychosis

I never smoked dope, did cocaine or drank alcohol. But what happened one day was that someone put hash in my cake, unbeknownst to me.  Nothing happened right away so they put a lot more.  One hour later I awoke with a start saying that Bob Dylan was playing inside my body, which of course he was.  When we listen to music it is also a physiologic process going on inside of us.  The hash wiped away all filters so I experienced something with no defenses left.  But that was not the end of the story at all.

I went insane for 20 hours.  I could not stand any input and guided those around me not to input anything; no conversation whatsoever.  Too many trees became overwhelming.  I showed friends how to keep me grounded; still I was nuts. It came out in poetry. I spoke only in poetry for hours.  And I had strange ideas.  The hash might have been innocuous to anyone else but with me and my lack of defenses everything below came to the top; and I sprouted poems that I wrote in my head which was  bubbling with feelings.  It was a benign psychosis but psychosis it was.

Aside from the drug helping me discover and write about the three levels of consciousness, it also gave me insight into psychosis. And we go crazy in line with what lies below.  You know the old saying about mean drunks and nice drunks?  Well, we go crazy in the same way.  Someone filled with rage is going to be a mean nutcase.  In other words when defenses crumble either due to life’s misfortunes or from the use of drugs like hash, the unconscious surges forward.  And it often takes over.  It continuously nudges the top level neo-cortex into action.  The result is often paranoid ideation, someone is trying to hurt me, or they are talking behind my back.  Once it fully takes charge there is very little awareness of what we are thinking or doing.

In my case, I absolutely had no room from any input at all.  Nothing could penetrate, which is why we can never talk someone out of his  psychosis.  We are not talking to the rational mind; we are addressing a brain that is flooded with symbols of his life.  It is not a matter of what ideas the psychotic is using; they are in the service of defenses.  They are an attempt to rationalize the potpourri of feelings rising to the top.  These ideas are essential and are not to be tampered with; surely not to be talked out of.  We need to see strange ideas in the context of the gestalt, of the overall function of the brain.

  We see all this when someone takes an hallucinogen which does pretty much the same thing, unleashing feelings.  Once out of the flooding state we are rational again and can become aware of how we reacted.  It is also true when someone has a transitory psychosis due to drugs; they suddenly get rational when the drug wears off.  But in true psychosis there is nothing to wear off.  The gates have been shattered and cannot close up easily.  That is the danger of most drugs including marijuana.  The chronic use of marijuana produces a paranoid personality.  Not only have I seen it over and over but there are many studies out there that come to the same conclusion.  Marijuana over time becomes dangerous.  It makes sense since any continuous alteration in the brain’s chemistry and routing will eventually produce damage and/or impairment.

   The brain is a most delicate structure, never to be fooled with.  We often don’t see psychosis here because this kind of psychosis is not so blatant.  Let me give an example.  We have friends in Europe who insist that someone (a movie star) was murdered.  Every bit of information pointed to a suicide.  But they would not accept it. They smoked pot every day of their lives.  The result was manufacturing notions that had no basis in reality……a benign psychosis.  In real psychosis the paranoid ideation is much more bizarre because it is driven by imprints very deep down in the neuraxis.  When an imprint evolves from deep in the brain it is heavy; because of its whopping valence the ideas it drives must perforce be far out and strange.  So we can be strange and slightly nuts or be a florid type of psychosis.  Choose your poison but be careful of marijuana; it is not innocuous in any way at all. Believe me I am not a moralist.    But I want to save mental health.  Marijuana is not the way.  I know that it temporarily eases repression in those who are intellectual and deeply repressed.  It makes you feel at ease … normal … for a time.  Much better to get to your feelings in a systematic way and not need drugs at all.

The Psychology of a Great Actor

  I  have often thought about what makes a great actor, not a good one, but a great one.  Marlon Brando is one, Gerard Depardieu (France)  is another.  I think what it involves is those with leaky gates and therefore great access to feelings.  They can portray emotions to their depths because they are already awash in them. It makes them great and already out of control.  They are impulsive, aggressive, narcissistic, having never enough love and attention, and above all, self referent: that is, everything they say or do is related to them. You say something and they immediately retort, “I remember when I..,……” blah blah.  They are always story tellers , and the story is usually about them.

    Their whole world is acting and that is where they are real. They can blend into any character and become that character.    Reality is not their thing except inside a fantasy character.  They have no self-consciousness because the self is in the character; they are not examining the character, they are living it.  They are it.  One of my actresses put it this way:  “I’ll be anything you want me to be, mommy,  if you will only love me.” Alas, that is not to be because because too often the parent is also self-centered and has no time or space for anyone else.  They cannot give anything to anyone.  The minute an actor steps back to look at the role he is playing he is no longer great; he is as they say in French, quelconque.  He  is everyman, a wanna-be.  Let’s be clear; when an actor thinks too much about what he is doing he is back in his head and apart from the role.  He has to be in it totally to be great.

      So why is their lives such a mess; and it nearly always is.  Because they cannot love anyone.  The unloved children go to a therapist who claims: you have to love yourself.  What nonsense. How can you when there is nothing inside to do that? That is a double mind-fuck. Now the children have to wonder, “What’s wrong  with me” Why can’t I love myself?  And if they imagine that they can love themselves then  all is lost because they have bought the fantasy without the essence.  If they knew anything about neurophysiology they would know that you cannot love yourself unless you totally distort the meaning of love, and neurologically there is a critical period when you can be  loved and only during  that period.  If you try to “love yourself” at age forty, good luck.  You need to be loved when the critical period for love is relevant and that is during gestation and infancy.  That sets your life.

    I am trying to figure out how you love yourself?  You tell yourself “I love you?”  You hug yourself?  Buy nice things for yourself?  What??  There is no good answer because it  is nonsense. This is doubly true if a great actor goes to therapy; he will incorporate the therapy and therapist into his narcissism and not change  one scintilla.  He can’t.  He  is  driven for love and manages to find a profession where  he can think he can get it:  Applause, “they just loved you tonight, “ blah  blah.  That is  what he gets for love but he keeps on perfecting his craft to get more and more.  I have treated some near-greats but the dynamic is the same.  Love me, love me.

  I have treated young actresses who run the minute there is an interview for  a role.  There is a desperation about it as there is so much at stake for them: a chance for love, approval, appreciation, attention; everything that was missing in their home-life.  They will settle at age twenty for hundreds “loving them” for what they missed early on.  And what they missed  early on is  gone  and will never be retrieved.  What they can retrieve is reality; feeling unloved.  And dialectically, that will finally enable  them to feel loved again.  The repressive barriers  have been penetrated and there is again access to real feelings and the ability to feel real love.  A major actor wrote a book about that after his therapy.  The point is that when you are loved you feel it and act it; you don’t go around saying, “I love myself.”  You don’t think about it because whatever you do is natural; the way things need to be.  You don’t run around thinking , I am tall.  That is simply the nature of things. So is feeling loved.  And if acting and getting love from thousands were satisfying then the actor would not be so driven to do it again and again.  But it is like a tranquilizer; it only lasts for a moment.  It is not truly fulfilling because the actor often cannot truly let love in.  Yes of course, there is the true artistry of acting and the actor wants to do it over and over, but I am discussing the inner drive, the ultimate motivation.

