Arthur Janov's Blog, page 41

On More Therapeutic Nonsense

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

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

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

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

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

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

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

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

The Meaning of Life

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

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

On the Availability of Our Therapy

Recently, Jack Waddington raised some important issues (see his entry on April 20 under my April 19 blog “On the Real Meaning of LSD and Hallucinogens”) on the availability of primal therapy and the use of drugs, especially hallucinogens, for therapeutic purposes.

First, why isn’t our therapy available in more places? Why just Santa Monica, California?

Because it is a very complex affair, requiring years to learn, so there are only a few who have mastered it and they want to remain in our group. We are dealing with dozens and dozens of different problems, from suicide to anxiety states to migraines and severe depression, to name but a few. We have to learn how to deal with all of this. It takes perseverance and tenacity, a real sense of wanting to help humanity for pay that is not extravagant, and lower than therapists deserve. France and I take no profits and no salary (except what the Feds require us to take to keep our insurance), and we haven't for years.

We do not have profits because the fee today is only about 10% more than what it was 40 years ago. But expenses are ten times as high. Just our malpractice insurance is more than the rent we used to pay. France and I have kept the clinic going for many years just for the love of it and the people we can help...and it is reward enough.

This is never a therapy to be practiced alone. We need each other to keep us straight, to check our systematic errors and correct our techniques. Those who have gone on alone inevitably make systematic errors which get worse over time. And we need to keep up with science, which changes daily. Those who are alone with a big practice do not have the time to do that. We learn every day from each other what to do in this kind of case or another. There is always something to learn. And a small practice means compromises; fewer sessions, fewer or no groups, no vital sign research, etc. It is too easy to relax the strict discipline that is part of primal therapy.

And how about drugs?

Sometimes we get in a hurry and want to do drugs to speed things up; always a dangerous idea, because the system opens up slowly and only on the person’s biologic timetable, not on ours. We do use certain drugs on some patients, not to subvert the evolutionary timetable but to slow down too much access to pain; this typically for those who took drugs and now have leaky gates, those who have previously used drugs to subvert evolution (and this includes pot). You cannot extrapolate from your own case to that of many others with regard to using drugs in therapy. You need a broad range of patients to be able to make proper diagnoses. If the therapy is done right, the patients usually get there; some much slower than others, and rightly so, since they are far more defended and often in deep emotional pain. Anything you do from the outside, like drugs, abrogates the slow evolution we need in a therapy that follows evolutionary destinations tightly. The point is that the patient’s body knows much more than we do; we need to respect that. Repeat: only if the therapy is not done right does it become necessary to use drugs to hurry up the process. The pain, no doubt, was laid down in heavy increments, slowly, over years, and it is not going to be undone in a few weeks or in a weekend seminar.

A supervised dose of LSD is ridiculous. What will the supervisor know and do once it is too late? And who can predict the exact outcome of LSD? Once the gating system is cracked it may be cracked forever. Do you want to take that chance? And who knows how leaky someone’s gates really are? Are you prepared for a psychotic reaction? It is a precious thing, our brains; not to be messed with.

The problem is that because a therapist doesn’t know what he is doing, he tends to blame the therapy. And decides therefore to use drugs, thinking it will speed up the process. No, it won’t. It will flood the patient and produce delusions. I refer you to current work where patients are given hallucinogens. These patients’ delusions with LSD can meld with the therapist’s, so that they seem normal while the patients are literally going crazy. The doctor sees patients’ “cosmic unity” as a good thing, whereas it can be pathognomonic of serious mental illness. The brain is not something to be tinkered with. There is plenty of science now to help us understand how it works. Primal therapists need to understand recent science.

I have studied LSD for a long time; there is nothing to be gained from it except serious damage to the gating system. That is what it does: shatters defenses and lets feelings up (see Carhart-Harris, et al., 2012, for a detailed look at where and how psychedelics work in the human brain). Can you guarantee that those defenses will re-establish themselves? I cannot. If you want to see how psychosis comes into being, use LSD. It shatters the gates and allows cerebral flooding; then the cortex must go to work to suppress it all with bizarre ideas that try to corral and bind the feelings. The best way to loosen up someone up is to do the therapy correctly.

Look: our neurosis, our repression, built itself up through an adverse evolutionary trajectory. We need to use evolution, evolution in reverse, to correct that—not to overlook it. How can you overlook evolution since it is a law of nature, not some intellectual concoction dreamed up by someone who likes to look dramatic and powerful?

Carhart-Harris, R.L., Erritzoe, D., Williams, T., Stone, J.M., Reed, L., Colasanti, A., Tyacke, R.J., Leech, R., Malizia, A.L., Murphy, K., Hobden, P., Evans, J., Feilding, A., Wise, R.G., and Nutt, D.J. (2012) Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin.  Proc Natl Acad Sci USA, 109(6):2138-2143

Addiction: It’s Not About the Brain, by Bruce Wilson (Science and Medical Writer)

Art and I were expressing our exasperation about two items that crossed our attention this week, both of them related to addiction.

The first was a WSJ article about a study looking at the adolescent brain: “Are Some Teenagers Wired for Addiction?” Using fMRI, the researchers identified a particular pattern of neural activity in teens who had a tendency to become addicted to drugs or alcohol. Specifically, these teens had lower activity in the orbitofrontal cortex (OFC), a region that mediates impulse control. The implication is that faulty brain activity causes poor impulse control which in turn causes kids to become easily addicted. A different pattern of faulty networks was found in kids with ADHD, also related to impulse control. In other words, the brain is the problem.