So why are actors and directors so depressed when not on stage?  Because they feel what  they really feel, profoundly unloved; they are bereft of their defense.  When they work they can struggle for love,  and there is hope again.  They see the applause, the approval and appreciation. It allows their defenses to work again.  And all is well in life.  They will undergo years of rejection, as they did in their early life, for that crumb of love.  They expect rejection; it was their mode of life early on; they know it well.

Where Do Anxiety and Panic Attacks Come From?

For years I have been discussing limbic fear versus brainstem terror; that is, as we go deeper in the brain the responses become  more exaggerated; mild hopelessness becomes suicidal hopelessness, fear becomes terror, anger becomes rage, and on.  The responses become more primitive as they emanate from a brain that is more primitive; older  and pre-human.  Those deep responses go way back in time to when they were the reigning animal reactions extant.  That brain is still alive inside of us and it provides all of the responses that existed millions of years ago.  In some respects we are still that alligator or shark with no pity or remorse, just instinct.  Those primitive animals are pre-emotion before caring and concern existed;  they do allow us to murder.  They also permit panic attacks.  And where do those attacks come from?  Ah.....They seem to come from a brain where panic is life-saving.  Where rapid and ferocious responses meant survival.    And where someone overwhelmed by his brainstem can  react exactly like the alligator does....and kill. He is acting out of his brainstem.

The panic victim feels threatened but  he doesn't know what he is afraid of.  Or, believe it or not, that he is  even afraid; it sometimes doesn't feel like fear; it is some unknown feeling that seems so alien.  I know what he is afraid  of..... Whatever  lies  in his brainstem.  Oh my, what  might that be?  That is the rub as  my friend old Willie (Shakespeare) noted.  When I was in graduate school I learned about antecedent-consequent reactions.  All it meant was that if there is a response something caused it.  Well in rage and terror something causes it; and it is not ordinary reactions; they are primitive in the full meaning of the term.  So far we have not known what that meant.  Stay with  me  now as it starts  to get interesting.

  What is clear in  my writing is that there are three brains in our head, (The Triune Brain), but we have ignored the first one, that I call "first-line."  In the first line  lies all of those primitive reactions; when there is trauma at birth or during gestation, long before we have an an intact emotional brain, our reactions are coded and  stored down on the first  line, the brainstem and the ancient parts of the limbic system.  When we suffer great trauma during those early times the gating system weakens and we have "leaky gates".  The trauma causes us to use up major supplies of repressive chemicals, such  as serotonin, that impairs the proper functioning of the repressive gates.....our defense system.  Not only does trauma use up serotonin; it damages parts of the brain that produce it, as well as dopamine and epinephrine.  This is especially true of smoking mothers, in my experience.

    We are less defended, so when we arrive at age thirty with  a panic attack it is such a mystery.  No longer, we can now understand its provenance.  It comes out of a remote nervous system, so remote  as to be constantly ignored, yet it is responsible for so much of our aberrant behavior.  Who would dream that inside us  lies all those primitive instincts that  can surge forth when our defenses weaken?  And up comes terror from a carrying mother who smoked and  drank  and who was effectively killing or damaging the baby from diminished oxygen.  That and many other configurations conspire to inculcate terror  in the baby that is imprinted  and sealed in  as a (Primal) memory.  When there is a panic attack or rage attack we must look to that brain for understanding and cure.  It is only with that brain that we can find  causes  and answers. And the cure involves reliving, as I have explained at length in my books and blog articles.  If  you all are interested I will go over it again but I think 2 blog articles ago I discussed in How to  Make a Cure.    Now comes the fascinating part:

Some recent research by Justin Feinstein at the University of Iowa City (Nature Neuroscience 2013), did a study with those who had a damaged  amygdala, the hub of the emotional system.  They did not have normal fear responses.  But if oxygen supplies were lowered and carbon dioxide supplies were increased, mimicking  suffocation (increasing acidity of the blood) there were panic attacks.  Where in the world  did those attacks come from?  Certainly not from the usual emotional structures.  They believe it includes the brainstem!  Because the lowering of oxygen supplies and adding carbon dioxide provoked the lower structures to sense the danger and reacted  appropriately.  Very much like what happens to a fetus when the mother smokes during pregnancy and produces those same effects.  What  all this means is what  I have been writing about for decades; fear and terror  are  two different reactions involving different brain structures emanating from structures million of years  apart in evolution.  However the emotional reactions have some similarities which allows resonance; that is, enough fear can travel  down in the brain  and trigger off those primitive panic/terror responses that I call first-line. It is not ordinary fear; it means a life-endangering cause and that come from our time in the womb and at birth.  In the  experimental patients, it meant and means  terror  of dying; that is what it feels like  to the sufferer because that is exactly what it is.  In the memory he is dying and the fear it evokes has a reason; a reason that is knowable. and therefore explains the reaction....and once known can lead to understanding about first-line and  a  cure.  If all this is ignored there will  never be a  cure,  no matter what the technique  use  to treat it.

    It is interesting that suffocation has such a great terror reaction associated with it.  And not so oddly in the panic attack there is often a feeling of suffocation, cannot catch one's breath, the heart beating so fast that it is about to jump out of the chest.  And these breathing problems are again brainstem originated (included the medulla of the brainstem).  It is all an ensemble of reactions originating deep down that later on set the stage for many kinds of pulmonary problems, asthma, shallow breathing and other malfunctions.  One other part of this reaction is that there may be a certain vulnerability for the suffocation feeling during birth; that is, if a mother smoked during pregnancy there is already a groundwork for the suffocation feeling at birth.  It  becomes  compounded, the anesthesia at birth in the mother and the background of a smoking mother.    We must keep in mind that this is all an imprint from the beginning of life that will affect so many parts of us including constant nightmares........again where one cannot catch one's breath; a nightmare of being in a dark room with no air or someone putting a pillow on our head.  It is fine to treat the nightmare, even to drug or medicate it but we cannot medicate an imprint; that remains to go on causing damage.  So nightmares, panic attacks, breathing problems pulmonary dysfunction are all part of an ensemble, a gestalt, if you will that must be considered as one problem, not many many problems.  Yes, there are many, many symptoms each must be treated until.....until we go to the generating source where it is all  treated at once and permanently.  What we must understand is that the physiology memory comes up intact with the whole panoply of feelings.  There is often too much terror to feel it all at once and integrate it.  That is why it needs to be revisited time and again.  So how does the patient know where it comes from?  Often not at first but after many relivings it becomes comprehensible. Clearly it is so remote an experience that it can be experienced but not immediately understood for what it is.  It is the same when reliving a gestational trauma.  We can experience it long before we understand it, and experiencing it is crucial for integration.  Non-verbal experiences can be relived and experienced on their own terms and in their own way; they can be integrated, nevertheless.  Let me explain further:

There are times when a patient can remember when his dog died, being hit by a car.  What  needed to be experienced and expressed was the repressed emotional aspect of the experience.  The pain needs to be unleashed and finally felt. It is the same with preverbal pains.  They need to be unleashed from their biologic constraints and fully experienced.  They then are integrated and become part of us.  That is the essence of a Primal.  We don’t have to know exactly where  it comes from because the fetus did not.  But he experienced it and repressed the pain.  It needs liberating.  It is what we do.