The second item was a segment on CBS’s 60 Minutes about the work of addiction researcher, Nora Volkow. In addition to being the director of the US National Institute on Drug Abuse, Volkow has the dubious distinction of being Leon Trotsky’s great granddaughter and actually grew up in the house where he was murdered. She describes addiction as a physical disease: “we know that drug addiction is a chronic disease; the drugs physically change the brain…those changes are very long lasting and persist for a long period of time after the person stops taking the drug.” The culprit? Dopamine! In Volkow’s view, addicts are conditioned by triggers that cause a dopamine rush, making them feel, “I want that!” And because of drug tolerance, “I want that!” becomes “I want more and more!” Hardened addicts are merely conditioned, like Pavlov’s dog, perhaps by a genetic disposition, the theory goes. But instead of salivating; they crave. Show them a photo of someone hitting up their favourite substance of abuse and the dopamine surges through their midbrain, reinforcing more brain dysfunction. Once again, the brain is the problem.

The problem with both of these reports is that the brain is not the problem; it’s what’s deep within the brain that’s the problem – the pain of unmet need. But why don’t these researchers see this?

The answer is that you have to feel it to see it, and they don’t feel it.

Over my twenty-year history working in the medical community, I’ve met precious few scientists who are able to see the full implications of what they are studying. Medical scientists are trained to analyze and to seek explanations for living processes in terms of the bits and pieces of life: molecules, biochemistry, pathways, and genes. This works well for genetic diseases such as cystic fibrosis or Huntington disease, but is utterly inadequate for mental conditions such as depression, schizophrenia, and…addiction.

As Iain McGilchrist points out in his brilliant work, The Master and His Emissary, analysis is a function of the left hemisphere whereas synthesis and intuition are functions of the right hemisphere. Whereas the left sees only the bits and pieces, the right sees the “big picture.” The best scientists use both processes when trying to explain phenomena but modern behavioral scientists seem to have forgotten that. The very term, “behavioral science” implies that people are stimulus-response units—turn on the stimulus switch and the response follows as behavior. The left brain scientist tries to explain that behavior in terms of brain mechanisms. As one cognitive scientist put it, the brain is nothing more than a “computer made of meat.”

Apparently, Volkow gets $1 billion a year to study the biological mechanisms of addiction, delving ever deeper into the neurons, synapses, receptors and cellular biochemisty, searching for the cure for this “brain disease.” The same is true at addiction research centres everywhere.

Meanwhile, the real cause of addiction is ignored, except for those who can see it because they feel it. Art Janov was writing about the primal causes of addiction as early as The Primal Scream. Gabor Maté, no stranger to addiction himself, works with hopelessly addicted patients in Vancouver’s Downtown Eastside, which he tells in his heart-wrenching book, In the Realm of Hungry Ghosts. Every one of Maté’s patients suffers from the pain of terrible childhood abuse, which is clearly the cause of their addictions. Neuroscientist, Jaak Panksepp, who has spent his  career studying the neurology of animal feelings, sees addiction as an attempt to resolve the pain of unresolved separation distress, or in primal terms, a futile effort to get the love one didn’t get as a child. Addictive substances not only stimulate brain dopamine, they stimulate endogenous opioids as well – the body’s own pain killers.

No doubt, brain function is deeply altered by addiction; levels of neurotransmitters are altered; receptors are changed. But to conclude that these aberrations constitute a disease process that appears out of nowhere or is influenced by brain biology or genes is scientific reductionism at its worst. What about the personal history? The family history? What about the social determinants of addiction? What about poverty, stress, and the hopelessness of your life situation?

None of this counts in mainstream addiction research – the biological cause must be identified and a chemical cure must be found! So an army of left brain analytical scientists continues to spend more effort and more money to find what will never be found, the medical “cure” for addiction. Volkow—who goes for a seven-mile run each morning to get her own addictive hit of dopamine—envisions a vaccine that will banish addiction once and for all, as though it were a virus. But the real virus seems to be the one preventing scientists from recognizing addiction’s true cause and we already have a treatment for that – feeling.

On the Use of Statistics as "Proof" of Our Ideas

Although we are accustomed to scientific references and citations in books on psychology, which wash them with a patina of legitimacy, we should not lose sight of the overarching truth—feelings are their own validation. We can quote and cite all day long but the truth ultimately lies in the experience of human beings. Their feelings explain so much that statistical evidence is irrelevant. Cognitive therapy seeks statistical truths to corroborate their hypotheses and theories; these theories are too often just intellectual constructs that do need statistical validation. Statistics help to reify non-biologic findings. In the area of mathematical abstraction we can make anything look true. Look at EMDR, a booga booga approach if there ever were one, but they have many research studies to “prove” their approach.

We are after biological truths beyond mathematical facts, a place where biology and neurology coalesce with psychology. What biopsychology studies imply is a kind of universality, a continuum, with all kinds of organic life. These studies are corollaries, not separate, inviolate realities; a kind of intellectual genuflection to the left brain, but, without contact to the right brain those realities are confined to the intellectual. Anything can be true with statistics because they ignore biologic realities; they can be manipulated any number of ways. When we take into account the neurobiological, we add the total effects of experience on all of us, everywhere. We not only see how neglect and lack of love make us behave, but also how they change our brains and body.
   
All this may escape those who have no access into the right brain unconscious, where history and feelings lie. Animal research is interesting, but we are not trying to understand the psyche of rats; we need to understand our own psyche by analogy or corollary. Those who suffer, who have faulty gates, have a sort of inchoate entry into the unconscious but it is not complete. We have an experimental laboratory in our clinical work, where we see the unconscious every day with patients. We do not need statistical truths. We know that if the patient is feeling this, then that is likely to happen; a replicated experiment, at its heart. When we see it over and over, hundreds of times, we have a good idea about what drives what kind of behavior, and what feelings cause which symptoms.

Yes, objective studies are helpful and necessary; they are being done by the hundreds now and supporting our work, without the primal syntax. Take for instance, the notion of the imprint; the work on methylation and acetylation are giving us a good biologic look at how the imprint is set down. They give us a precise microscopic view but neglect the macro view that would put it into context, and maybe even tells us how to change things. The imprint is now a fact, which we have seen and known about for 40 years, and it is good to have corroboration for it. But besides facts, we need truths, a frame of reference that puts it all in perspective and helps guide our future work.

Those in cognitive therapy are able to “feel better”, but confuse that with getting better because they can use language and words to suffocate pain. They use thoughts to anesthetize feelings, and imagine and think that all is well. This is reified by the doctor who also thinks that what the patient says matters—it does, but not in the way they think.

There is a world of the deep unconscious that needs to be explored, an unconscious from our animal legacy. That unconscious can never be understood in verbal language. We cannot talk to a salamander, and he therefore cannot tell us what we need to know. But wait! Yes, he can. We can communicate with it as humans through addressing the brainstem and primitive limbic system, the salamander brain in each of us. That tells us a lot. It explains so much, especially when we see rage in patients and wonder where it comes from.

If there is no place in a theory for that unconscious there is no way that one can be cured of all sorts of emotional problems; problems that may have their origin in the residue of reptilian life. To observe patients writhing in reptilian fashion when they are in the grips of an ancient brain makes all of that clear. We have measured this over and over, and filmed it to be shown in a primal documentary in process. It can never be clear so long as we remain on the cognitive level, so long as we deal with facts but no truths.  So long as we use the abstractions of statistics to support our case we are bereft of the one thing we need to truly understand what we observe: feelings.

Let us not forget that in the world of cosmology there is the discovery of dark matter that makes up the majority of what we used to call empty space. We are part of that universe; only our dark matter is called the unconscious. Heretofore, psychotherapy has dealt with only the tip of the iceberg, leaving an unexplored universe untouched. Although cosmology usually deals with the external universe, we are also part of that universe, and the laws that apply to external cosmology must also apply to us humans. After all, we are made of stardust—carbon, hydrogen, oxygen, iron and other elements. Carbon, when combined with hydrogen and oxygen, form organic compounds. The laws that apply sui generis to the universe above must also apply to the universe below. There is no simple dividing line between the two.

The history of the universe abides in each of us. Nothing is lost in our evolution; we simply add on. We still have part of that ancient brain encased in our skulls. We are the history of the universe incarnate; walking archives—a fact that is largely ignored in the field of insight psychotherapy. The more we discover about the laws of the universe the more we shall learn about ourselves. The key here is that the more we travel back in personal time the more present we can be; for it is fact that the past is imprinted in our systems, and until we relive and connect it to consciousness we will be enslaved to our history. The deeper we travel into the antipodes of our unconscious, the clearer we see our ancient history. Chronic high body temperature speaks about our history; it shouts its meaning but too often remains incomprehensible to the sophisticated intellectual. Abstracted from oneself and one’s feelings usually means fixated on abstractions in psychology and medicine.
   
We need to consider Primal psychology a branch of cosmology—a study of the inner universe. How can we learn about the laws of human intercourse if we never delve into the dark mass of the unconscious? Otherwise, we are pushed by forces we do not understand and over which we have no control. We develop symptoms for unknown reasons, and fall ill for reasons quite mysterious. It does not have to be this way. The unconscious speaks to us all of the time in its own language; too often we do not know it for what it is, nor can we speak it, for it has nothing to do with words. Proper therapy must use non-verbal language. Migraine may speak loudly about anoxia at birth. Our salamander brain speaks to us every minute of every day. We need to listen and learn what it says, and too often it says: you are in danger.

The Die is Cast: Early Trauma Affect Us for the Rest of Our Lives

It seems like I am still drowning the fish, so I won’t write too much more on this but the evidence is now overwhelming that very early childhood, and that includes gestation time, changes us for a lifetime.

Here is an example: scientists have found how certain birth defects take place. It turns out that it is not just a birth defect but also experience plus the genetic defect that makes for serious illness. A group of scientists from many universities showed how a genetic tendency plus a period of low oxygen during gestation led to a malformation of the spine (scoliosis). In another related study, they discussed how early trauma led also to later heart problems, as well as impaired kidneys and cleft palate. Low oxygen is often the culprit due to the mother smoking, living at high altitude, diabetes and other diseases. But the point is that the environment working on a gene can produce an affliction, often much later in later in life. Cleft palate certainly looks like a genetic defect but perhaps it isn’t. I call this “envirogenes”; how the environment intersects with genes. Two siblings may have the same early life but differ in their genetic makeup and in their womb-life. What this research shows is nature and nurture working together.

What the researchers on scoliosis found is that having one defective gene allows the womb-milieu to have a great affect on the genetic apparatus. Lack of oxygen working on different genes can produce a different kind of malady; again, later on in life. This is especially true in heart disease. Investigators have found that very early trauma can set up an inflammation in the heart that endures, ending up finally as a heart attack. I have written about low oxygen during womb-life for many years. This is particularly sharpened during the birth trauma where a mother, heavily drugged (and therefore low on oxygen), produces an offspring low on oxygen as well. The problem is that his low state doesn’t just pass away, over a bit of time; it is an imprint that produces an alteration in the system over years. One of those alterations is an inflammation around the heart. Later on, with smoking, drinking, being overweight, lack of exercise, it becomes a full-fledged attack. Did bad diet do it? All of the above did, working on a weak heart muscle. Those with inflamed hearts nearly always have a bad outcome prematurely in later age. And the doctor then wonders what happened to make that appear; and the answer is way back in history; and that is the history the doctor must take, at the outset.