To reiterate:  because it is now established that lowered oxygen levels in the fetus creates panic in him, it should be clear that a carrying mother who smokes is damaging the baby severely.  Can he really feel terror?  I recommend to you the work of K. Anand.  He did an amniocentesis on fetuses and found as the probe invaded fetal space all of his stress hormones rose; he also grimaced and show signs of distress. He felt pain and terror.

    We have successfully  treated panic attacks (they are anxiety attacks, and they are terror attacks) and rage because we address the first line.  It is not a mystery; it just belongs to an ancient brain system that we have ignored for too long.  If we want to help those in danger of acting out in rage  and to help those who suffer panic we must travel to millions of years of phylogenetic history, deep in the brain  to find our answers.

Estranged From Nature and Evolution

We are all part of nature; the end result of evolution.  Not only are we bound by evolution but are the embodiment of it.  We are evolution; therefore, we must pay attention to it when we practice therapy.  When we ignore  evolution  we always will make a mistake in treatment.  The brainstem was in place before the neo(new)cortex.  And when we plunge patients into the brainstem in rebirthing, it is far too soon and premature in terms of  neurologic evolution.  We unleash primitive material far too soon in therapy; the result is an overload of high valence imprints which suffuse the entire cortex and scatter thoughts, concentration and  focus.  What happens then is the concoction by the patient of weird ideas,  bizarre notions and  non-reality based thoughts as the lower levels feelings drive the cortex to manufacture something that will help suppress those very same feelings.  So heavy feelings cause the production of indigenous tranquilizers—thoughts and ideas —to shut down those very same feelings.  In this case those ideas are the result of repression and is also the agent of repression—the dialectic.  And now we see one key factor in evolution: the ability to fabricate ideas in the service of repression.  And it may well be the one key reason for the evolutionary development of ideas;  to be able to escape the enemy from within…feelings.

  Now let’s  turn it around; the therapy that involves ideas and insights as its key mode.  Cognitive therapy gets stuck in the last stage of evolution and neglects feelings and our history both personal, (ontogenetic), and historical, (phylogenetic).  So on the one hand we  have a therapy that dives into heavy primal material long before we are ready for it, and on the other hand, we remain on one level, in one mode that neglects evolution completely.  Both are  dismissive of evolution and, remember, we are evolution.  And we can perform this neglect when we ignore feelings……too deep too soon; or too late, too late.  We must never be asked in therapy to express  or say our feelings because that is an oxymoron.  There are many pre-verbal feelings that  have no words  Putting words to them  negates those specific feelings.  It uses one level to get to another (words to express feelings); when they are separate and independent.

  So when we anchor the patient in the present and make a slow descent into feelings it will all be natural  and in evolutionary order.  We have to return to the past because that is where feelings first evolved.  Repeat:  the natural order helps us become natural and normal.  We are no longer estranged from our nature; and what that means is that we feel a  commonality with  animals and plants and flowers.  We can again see beauty; that is one effect of a feeling and evolutionary therapy.  That is one effect that cannot be achieved in cognitive/insight therapy.  So long as the feeling band is missing we cannot be at one with nature.  Rebirthing does nothing to re-establish the feeling band.

Feelings do that.

    All this means is that our history lies inside of us; we respond to two worlds at once.  The outer world and the inner one. If there is too much input from our imprinted history we cannot take much from our outer world.  We cannot stand much stimulation.  When there are  imprints from gestation and birth that are lying in wait, trying to get out, moving relentlessly upwards and forwards, putting pressure on the neo-cortex, there  is a tendency to be easily overwhelmed.  Here lies ADD and confusion.    Added to it is addiction, deep, deep addiction in accordance with very deep imprints.  Here lies hysteria and over-reaction.  Here lies impulsive tendencies. Here lies weakened cortical control and  “leaky gates.”  The gates are in an endless battle to keep too much input away so it cannot be overloaded.  And,
 here  lies impatience and intolerance; here lies a mess.

How to Make a Cure (Part 2/2)

It is those deep and remote imprints that set up a background of pain that need quieting. But until we understand early imprints we can never find a cure for deep addiction. Let’s say it again: stress in the carrying mother is passed on to the baby in the womb. The stress receptors undergo serious change and helps produce the platform for the baby’s latent stress/anxiety level; all because of bickering over time between the parents. And chronically high stress levels not only decrease immune function but increase the possibility of tumor growth (in animal studies). So when we come down with cancer at thirty we need to change our diet and exercise more, stop smoking, etc. etc., but most importantly, we need to see if the carrying mother was under stress; was there spousal fighting or was there a war going on? Was the mother depressed? These are the factors that count so much. These are the intangibles that create so much tangible wreckage. Reuter’s Health (Aug. 21, 20012) reports that mothers who smoked while pregnant gave birth to children with a much greater risk of asthma.(See )
 Speaking of serious disease--cancer, there are many studies extant correlating parental abuse with later cancer. A study (“Children abused by parents face increased cancer risk.” Purdue University, Science Daily, July 17,20012, see http://www.sciencedaily.com/releases/2012/07/120717121922.htm ) from Purdue University found that adults who were emotionally and physically abused as children had a much greater likelihood of cancer as adults. The more intense the abuse, the more likely the cancer. Imagine now if we have left out of the mix one of the greatest risks of all: constant abuse while in the womb—a drugged mother, a depressed one, someone who is chronically anxious or tense and angry. Add that to it all and you have one of the great causes of later cancer. Mind you, that the critical period for so many functions lies in gestation. It is a time when the imprints that are laid down are engraved into the system and almost impossible to eradicate. The damage sticks and has lifelong effects. We carry that primal burden every minute of our lives and there is no escaping it. It is the appointment in Samarra again. In the old tale, someone fears that death is coming to get him and moves to a remote city (Samarra) to escape him, only to find that death has changed his plans and will be coming to Samarra. There is no escape from primal pain, and yet many of us spend our lives running from it.
 It is clear that if we want cure, we need to descend to the lower depths, the zone of the interior to read the notes from the underground. Those notes have a most painful message, can only be read a bit at a time. An example of delving deep: below so much of depression lies hopelessness (I have written extensively on this). If we could relive current hopelessness we would still be dogged by a memory where mother smoked or drank and endangered the life of the fetus. In short, depression would persist because of preverbal experiences that were never resolved. It would be deep and unexplained depressions, a seeming mystery because it comes from so deep and such remote places. We would alleviate the depression when we addressed some of it (hopelessness) in current life but it never would be cure. If you do not believe in imprints then all is lost and you will never arrive at the generating sources of an affliction or symptom.
 Let’s be more explicit. When we are depressed there are biochemical elements involved in addition to the psychological symptoms. Those same elements in inchoate form exist in the womb so that when the mother smokes incessantly or drinks, the baby cannot escape: the biochemistry kicks in and there is the starting basis for depression. It is that aspect of depression/hopelessness that resonates when one feels depressed in the present. When the fetus is in an inescapable situation and feels helpless and hopeless, as when he is suffused with smoke that reduces oxygen supply that the elements of depression occur. It is not called that in a six month old fetus but he now is beginning to have the building blocks for it later on when we can give it a name…depression. It is repression raised to a higher level, due to the tremendous force of the original imprint. And what can happen when the fetus is overwhelmed with the inescapable input is that the brain does what it can to combat that deleterious input; sometimes the brain is pushed to such a limit that the seeds of serious mental illness are set down. The brain is awash in the massive imprint, which does not go away. It starts with ADD when the child is young and deteriorates later on into mental illness. And when he goes to a doctor to see what is wrong…..heredity can be the only answer……because no one can imagine the imprint and its effects. And no one can imagine the epigenetic effects of how memories are sealed in early on. One way is through methylation (adding part of a methyl group to an imprint). This changes how the genes are expressed or not, and that leads us to claiming something is hereditary when it results from experience that changes how heredity is expressed. But more on cure in a moment.
 There is not a great deal of difference here between physical and emotional pain. When someone feels lonely or rejected she hurts just as if she were burned. Part of the limbic system is critical in both kinds of hurts (the anterior cingulate cortex lights up in both). Being rejected in high school (possibly a critical period in some) can leave a residue of that feeling for the decades to come. It leaves an actual mark so that in a recent study those with chronic feelings of rejection died much sooner than controls who did not feel that way. (see: “Childhood Trauma Leaves a Mark on the brain.” Translational Psychiatry, January 15, 2013. Carmen Sandi et al; see http://medicalxpress.com/news/2013-01-childhood-trauma-brain.html ). Loneliness can be traced all the way back to just after birth when a child must be held and caressed. If he is not held, then he hurts for a lifetime and dies sooner. Pain and repression kill. Neurotics die earlier. It turns out that chronically lonely people are more likely to suffer Alzheimers and Parkinson disease. Wherever we look we find the same thing: early trauma has terrible effects later in life. (see: Social Science and Medicine. Vol 74) What is most important from my perspective is that when the brain is marked by trauma, it helps deplete serotonin supplies; and when that happens we have what I call “leaky gates’ for a lifetime. We are then less effective in our efforts to repress. Pain roils the brain. We are disturbed and cannot concentrate or learn. This was found in a study in Quebec, Canada (June, 2012. European Neuro-pharmacology; see http://www.ncbi.nlm.nih.gov/pubmed/22257439 ). Traumas around birth showed lower serotonin in the hippocampus. (lower C-AMT trapping). Here the study reports that limbic pathways were impaired during birth trauma and there was a greater vulnerability for psychiatric disorders later on. Here we see that birth trauma can affect us for most of our lives, and that happens when serotonin is so weakened that it cannot do its job of repression. The gates are leaky. And what do we prescribe for this condition? Something that makes up for what was impaired at birth……serotonin. Prozac is exactly that drug that boosts missing supplies. And why does serotonin play such a role? Because it is largely a “gate-keeper.” It provides the defenses we need against pain. It is the missing molecule depleted when traumatic birth occurred. It is making up for what is missing. We take it to try to feel normal; to normalize. We have to keep on doing it until we go back to the original trauma and relive it, making the connection that is integrating and resolving. Then we don’t need pills every day. We no longer try to replace missing parts; we re-establish harmony and change what is missing. Our studies showed that. Patients low in serotonin at the start of therapy came up to normal at the end (Imipramine Binding, Paris, 1982). What this shows is “cure”; levels become normal due to primal/reliving. It was more than an amelioration and more permanent. Here is what cure is about: making permanent change, not trying this or that to see what works. We need a theory to achieve cure in psychology.

 Sticks and stones can break my bones but words can really hurt me.

 Recently, they have found a specific neurosis associated with a birth trauma: namely obsessive-compulsive disorder. Thus, children with OCD are much more likely to suffer a birth trauma than controls. (J. Adol. Psychopharmacology. 2008, August; 18 -4- 373-9, see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935829/ ). And the question is, why does this reaction get imprinted and lasts so long? Because it is essential for survival that we remember what is dangerous and how to react to it. We need to have the capacity to feel terror and get galvanized to react immediately. Survival is rarely a leisure activity. Part of this is that the secretion of nor-adrenaline affects the amygdala and elements of the brainstem, which are mobilized. We become hyper-alert and ready for action, and this alertness interacts with the memory system to direct our efforts.

By the way, the same has been found for bi-polar disorder. Not a surprise, and I have written about this for 45 years.

 It turns out that there are signs of oncoming panic. (Scientific American, Aug. 3, 2011) The subject is usually not aware of dizziness, trembling, agitation, that form the precursor of panic attacks. It is as though the pain/terror is on the rise and we are not aware of it until it is full-blown. Because the terror is set down so early, in the beginning months of gestation and imprinted so deep in the brain, we have no idea where it comes from. Terror surely begins its life in the brainstem and in archaic parts of the limbic system (amygdala). It is only when the gates falter and the terror bursts through that we become aware of it. Being aware is only half the job; then the work begins……getting to the source and reliving it.

How to Make a Cure (Part 1/2)

So you think affecting a cure is complicated?  Not that much.  But it does take a little thought.  Not much;  just add a heavy mixture of feeling and you’ve got it.  So let’s see how we do it. And while we are at it, let’s define it .  Not so difficult: cure must be tied to causes, to generating sources so that we can eliminate those events that caused it all in the first place.  If we leave causes aside, we can only palliate, and that cannot be cure.  If there is no “why” in the equation, there is no cure.

  First, we know that the brain has two sides; one more feeling and the other left side more thinking, grosso modo.  And that  the right side develops earlier than the left and absorbs  so much early trauma long before we can understand it and  give it a name.  We are driven by those right side imprints so that by he time we are born we are allergic, colicky, (and choleric—bad tempered), nervous and have to constantly move, epileptics, and so on.  So we are taken to  the  doctor who is mystified. But it can be  understood and treated….if…….if  we follow  science and brain development.

  The first thing to know is about the imprint and how and when it is set down. Then to know how imprints affect the whole neurophysical system.  Then how the imprints endure and run our lives forever.  Then, how to reverse the imprint.  It can be undone biochemically or, more sure and effective, through primal therapy.