Does bad diet do it? Usually not one factor alone does it. It has to play on a weakened heart, and now we know that this happens so early in our lives as to seem mysterious and unknowable. Yes, we have to die of something, but we shouldn’t have to die before our real time, not on neurotic time. Real time means without excess imprinted trauma early on. And I suggest again that we can get rid of those early traumas in our primal process of reliving. I know a lot about the scientific literature, and I have not seen another way to do it; to do it naturally, without drugs and mechanical intervention. If we take pain out of the system, it seems to me, we won’t die on neurotic time.

Primal Therapy Research Proposal

What you find below is the outline of a proposal for research. We have neither the funds nor personnel to carry it  out. We seek help from all of you. I do believe we lengthen lifespan, and I want to confirm it. I also believe that gestational trauma is behind so much later dementia and other disease. art janov

Research Question: Can Primal Therapy reverse biological markers caused by early life stress and slow the rate of aging? Epigenetics, telomere length, and Alzheimer’s Disease
Background
Primal Therapy is an affect-based psychotherapy created and developed by Arthur Janov, PhD, of Los Angeles, Calif. First popularized in 1970 after the publication of The Primal Scream, Primal Therapy has undergone continuous development under Janov’s direction, both in theory and practice. Now in his 80s, Janov and his wife, France Janov, PysD, continue to practice and train therapists at the Primal Center in Santa Monica, Calif.
The fundamental tenet of Primal Therapy is that the cause of most psychological disorders (and many physical disorders) is early life trauma. From the moment of conception, humans have needs, and when those needs go unmet, the result is trauma. A vast body of research conducted in recent years demonstrates that trauma begins in utero when the fetus is subjected to environmental stressors, including maternal stress hormones, malnutrition, tobacco, alcohol, drugs, chemical toxins, and a host of other stressors. The result is a biological imprint—or wound—that lasts a lifetime. Later events, such as birth complications, poor maternal attachment, parental neglect or abuse, bullying, failure in school, etc. add to the earlier trauma and reinforce the imprint. Janov has made the hypothesis that a neural resonance exists within the brain that “links” earlier and later trauma. For example, when an adult is rejected by a love interest or frustrated at not being able to find a job, the feelings of rejection or futility may trigger implicit memories of neglect in childhood or maternal separation in infancy. This in turn may resonate with implicit, physical memories of a life-and-death struggle at birth or toxic stress in utero. Although controversial, the idea that fetal memories and learning can influence later life is supported with recent research (Wintour, et al., 2006; Entringera, et al.,2004).  The end result may be an overwhelming feeling of despair leading to suicidal depression. In other words, a psychobiological response is evoked that involves the entire body and mind. Janov calls this the Primal Imprint. This imprint endures and affects nearly all systems during our evolution. It is the key motivational entity.
Rationale for the Study
It is established that early life stress leaves a permanent imprint on the physiology, predisposing the individual to a wide range of diseases, including coronary heart disease, hypertension, metabolic syndrome, diabetes, obesity, autism, depression, anxiety, schizophrenia, learning disabilities, accelerated aging, cancer, etc. This is known as the Early Life Origins of Health and Disease paradigm (Wintour, et al., 2006). One of the main mechanisms by which this imprint is encoded is through epigenetic changes. Meaney and colleagues have shown that parental neglect leads to changes in genetic expression via DNA methylation and histone acetylation. (Meaney, 2001; Weaver, et al., 2004; Weaver, et al., 2006; Weaver, 2007; Diorio and Meaney, 2007; McGowan, et al., 2008) In another study by the same group, suicide victims who had been abused in childhood showed methylation of the glucocorticoid receptor (GR) gene promoter in their hippocampal tissues, indicating lower GR expression. GR is a key component of the hypothalamic-pituitary-adrenal (HPA) axis and necessary for downregulating the stress response (McGowan, et al., 2009).
Long-term clinical observation has shown that many patients undergoing Primal Therapy become both physically and psychologically healthier, suggesting that the therapy ameliorates the biological imprints caused by early life trauma. Over the decades, Janov and his therapists have routinely monitored clinical signs such as blood pressure, heart rate, body temperature, serum cortisol levels, EEG patterns and others. As the therapy proceeds, these parameters tend to settle toward healthier set-points signifying lower levels of chronic stress. Emotional regulation, resilience, and stress tolerance also increases for many patients, suggesting that Primal Therapy effects a fundamental change in the underlying neurohormonal mechanisms regulating the stress response. In other words, Primal Therapy appears to normalize the physiology of many patients.
For some time now we have been preparing to do a research project about telomeres, which cap the chromosomes and keep the DNA of the cell stable. Telomere length is known to be associated with aging: when the telomeres are longer, we live longer, and when they are shorter we know life gets shorter. It turns out that telomeres do get shorter with stress (Epel, et al., 2004) and shortened telomeres are associated with depression and high levels of the stress hormone cortisol (Wikgren, et al., 2012). Our thought was that since cortisol levels come down in our patients, it should be reflected in longer telomeres. Further at Brown University (Carpenter, et al., 2009), they studied those adults who had been abused as children. Their telomeres shortened more rapidly. One of that study’s authors, Audrey Tyrka, stated “It gives us a hint that early developmental experiences may have profound effects on biology that can influence cellular mechanisms at a very basic level.” More recently, researchers have found telomere shortening with deprivation in early childhood (Drury, et al., 2011) and, importantly, that intrauterine stress led to shortened telomeres in young adults (Entringer, et al., 2011); the authors of that study state: “To the best of our knowledge, this study provides the first evidence in humans of an association between prenatal stress exposure and subsequent shorter telomere length. This observation may help shed light on an important biological pathway underlying the developmental origins of adult health anddisease risk.” Again, the kind of abuse we know about and write about is even more profound, more remote in time and deeper in the brain than the obvious kind of abuse that is ascribed in the literature.
The purpose of the first leg of our research project is to examine whether or not Primal Therapy has an effect on: (1) the rate of telomere shortening, an indicator of aging; (2) DNA methylation and histone acetylation caused by early life stress; and, (3) whether Alzheimer’s Disease is related to fetal or early life stress in infancy. Epigenetic factors (environmental effects that result in functional modifications in the genome without changing the underlying DNA sequence) are crucial, since we may have a way of measuring how the imprint is laid down and how the imprint changes with reliving of imprints in Primal Therapy.