  We do know that it is the right brain that is active when we retrieve old memories and when we relive those memories,  and it is only through that brain  that we can get to those memories, very early ones, that were registered on the right.  Otherwise no matter how much we dig  down, when we leave those memories  intact that still affect  and drive us.  (see all of Wilder Penield.  Also, Journal of Clinical Neuroscience. 9  420-8).  When we are in an intellectual therapy we will never dig out those early memories.  In our therapy we dig them out in nonverbal ways, nearly always through physiological means that have resonated from above. That is, when something higher up elicits the same kind  of feeling only deeper and nonverbal down below.  The point is that when we use talk as the key mode of therapy we still remain driven  and unresolved.  We  still leave a cache of feelings lying in wait.  Interestingly, when we  electrically stimulate the right side those early memories and early past experiences come up.

    When a baby or fetus is traumatized he is more sensitive to later stress.  His immune system is affected and he is more vulnerable to such things as Epstein-Barr disease or the herpes virus.  In other words, when there is a virus around he will be more liable to fall ill, especially if he were unloved even in  the womb (did not have his basic needs fulfilled).  (Health  Psych.  2012. July 2.  Fagundes CP et al.).  These afflictions are not considered mental illness  but they are often the same imprints involved in serious mental ailments.  Here there is dysregulation  of immune function but it can  other effects, as well.  Do we want to alleviate that immune problem or cure it?  To cure it, we must find the imprints.  They are there and when the patient is given access he will get there.  Memories will come to greet him.  Yes we must treat the allergies, etc., but that only deals  with manifestations not cure.

  So what sets cure in motion? The necessity for connection.  Connection of what and to what?  And what is that connection?  It means feelings moving from the right to left brain (connection), and sensations and feelings moving vertically from bottom to top  (from brainstem to neo-cortex).  All roads must lead to the cortex; from the unconscious to conscious/awareness.  They must move both horizontally and vertically.  The deepest sensations generally move from low in the brain  upward and forward to the new cortex;  they must move,  in short, following the dictates of evolution, from history to the present, from preverbal to verbal, from feelings to ideas and comprehension.  It is evolution  that dictates how the therapy shall  proceed, and we can abrogate that at our peril. When everything converges at the top we have consolidation and integration; we become whole and one.  We are no longer driven by the unconscious and finally can achieve a bit of objectivity, even in doing psychotherapy.  This is only a guess; it may be that we dredge up first line deeply placed first-line pain vertically, while the more feeling aspects are brought in horizontally.  Not at all sure of this.  It seems like first-line has a longer way to go to reach the frontal area.  But logic may not be logical.

    Contrarily,  we can perform therapy by evolution in reverse; using the neo-cortex to travel back down to suppress feelings.  Through the hope of getting well the patient is more repressed and sicker. He uses the last tool in evolution, language, in the service of repression instead of expression.  That is why insights/language  must always follow feelings and not vice versa.  You cannot fool with mother nature and her timetable.  If words came after feelings in our lives and in our history they must do so in our therapy. There is a reason to follow evolution because that is how our adaptation was built.  The problem is  that those who are repressed claim they feel better after cognitive help…..because feeling and pain are further away.  The mindfulness people think this distanciation is good.  I cannot figure out why.  They teach us to be more mindful  instead of more  feelingful.  They trounce evolution in a flight to their head.

    So how do we know that feelings are so important?  And that early imprints count for so much?  There are literally hundreds of research studies underlining this point.  There was a review of this work in the economist (July 2011). The major point they made was that a carrying mother’s stress can have long-lasting effects on how the genes unravel in the offspring, (a process known as  epigenetics). Those brought up in abusive and unloving homes (famine, violence, war, divorce, etc) had life-long changes in their development, including chronically high levels  of the s tress hormone, cortisol.  Women who were abused  by their husbands had children with excessive methylation of their  genes; an alteration  in how  the genes evolved.  And this alteration was passed on to the baby just as if it were inherited.  In this way, and in many others, the anxiety and depression of the carrying mother get translated into the baby.  And  the baby is born with an enhanced tendency to anxiety or depression in addition to chronically high cortisol levels.  In short, he is born stressed.  Later on,  he will over-react to tense events with higher stress levels. (See the study done at Welcome  Laboratory in the neuroscience department of the University of Bristol, England.  August, 2011). 

Their work emphasizes the long lasting effects of early trauma.  Higher stress levels affects learning and, above all, creates serious Attention  Deficit.  This is the definition of post-traumatic-stress-disorder.  And the point is that many of us carry around this latent high  stress level for a lifetime. (We tested many of our entering patients for cortisol levels, and they were  universally high).  Then we add an unloving home and other stress so that the latent levels  are inordinately elevated.  So then a man enters combat and later suffers PTSD, we think that combat did it.  Combat only exacerbated the reaction and made it manifest; it became an overt symptom.  He was already PTSD, only latent.  There is a recent study that shows that those who had combat fatigue generally had more trauma in growing up.    To cure this affliction we need to deal with combat and also the adversity from childhood that set the stage for it.  In other words, there were antecedents for this affliction.  Cure occurs when all the current and antecedent factors are addressed and relived.  (please see: “Embattled Childhood, The  Real Trauma in PTSD.  Scientific American Mind, Nov. 2012).    So a soldier can be aware  of his combat trauma and unconscious  of the traumas underlying it.  It is what we can’t see that  does so much damage.  Moreover, it is the traumas that occurred during the early critical period that are so deleterious; the critical period means when a trauma is set down while need is greatest and pain is at its asymptote. It means that imprint sealed in is almost irreversible in its effects (excluding Primal Therapy).  War usually doesn’t happen during a critical period but it is such a powerful force that its effects can be engraved  just as during  a  critical period.  It turns out that  PTSD is more predictable by childhood abuse rather than combat experience.  The internal war zone seems to be of utmost importance in producing PTSD.  There is, therefore a confluence of two traumas, one we cannot see and the other that is obvious.  We must not only treat what is obvious if we want to make sure that the PTSD does linger on and on.  To leave the basic prime-evil imprint intact and untouched means always that we must do something each day to handle the symptoms which never seem to go away.

    Abused children do have a dysregulation of their response to stress.  Cortisol is sustained, becomes toxic and does its damage over time. The person becomes hyper-reactive and over-responds.  And in the mother it can be passed on to the offspring.  He is born with a tendency to be anxious and hyperactive; born, maybe, with a propensity for Attention Deficit and learning disorders.  It sure looks like pure heredity but it’s not.  It is experience, laid on top of what has been inherited; an experience during the critical period.  It seems like one abuse cannot be that bad; but it is one abuse among many, and an abuse that is imprinted and endures and becomes a lifelong abuse.  That is why we must always include the concept of the imprint in any attempt to understand human behavior.

    I have discussed methylation before; the way that  part of the methyl group helps alter the expression  of a gene and seals in the  experience; thereafter, we have something that can  drive  our lives maybe forever.  A mother who fights with her spouse over time is  setting up future behavior on the part of the offspring.  It just doesn’t upset the mother but it also upsets the baby for life by changing his genetic evolution.  These are the experiences left out of the usual psychotherapy that are key motivations for how we behave, how we learn and how and if we make love.  It also plays a part in if the offspring can have children or is sterile.  It can also help determine if we become obese, to say nothing of mental illness.  In this period when the body and brain are rapidly developing, it is not a surprise that adversity affects so much of us (body and brain).  When a carrying mother is chronically stressed and anxious it affects the HPA axis (those of you who know about it, fine, and those who do not know the details can  look it up if you are  interested. Not important for the layman.), and therefore sets the stage for later anxiety in the offspring.  It can set up changes in his stress regulation mechanisms, and some of this is accomplished by methylation.  These are known as epigenetic events; beyond genes. Yet it happens so early it looks like genetics.  There is little question now that stress and chronic anxiety of the mother affects the baby’s HPA–hypothalamic/pituitary/axis.  It heightens cortisol levels, and chronically high stress hormones affects so many functions later in life, not the least of which is thinking and memory.  (see: KM Ratke, et  al, ‘Transgenerational impact of partner violence on methylation in the promoter of the glucocorticoid receptor.”  Translational Psychiatry, 2001).  Much further down the road it may affect the development of both Alzheimer and Parkinson disease.  

What is important here is that in utero, events and trauma set the program for adult behavior.  Especially afflictions such as heroin addiction.  The person is trying to calm something inside that she has no idea it exists or what it is.  Years later there maybe panic attacks that seem to come out of nowhere.  But they come out of somewhere; it is our job to find out where.  If we ignore early womb-life experience we will never discover origins, and we will keep looking into the current environment for answers.  What  is clear now is that some get addicted to heavy drugs to keep panic attacks from happening.  That is, it may be the same imprint involved in both; only the drug user has found a way to block it.  Not different when the panic-laden person who goes to a doctor and gets some of the same pain-killers included in heroin.
(To be continued...)

What Does the Unconscious Make Us Do?

  I often note that we are driven by our unconscious;  so what does that mean?  What drives us and how?  Memories; not often verbal but memories, nevertheless.  Let’s recap a bit.  We have traumas very early in life that become imprinted  and remain locked-into the system.  Imprints usually mean that key needs were not met; as for example, in the womb, a lack of proper nutrients or a mother who  smokes and drinks.  Oh by the way, there is a “scientific” report this week  that states that  it is OK for the carrying mother  to have one drink.  NOT SO, EVER.  It affects the fetus developing brain and we can  only imagine what alcohol does, but whatever it is, it is not good  and should never be allowed, even by the sages among us.  And when one drink leads to another with one puff leading to another we have  the makings of later serious mental illness.

    So key needs are left unfulfilled and the system remembers it for a lifetime, and it drives us for a lifetime.  And the act-out is  direct  reflection of the early imprinted memory.  The imprint means pain, a pain of such magnitude that it must be repressed.  And act out is in some way a means of obtaining  fulfillment.  Maybe later it can mean overeating to make up for starvation in the womb.  Or it can be a sexual act out as the person needs touch and caress which went missing just after birth.  The earlier the imprint the more powerful it is and the stronger the force attached to it.  That translates into obsessive compulsive behavior as the drive is so strong as to be unrelenting.  And so when someone finds religion as an act out, it is often because she needs someone  to care  and protect her.  Someone to watch over her and be there the minute she needs him .  So long as there are unconscious imprints, there will be act-outs.  Smoking is a great act-out; the minute there is pain, often not aware,  she reaches for a smoke.  It is always there and ready to ease the pain.  It is the  nature of the pain that it is repressed so that we are seldom aware of it or our act-outs.  But breathing deep and feeling the warmth from the cigarette go deep inside is relaxing and addictive.  And so what do the Behaviorists do?  They try to stop  the act-out, stopping the only possible release there  is and the only possible means of seeking out fulfillment.  I have seen too many actors and directors  who get depressed when they are not working.  They need that outlet all of the time.  When it is not there they slip into depression.  Why?  Their act-out is removed for a time and  they are left with their pain and unmet need.  They are literally bereft.  They are getting close to, “Love me momma,  hold me, be with me!”  They smoke and drink more and do what they can to keep pain sequestered; again, a pain never or rarely acknowledged.  I was once consultant on a film where the director, so insecure, kept sending the star notes of how much he admired and loved her.  It eased her and him.

  When we examine the nature of the act-out we can often pinpoint when the imprint was set down and how.  One patient could not stand enclosed restaurants.  She needed a constant supply of air.  She became claustrophobic, and it got worse  and worse.  Until she felt it; and, as we suspected, her mother’s cord was wrapped around her neck and she could not breathe.  Another patient had to keep moving, could not sit still, was ADD,  and needed to travel  all of the time.  She was blocked in the canal and had a terrible time getting out.  Her anxiety was having to sit still;  and  when she was blocked in a line she became anxiety ridden, the very same anxiety she had originally that had no name.  Now it does, but that name does nothing toward a cure.  It is what that name signifies  that matters.  Here it means being blocked when its result meant life and death.  It is the meaning that matters and not  the  resulting act-out alone.

  We see the importance of the act-out, because  removing it opens us up to  pain.  So someone deprived of enough food in the womb is forced to overeat, that is, eating for now and  then.  The act-out seems neurotic only because it is behavior out of  context.  The minute we put it into context, it becomes real and adaptive.  To relive being born and not immediately being held and caressed makes it clear to the patient what his act-out of having to be connected at all times means.  He was detached from his mother with nothing to hang onto. His mother was quite sick and had to be isolated from several weeks.  He had to feel  this over and over again as it was set down, not as an adult crying about it.  The pain of it went on for weeks and had to be relived methodically and slowly over time.  It could not be rushed. But the more consciously aware it became the less force there was left and  therefore the less he was being driven to act  out.  He did not have to get on the phone whenever he was alone in order to feel connected.  He experienced the ultimate primal disconnection.

  What is in the unconscious?  A lot of pain and a lot of memories……..engraved.  These are not just verbal memories; they are systemic, infused into every cell in our bodies.  If we want to get rid of frigidity and other sexual problems, we need to experience a therapy that is global and physiologic; not simply intellectual.  We need to free the body of its pain.  The whole body must be involved again in the memory; otherwise it is a mental event.  Too much of today’s therapies deal with act-outs because it is only a matter of behavior to change.  We are not just changing minds; we are changing all of us because that is where the pain is.

How to Deny Your Feelings and Die Early?

I swear I try to avoid nonsense, but when it stares me in the face, and when it appears in a scientific journal, I feel I must reply.  Scientific American published a piece on anger and anxiety by cognitive people where there is not one word about what anxiety is or how to treat it except … except through changing your mind and thinking your way to health.  (Sci. American 1-4-13).

   What the article states is that we cannot always avoid what upsets us, so we need to reframe the experience; that is, look at it differently and deny our feelings.  In short, use our prefrontal cortex to suppress our feelings.  But of course suppression does nothing to eliminate the causes of anxiety.  And therein lies the rub; the imprint lying below still continues to do its damage to our organs and behavior. No denial can change that.