Study #1: Measurement of Telomere Length in Patients Undergoing Primal Therapy
Purpose: To correlate the rate of telomere shortening (a correlate of aging) with progress in primal therapy. The hypothesis is that Primal Therapy will correlate with reduced rate of telomere shortening, indicating a reduction in the rate of aging.
Patients: All incoming patients at the Janov Primal Center will be eligible for the study.
Inclusion criteria: ·               Age range: ??·               Clinical assessment: any diagnostic criteria?·               Access to primal feelings (therapist assessment)·               Subgroup: Access to first-line feelings (therapist assessment)·               Others?
Exclusion criteria:·               Unable or unwilling to commit to at least one year of therapy (may need longer period of time)·               Unable or unwilling to commit to regular follow-up (e.g. interviews, taking tissue samples, etc.)·               Others? (e.g. psychosis, substance abuse, smoking, HIV-positive, etc.)
Study Design: A prospective, non-randomized, non-controlled, case series study of one year duration or longer (whatever is needed to observe significant changes).
Methods: Baseline assessments will be made on the following:·               General physical health, medical history·               Psychological diagnosis: levels of the imprint; what level the patient presents at the start of therapy·               Psychological scores: life quality, anxiety levels, depression, etc. Many scales for this. We should do this to make it more objective.·               Vital sign measures: blood pressure, heart rate, serum cortisol, deep body temperature, other?
Blood samples At regular intervals over one year blood samples will be drawn and stored. These samples will be used to analyze leukocyte telomere length (telomeres can be measured in several ways: see Aubert, et al, 2012).
Physical and psychological measures of stress All baseline measurements will be repeated at the same intervals (physical health, psychological assessment, vital signs, cortisol, etc.)
Statistical analysis: To be determined. Factor analysis will examine interaction between telomere length and other outcomes.
Outcomes:·               Leukocyte telomere length·               General health·               Vital signs·               Serum cortisol·               Psychological outcomes: anxiety, depression, etc. (Patient and therapist assessment using recognized scales.)·               Success at Primal Therapy (therapist assessment)·               This is important for we hope to show that Primal therapy can help lengthen life and make it healthier; not a negligible effect.  In other words, if we normalize function, if we normalize the rerouting of the neurobiology due to primal pain and right the dislocation of function the normal system would have a chance of a longer life.      

Study #2: Measurement of Epigenetic Changes in Patients Undergoing Primal Therapy
Purpose: To examine the effect of Primal Therapy on epigenetic imprints.
Study design: Design will be similar to study #1, however, DNA methylation and histone acetylation in certain tissues will be examined.  The implications are the same as the above.

Study #3: Correlating Alzheimer’s Disease with Early Life Trauma
Purpose: To correlate the incidence of Alzheimer’s Disease (AD) with scores on an Early Life Stress survey. The purpose of this study is to determine whether or not there is a link between early life stress and later Alzheimer’s, according to the LEARn (Latent Early-life Associated Regulation) model of AD (Lahiri & Malony, 2010).  The hypothesis is that gestational stress (as well as infancy trauma) may be a prime factor in the development of later Alzheimer’s. 
Design: Survey
Methods: The ELS survey will be given to all patients or caregivers of patients diagnosed with AD.
Statistical Analysis: To be determined.
Survey:  
1.     Can you describe your birth? Was your mother given any drugs or anesthesia? Was your birth natural, breech or cesarean? Did you have a pre-term or late birth? Home or hospital birth? Were there any complications associated with your birth? Were you breastfed or bottle-fed? If breastfed, how long? Did your mother have adequate milk?
2.     Can you describe your gestation period? Was your mother and the household calm and not under stress? Was there marital discord of any kind? Was the father in the home through your being carried? Was there any talk of separation or divorce? Was there a recognized marriage before your birth?
3.     Was the external environment benevolent? Were there environmental stressors, such as poverty, war, strikes, or natural disasters?
4.     Were one or both parents under stress? For what reasons?
5.     Did your mother regularly take medication, tranquilizers or pain killers?
6.     What did your mother eat during your gestation. By today’s standards, was her diet considered healthy or not?
7.     Would you describe the family as loving or unloving?
8.     Was your mother chronically anxious or depressed? For how long?  Was she exceptionally tense?
9.     Was your conception planned or accidental? Were you born long after your next oldest sibling?
10.  Were you held immediately after birth? Were you sickly as a newborn? Describe.
These are the factors to be scored to determine how much trauma there was and the valence of the trauma.
All the above is preliminary, possible hypotheses to be fleshed out over time. It points to what we want to try to accomplish both in our therapy and our research on that therapy. We already have many studies (see Primal Healing for discussion), but now we want to refine our investigations.