  It all depends here on their experiment;  (by Dominik Mischkowski and others), where they had a group of volunteers (students), led them to believe they were waiting to start, kept them waiting, were curt with them, and later asking them to reimagine the situation.  There is more but that is essentially it.  What that has to do with real anxiety, I do not know.  It seems more like annoyance.  Their conclusion:  the next time a car zips in front of you don’t focus on the anger.  Imagine yourself looking at if from a distance, and “KEEP YOUR EMOTIONS AT ARMS LENGTH.”  Some advice.   Keep feelings at a distance…..and become robots?  Or what?  Is this science?

   What they say is that it is not hard to dwell on the bad but focusing on the good could be the difference between health and sickness.  It is quite the opposite; denying feelings makes you sick and hurries along a premature death.  I have quoted study after study to this effect in my books.  But look at the logic of it: keeping down and suppressing feelings is healthy?  I suppose you could come to that conclusion if you deny history, deny imprints and neurological science and focus only on the present, which the cognitive people do ad nauseam.  Feelings are the essence of life; why would we want to deny them?  But scientists who live in their heads can do this because they do.  So when a loved one dies we are supposed to think, how can I think about this differently?   Crying is so essential that those who cannot cry fully need to go to grieving therapy to learn to cry so as to get some relief.
Can we really think our way to health?  When over-thinking is the way to sickness.   Those who come to us who live in their head have to learn to recapture their feelings again and become human.

  And if all else fails in their approach, they say it helps to write a journal about it; another way of keeping it intellectual.  Why not feel those feelings; they are a natural response, not an aberration to be hidden and forgotten.   There is a reason that feelings exist,  otherwise, evolution would have denied and eliminated them.  They are a survival mechanism and as important as hunger and thirst.   Feelings inform us who is good for us and who isn’t.  Especially who is not is good for us and wo will not be dangerous.   Feelings predate thoughts and long before we think they inform us about life.   They are life, in essence….ecstasy, beauty and love.  When  you lose your feelings, you are dying.

  What I think happens is that advanced university graduates apotheosize the intellect and denial is their way of life which they then elevate to the level of a theory.  And then they find a therapy that accommodates this concoction (sorry, but it is a concoction out of their life style).   They  help patients get sicker in the name of psychological health.  After all, they made it through life with their intellect, why not the rest of us?

  They use phrases such as “moving past unwanted, negative feelings.”  And they dress it up with a “scientific” phrase called self’-distancing.  All that means is how to run away from feelings.  Do I sound angry?  I am, because people read science to find out how they can feel better not die earlier.    They note that denying feeling is healthy coping while suffering and feelings is unhealthy coping.

  So it is a turn on the old idea of thinking your way to health.  Why are our feelings unwanted?  They are natural reactions, not aliens.   The researchers recommend being distant from feelings.  Is that mental health or is that denial in the name of mental health?  And denial is not just an idea; it means repressing feelings and most often that is not healthy, unless you want cancer and heart disease.

Can I Hurt Your Feelings?

I have long maintained that this was impossible since feelings can hurt but cannot be hurt.   It is like an oxymoron: how can we hurt something that is already hurt?  What we usually mean is that something we said sets off something in someone else that pains them.  Then they hurt, usually only when what we said resonates with some hidden pain. If we say, “You are wrong.  You made a mistake,” it can set off years of criticism by one’s mother who demonstrated in this way that she hated us.  Therefore any criticism hurts our feelings when it sets off already hurt feeling buried inside of us.    So it is not, “I hurt her feelings;”  it is “ I said something that triggered hurt feelings inside”.

    Let’s look at this from another perspective.  We have a brain structure called the dorsal anterior cingulate cortex (dACC).  It is central to our limbic system/feeling center.  When we begin to feel isolated or neglected this structure takes part and adds the “hurt” to our reaction. It becomes part of our pain network.  (see: New Scientist, 1, Dec. 2012, page 37). This structure adds the force, valence or oomph to our reactions.  But when we hurt emotionally there is another group of structures, the sensory group, (the anterior insula and others) that enter the fray and helps the emotions become physical hurt.  They become intertwined and are “one.”  Feeling neglected hurts both emotionally and physically.  Emotional hurts, in short, have bodily accouterments; which is obvious.  So when our feelings are hurt we hurt physically:  it is not simply “in our head.” And therefore “head” therapy or cognitive approaches cannot touch it.  Remember, we are in pain.

   When we say that “breaks my heart,” it is literally true, and  it can kill as readily as a gunshot.  I have on film a woman I treated who was feeling deeply and who cried out, “my heart, my heart.”  When she came out of it she felt her childhood heartbreak (sent to a foster home)  and how much it affected her heart. Normally, repression keeps that from happening, except that repression  does not erase it; it only drives it underground.  It is repressed feelings that can kill us; for they do affect our organs, especially our heart.  There is no escape; either we feel or we suffer.  Pills can sometimes take care of parts of our hurt but they only suppress the conscious/awareness of the hurt, not the hurt itself nor its provenance.

  Very early trauma can affect (mutate) a gene that helps construct opiate receptors that should dampen pain.  And that can therefore exacerbate our reactions to hurt early on.  (receptors are very dense in the dACC).  We become more “sensitive” as human beings.  It becomes part of our personality.  These people need more opiates later on to make up for what was and is missing.  They may be  the “over-reactors.”  And then we can add the epigenetic factors, traumas that occur while we live in the womb and just after, which compounds the problem. We then suffer, compounded, chronic pain; it may not show itself as such, but it can manifest itself in chronic allergies, which was my case.  I had a runny nose that lasted years after I was sent away to a foster home when I was five.  I knew nothing about pain. We see patients all of the time who claim never to have been in pain or feeling unloved; at least at first.

  So we have genetic mutations coupled with epigenetic factors that compound the problem and produce highly sensitive beings.  They were known by Freud as “hysterics.”   The memories are imprinted and stay for a lifetime because we are then structurally different.  So lack of love in the womb (a carrying mother who diets, smokes and drinks and who is chronically anxious), remains as a new part of us with a different brain and biochemistry.  Not only is the anterior cingulate active in the anxious, carrying mother but no doubt the fetus is in the same physiologic state.  I have written about this in my Life Before Birth, where the fetus’s biochemistry reflects the mother’s.  And this is why we think it is due to heredity, and in a sense it is, and in a another sense, it is not.   But this can produce chronic inflammation and associated diseases.  The inflammation response is getting the body ready to combat intrusion, except that here the intrusion is from the pain trespassing into our system and our brains.  It is a lethal trespasser that alters our neuro-physical being for a lifetime.  It is not just our ideas that changes; it is our physical being that long predates the development of ideas.  And we carry that hurt around all of the time.  It first changes our bodies and then we when we have the capacity for  ideas it changes them too.  Here the lower level imprints send their messages upward and forward diverting ideas.