References
Aubert, G., Hills, M., Lansdorp, P.M. (2012) Telomere length measurement-Caveats and a critical assessment of the available technologies and tools. Mutat Res. 730(1-2):59-67.
Carpenter, L.L., Tyrka, A.R., Ross, N.A., Khoury, L., Anderson, G.M., Price, L.H. (2009) Effect of childhood emotional abuse and age on cortisol responsivity in adulthood. Biological Psychiatry, 66(1), 69-75.
Diorio, J. and Meaney, M.J. Maternal programming of defensive responses through sustained effects on gene expression. (2007) J Psychiatry Neurosci. 32(4):275–284.
Drury, S.S., Theall, K.P., Gleason, M.M., Smyke, A.T., Devivo, I., Wong, J.Y.Y., Fox, N.A., Zeanah, C.H. and Nelson, C.A. (2011, epub). Telomere length and early severe social deprivation: Linking early adversity and cellular aging. Molecular Psychiatry, 1-9.
Entringer, S., Epel, E.S., Kumsta, R., Lin, J., Hellhammer, D.H., Blackburn, E.H., Wüst, S., and Wadhwa, P.D., et al. (2011) Stress exposure in intrauterine life is associated with shorter telomere length in young adulthood. Proc Natl Acad Sci USA, 108:33, E513-E518.
Epel, E.S., Blackburn, E.H., Lin, J., Dhabhar, F.S., Adler, N.E., Morrow, J.D.and Cawthon, R.M. (2004) Accelerated telomere shortening in responseto life stress. Proc Natl Acad Sci USA, 101(49):17312–17315.
Lahiri, D.K. and Maloney, B. (2010) The “LEARn” (Latent Early–life Associated Regulation) model integrates environmental risk factors and the developmental basis of Alzheimer’s disease, and proposes remedial steps. Exp. Gerontology 45(4):291-6.
McGowan, P., Sasaki, A., Huang, T.C.T., Unterberger, A., Suderman, M., Ernst, C., Meaney, M.J., Turecki, G. and Szyf, M. (2008) Promoter-Wide Hypermethylation of the Ribosomal RNA Gene Promoter in the Suicide Brain. PLoS ONE. 3(5):e2085.
McGowan, P., Sasaki, A., D'Alessio, A.C., Dymov, S., Labonté, B., Szyf, M., Turecki, G. and Meaney, M.J. (2009) Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse. Nature Neuroscience, 12:342-348.
Meaney, M.J. (2001) Maternal care, gene expression, and the transmission of individual differences in stress reactivity across generations. Annual Review of Neuroscience, 24:1161-1192.
Weaver, I.C.G., Cervoni, N., Champagne, F.A., D’Alessio, A.C., Sharma, S., Seckl, J.R., Dymov, S., Szyf, M. and Meaney, M.J. (2004) Epigenetic programming by maternal behavior. Nature Neuroscience 7:847−854.
Weaver, I.C.G., Meaney, M.J. and Szyf, M. (2006) Maternal care effects on the hippocampal transcriptome and anxiety-mediated behaviors in the offspring that are reversible in adulthood. Proc Natl Acad Sci USA, 103(9):3480–3485.
Weaver, I.C.G., (2007) Review: Epigenetic Programming by Maternal Behavior and Pharmacological Intervention. Epigenetics,2:1, 22-28.
Wikgren, M., Maripuu, M., Karlsson, T., Nordfjäll, K., Bergdahl, J., Hultdin, J., Del-Favero, J., Roos, G., Nilsson, L., Adolfsson, R., Norrback, K. (2012) Short Telomeres in Depression and the General Population Are Associated with a Hypocortisolemic State.Biological Psychiatry, 71:4, 294-300.
Wintour, E. and Owens, J.A. (Eds) (2006) Early Life Origins of Health and Disease (Advances in Experimental Medicine and Biology, Vol 573). Springer.

On the Memory of Killing Afghan Civilians

I read a piece in the paper about a soldier who killed 16 Afghan civilians. He claims he can remember before and after, but not during the crime. His attorneys are going to argue in his defense that he had a “diminished capacity”. I assume that means he didn’t have all his marbles. Let’s look at it from a Primal perspective.

After several deployments where people were trying to kill him, and shortly after a bomb went off that injured his teammates, he finally cracked. What does that mean? The pain from his early life and his current traumas all merged and edged out his third line; the pain replaced his perceptive, critical apparatus and flushed out all ability to hold back impulses. It also replaced any reflective capacity for what he was doing. It was as if he was in a dream: what happens in that dream is that lower-level processes take over; logic is abrogated and feelings fill all cognitive space. No wonder he cannot remember. His conscious/awareness was missing. All the past and current pain merged together to blot out any awareness. He was acting as if sleepwalking. (We have had a patient who walked to a store and bought gum while asleep and later had no memory of it. He was in the same state as our soldier/killer: unconscious.) That is, his unconscious replaced conscious/awareness. When he discharged enough rage, fear, and pain he could finally realize what he did, but not during his act.