  We begin to see how complicated all this is because when we want to find out what causes severe addiction we need to be able to look way back and far earlier than we imagined.  There is a controversy as to how much of homosexuality could be genetic or epigenetic.   Many homosexuals I know and have treated insist that it is genetic; but after seeing all this new research we see how early deviations begin both in the brain and physical system. So it is hard to know how much is genetic and how much isn’t.  I still opt for epigenetics as  a major influence.  This may be added to genetic mutations very early on.  Then there is more trauma and  environmental influences are dominant.  This is very true in the addictions I have seen.  The earlier the trauma the more enduring and heavier the addiction, in my opinion, and in my experience.  So when we use Behavioral therapy to treat all this we are far from the target.  And years away from it and many millions of years distant in phylogenetic time.

    There can be all kinds of mutations of genes early on, we are discovering that form the matrix  for personality.  For example, there is the cholinergic gene that when affected can alter how we learn later on. It again affects reactivity and how sensitive we become.  This is the “mother” of the production of acetylcholine.  It affects our ability to pay attention.  The more the release the less ability to modulate and restrain our behavior.   The greater the release the lower the threshold for nerve firing; in brief, the greater our reactivity and lower restraint and control.  All this is heavily compounded by trauma during our life in the womb. So we have these very early settings for later personality; whether we are impulsive  or over-restrained.   Whether we speak our mind or hold everything in.  Whether we are normally sexual or we are frigid; do we suffer premature ejaculation or have delayed orgasm.

   There is something I left out: not only does the mother’s cells affect the baby, her emotional state and her moods but the contrary is true; the fetal cells affect the mother.  A piece in Scientific American (December 2012) found that fetal cells in animals migrate into the mother and can act very much like stem cells; they can migrate in the mother to where there is injury and help the healing process. So it is a two-way street.  The baby is a great help to the mother.  Let’s watch the developing research on this.

   So we note that very early experience changes brain structure and affects the developing neurons that already almost complete in the womb. When we want to understand the causes of allergies, migraines, asthma and high blood pressure we need to look in the right place and in the right epoch.  We must not forget that epigenetic factors, life in the womb, can turn on and off key genes; this causes further transformation of our biology.   So yes we are products of our genes and what happens to those genes along the way.  The question is:  are we only products of genes and epigenes?  Is there free will?   Not much.

Psychotherapy as a Cult

Maybe you think this is just a ploy to get your attention, or an exaggeration to ridiculous lengths but let us examine what a cult is and see if psychotherapy fits.  (Some of these ideas were inspired by a new book by Kramer and Alstad: The Guru Papers, and from my own forthcoming book: Beyond Belief).

  So what are the markings of a cult and a guru who runs it?  Absolute authority and someone without faults.   The leader is a know it all,  who runs your life and tells  you how to live.  Who demands obedience.  Someone who does not trust you thinking for yourself.  Someone who knows what is in your unconscious and interprets it for you; this teaches you to mistrust yourself and doubt your previous thoughts;  submission to the leader’s thoughts.  Never to question him or his beliefs even though it can lead to your deterioration…. A military mindset.   Accepting a new moral orientation.  An absolute belief in the leader’s theory. Believing he has a special wisdom and knows the secrets of the universe.   Best if you know nothing of the leader’s life so that he remains a mystery (nearly always a “he”).  Even if the theory makes no sense (as in Freudian theory) there is a need to believe and submit.

  Does this sound familiar?  Yes there are the cults and then there are therapies that fulfill nearly all of the requirements of  a cult. No matter what therapeutic approach it is nearly always the same.. A knowing doctor who knows what is best for you and will either tell you how to live, to find “wholesome thoughts”, or will do something to you to change your life. And what they do is based on a theory with little science behind it but lots of  free-form speculation masquerading as theory.  By and large, as with cults, we are renting a daddy or mommy who will tell us how to live because we feel so lost. They will protect and guide us, love us, be concerned about us and our future, and all they require is obedience; never said as such but implied.  But you do have to pay because the doctor says it gives value to the therapy and helps you treat it seriously.  This is what I was told when I came back from the war a complete wreck and needed help.   I was of course broke and could not pay.  The doctors who stayed home during the war wanted me to value their therapy when I felt I was dying.   And by the way most of them were Freudian psychoanalysts.   And when they gave speeches it was always, “A Psychoanalyst looks at blah blah”. They were Gods, cult leaders in every sense of the term; and my professors expected obedience at every turn and never to question their theories.

  The unspoken contract between patient and doctor is that they know what is best for you. No matter what kind of therapy it is always "I know what is best";   but they don’t.  That is the tragedy, and the patient stays for years thinking the therapist knows best. Since he makes his money keeping you in therapy he has an interest in the therapeutic longevity of the patient.  It is never expressed or even acknowledged but it is there.  Again, guru or therapist, the dynamics are largely the same.  Except in the cult it becomes dangerous to quit and the group can be threatening. That is not the case in therapy except the doctor warns about leaving therapy too early.  It seems to always be too early.

  We have had the experience of patients telling their doctor about Primal Therapy only to be pooh-poohed as a cult and worthless.   This often happens when the doctor knows nothing of what we do.  And what we do is the opposite of a cult.  We teach the patient what we do and want him or her out of there as soon as possible.   The only authority is the patient who knows best what is wrong and what is in their unconscious.    There is no great leader who demands obedience and insists on not being questioned.  Too often in patients, there is this search for certainty and we want a therapist who looks like a doctor and who speaks with an air of authority.  We do not want a hesitant doctor.  We do not want a doctor who is not completely sure of himself.  We want the rock of Gibraltar.  Why?  So we can relax, submit, be guided and taken care of.  Lovely.  And when we get that daddy and mommy that should have been,  we stay in therapy.  It is then a permanent act-out on both their parts.  The doctor gets the glory and adulation, while  the patient gets a kind,concerned doctor/parent.
It is addictive for both and that is why it lasts and lasts.  And never does the doctor call the patient on his act out; he encourages it; you must come three times a week instead of two, blah blah.   It encourages dependence, which is not what we want at all.

   More and more we come to trust the doctor’s advice and he readily supplies it.  We go to find out if we should get married, change jobs, go to school, leave this person, etc.  In our therapy we rarely if ever give advice; we believe in self-determination.  We want the patient to trust himself and not be infantilized.  By the way I finally found an Analyst to treat me for battle fatigue and what did we do? Dream analysis because that was his specialty.

    When your whole world is invested in your doctor you keep on going and do not question.  Your whole world is wrapped around him.  What does he think of my decision?  Would he approve of this or that?

  There are some in cults who change their names and become Swamy da da da.  It is as if  they had no history. But in current cognitive therapy there is also no history;  it is more and more a therapy of the here-and-now.  History doesn’t account for much.  Not a big difference.

  Here is the diabolic part in all this; once we spin a web of belief in our followers all we have to do is manipulate the beliefs. We have control.  Our beliefs/theories are now deeply inside the patient/follower and his life is in our hands.  He believes in the Id or Ego or Shadow Forces and other nonsense.  He has no other frame of reference.   In the cult they keep others away so that you will not have a contrary frame of reference; you are now a true believer.  The cult says the beliefs are our stairway to heaven while the doctor says you are on the way to more healthy beliefs and a stable way of life; ergo a stairway to heaven.