This is the classic Primal definition of transient psychosis: pockets of insanity due to being overcome with a combination of past and present pain. The third-line cognitive functions cede to the lower levels, which are in overload and need expression. It is all acted out as if in a dream; the perpetrator doesn’t know any better because there isn’t any functioning top level for the moment.

Now what is strange in all this is that in a Primal the patient’s brain must cede to lower levels so that she can have access to deeper levels of consciousness. And when that happens the patient is again in the past, reliving being yelled at by her mother, seeing her earrings and smelling the odors in the kitchen. She is “back there”; there is little top-level functioning. If there were, the Primal would be aborted and she would be back in the present. And she would be in control again. And patients who need control have a hard time letting go of top-level cognition. They often must exert control because of the power of lower-level pain.

Our killer was “back there” too, but he was not in a safe clinic where he could act out violently by punching the walls or screaming out his hate. He took his feelings into the present; he had no one to help him into his feelings. He didn’t even know that he had feelings or that they were hidden somewhere inside of him. But the signs were there, and if there were a shrink around who knew the signs the killing could have been avoided. If there were a group culture of knowing about feelings and understanding that it is important to see a professional when the pressure builds, there might not be any murder. We need to teach kids in school about feelings, not just punish them when they act out, but help them understand how feelings push them to act out and what they can do to avoid it. Everyone in the class must pass a test on this subject; it is essential to the learning process. They need to learn about ADD and what causes it, assuming the shrinks manage to learn about it as well. We can feel for all the murder victims and for the killer too. It is too late for him, his life is over; but let us change the zeitgeist of schools and the military and save lives.

On the Real Meaning of LSD and Hallucinogens

There is an article, I believe, from the recent New Yorker about someone who took Acid (LSD) in the seventies and wonders what happened to the youth of today who prefer the shutting down drugs such as Prozac versus the opening up drugs such as Acid. He claims that society no longer wants to take risks, preferring to keep it safe. He believes that our choice of drugs is indicative of the general zeitgeist, reflecting the world we live in. In the early years (the 70’s) we craved freedom; now we crave security. He seems to be nostalgic for those old Acid days. And doesn’t discuss their dangers enough; and I believe it is one of the most dangerous drugs around. What does it do?

Grosso modo, it immediately depletes serotonin and other Gaba chemicals, and diminishes the work of the gates, thus allowing all kinds of pain on all levels from surging ensemble toward the prefrontal cortex. Gamma amino butyric acid is a repressor holding down pain and blocking against feeling hurt. What Acid does is disrupt gating and allow us to feel our pain…..but all at once. Since that constitutes an overload, the exact feelings are blocked or disconnected but their energy level gets through to higher centers. And what do those higher centers do? They absorb all that force and begin the cognitive defense against it. They do what any person does when overloaded with imprinted pain; they manufacture far-out, bizarre ideas to encapsulate the force. This is true with LSD and in everyday life. That is why LSD is sometimes called a psychotomimetic. The ideas are far out because they are forced by a heavy load into concocting something. And the leitmotif of the feeling, the feeling of feeling, gets through so that the content of the hallucination somehow reflects what the person is dealing with. Someone is trying to kill me (death is near). Or they feel a cosmic oneness with the universe, which seems like an hallucination to me. Since what the person is thinking is idiosyncratic solely to her. And what helps eradicate the hallucination it for the moment is a tranquilizer/pain-killer. It is so easy to see the connection between pain and hallucinations since pain-killers stop those beliefs in their tracks.

The frontal cortex is the last refuge of defense; going psychotic to keep from becoming insane. Absorbing heavy energy with beliefs before they can affect the heart to produce a fatal cardiac arrest. It is not the drug that makes hallucinations; it is the pain that has no specific context that drives the higher levels to become exotic. There is a context but it is usually a very early imprint with no specific scene attached. Its force, however, is preverbal with life-threatening consequences. There is no specific scene for the cortex to hang onto.

If at first you had a good trip, it is because you have a good enough defense system to allow only some of the pain through….like smoking pot. But you will have a bad trip when first line terrors and rage surge through to produce the equivalent of a nightmare. And indeed, the trip is a nightmare. Daymares are nightmares with the sunlight. Otherwise, no difference. Terror is terror, day and night. The physiology does not change when the sun goes down. It bursts through unchecked because beliefs which work in see-saw fashion with imprinted feelings, are not strong enough to hold them down. Then you make no sense. These neural gates are not Huxley’s ‘Doors to Perception; on the contrary they block perception in specific ways and allow only global perceptions”; so-called Universal Truths. You are never “one with yourself or with the cosmos.” You mind has flown into pieces and you can only recapture pieces of yourself. You feel liberated because the lid of the repressive load has been temporarily lifted. It is primal therapy on speed. Instead of getting to one feeling at a time and integrating it; you get to all at once and it is really too much. But you do not have enough critical faculties left to understand what is happening. We did LSD research decades ago and found the brain very speeded up but with low amplitude which means to us the breakdown of defenses. We see on patients on the verge of deep non-verbal feeling that defenses mount with the heightening of the amplitude. When they crash, so does the amplitude. And after some ten trips the effects last for years; trouble sleeping, needing tranquilizers, cannot concentrate and unstable behavior, in general. That is the danger of rebirthing and drugs that prematurely unleash early pains out of sequence. You can and do often get hallucinations; “at one with the cosmos,” etc. I have seen it over and over in those who take drugs, smoke pot all of the time, or go to rebirthing centers. They come to us overloaded and seemingly “in space.” They are not all there. When a booga booga therapist thinks this is a good response to his therapy, watch out. When his beliefs merge with the patient all is lost. When the therapist thinks that “at one with the universe” is to be fervently sought they are both hallucinating.

Integration is the sine qua non of progress in psychotherapy. Nothing artificial can make that happen. It is a biologic law; not to be abrogated because someone has invented a quick way to ourselves. To defy biologic laws is to contravene nature and natural law. To bypass nature means not to get well, for it is only through nature that we can be cured. We need to go at nature’s pace, follow the rhythm of the evolution and not hurry the process up. The human brain is a delicate instrument. We need to play it carefully.

LSD has been used for treating depression. What it does is ease the cap of repression and thereby easing depression, which, as I have said over and over, depression is repression elevated to a high level. One no longer feels the specific feelings; they are usually preverbal and heavy valence so that they cannot be accessed easily.

The writer in the article (Marc Lewis) went from LSD to heroin. No surprise since the gates had been flung open by LSD and needed closing. What better way than through a powerful painkiller. If he did our therapy he would not need heroin. He would have felt the pain in all its agony one piece at a time. LSD shows us nothing except how it feels not to repress pain for a brief moment. That is good. Getting there through drugs is definitely not good. Doing the artificial can never produce natural responses. And it is always nature we are after. We are after inner harmony, and only nature can provide it.

On the Use of Medication in Sleep and Psychotherapy

There is a recent piece in the NY TIMES (“Pills’ Risk Complicate Long Wait For Sleep,” March 13, 2012, Science section) that states that those taking sleep medication on a regular basis are nearly five times as likely as non-users to die over a period of two and a half years. Now why is that? Before I answer, let me say that in my life and in my practice I find that at least half the people I come into contact with have trouble falling asleep or sleeping more than an hour or two without waking up. So many of us cannot sleep, and sadly that includes doctors and surgeons who really need their sleep, not to mention airline pilots. The article states that there were 60 million prescriptions for sleeping pills last year in America.

Of course, those who need sleeping pills are already in trouble, usually suffering from anxiety disorders and/or deep depression. And these people may already be on daytime pills for a variety of psychiatric disorders. So why no sleep? I think that lifetime sleep patterns are established in the womb and at birth and just after. A carrying mother who is highly anxious or depressed may interrupt the fetal sleep patterns. It dislocates how we sleep thereafter in the same way that trauma while we are being carried produces lifetime patterns of behavior or symptoms such as headaches. It is also the time when our hormone, neurotransmitter, and neuromodulator output all begins, so that traumas during this period can change the setpoints of so many neurochemicals that affect sleep. Just not enough serotonin can do it, as well as alterations in dopamine. The system may be imprinted with too high a level of vigilance hormones that work against sleep. Or there may be compromised gating functions that prevent us from blocking low-level imprints.

But let us not concentrate only on sleep because any serious anxiety imprint that the carrying mother suffers means the baby suffers too. And that means overloading the gating system early on. The result is that when we try to cede high-level cortical alerting functions in order to reach down deeper in sleep levels, the pain is there waiting and prevents any rest. This is usually the result of serious neglect and trauma while we are living in the womb. And so because the gating system is weak we cannot block enough of the pain in order to get some rest. And we take pills in order to quiet the onrush of pain. And those pills work on pain centers; some work directly on the vigilance centers of the brain stem such as the locus coeruleus. They do what they are supposed to do: quiet the agitation.

The faulty gating system already means serious pain when the gating system was being organized, sometime around the midpoint of pregnancy. An anxious or depressed mother can overtax the baby in the womb; too much input from the mother, so much so that the inchoate gating system becomes defective. And later in life when we try to sleep our minds are racing, racing because the first line is in a hyper state. Why hyper? Because there is danger from the imprinted deep first-line feelings, and so the system must stay alert against the feelings. So long as that imprint of a turbulent agitation remains in place sleep will always be a problem. That imprint has no doubt already lowered the effectiveness of the gating system, making sleep problems unavoidable. So of course we take pills to try to make the physiologic function be normal; those pills are an attempt to normalize the system, to establish a brain system that can shut down when necessary. So they are life-saving and life-threatening. In the daytime we see this in the anxious patient who is go-go-go all of the time, unable to sit still and relax. Sleep problems are only an extension of the daytime behavior. It is still the same person, night and day. He may also exhibit impulsive behavior during the day, as an expression of impaired gating. It isn’t that we have sleep problems at night but are perfect during the day. It is the same system misbehaving at night: on the go when one shouldn’t be, night and day. Same imprints driving it all.

Taking sleep pills is, of course, life-endangering. But here is what an expert, the president of the American Academy of Sleep Medicine, says: “If someone comes to me on a sleeping pill, usually my tactic is to try to take them off it.” Without looking into its biological necessity? Maybe one needs it to equalize the psychic economy. It is clearly what the system needs to go on functioning. Today the experts believe that it is safer to take non-benzodiazepine sedatives than benzodiazepines or barbiturates. Not sure. Maybe, although it is still suppressing the pain, just by a different method. How about discussing the pain, what it is and how to get rid of it? Why is it always a given that we must suppress? Why don’t we express? Assuming we know what we are dealing with, that is. Ah, that is the problem—not enough knowledge about what is behind sleeplessness. It is, after all, a big leap from womb-life to not being able to sleep last night. I could never have figured it out without observing patients who have sleep problems relive first-line feelings and begin to sleep peacefully at last. We see the great inner agitation during the primal, and then see the drops in blood pressure and heart rate and later, reports of sound sleep. One piece of advice: when there is that stab of some feeling upon arising in the morning, instead of running from it, lie back and let it sweep over you. It often helps, and you will eventually understand why that problem is there in the first place.