Friday, August 30, 2013

On Catatonia and the Freeze Response

We have a patient coming into therapy who has been diagnosed by an English clinic as catatonic. She freezes up and it can last 8 hours where she cannot move or react. She has no feelings during the episode, just numb. She has stayed in the clinic for eight months while they tried everything they could including art therapy and few booga-booga varieties of nonsense. Why am I mad while I am writing this? Because it is criminal what happened to her. They had no idea what was wrong so they tried a potpourri of all the things that the usual addiction clinic tries. And with the same result: nada.

So let’s look at what it really is: first it needs to be triggered. We are not triggering catatonic; what is triggered is first-line terror, and what happens is one of two responses, both originating in the hypothalamus. The first is attack and aggressive; fighting off menace. The second is the freeze, becoming paralyzed with terror where moving is life endangering; the mother on serious drugs or tranquilizers, for example. Here is where using up oxygen becomes life endangering; the whole system has learned that freezing is the first primal response against danger. And in the first instance where danger lurked it worked. The carried baby may have been reacting to heavy drug overdose or drinking. So some of us, depending on the nature of the early trauma and genetic tendencies admixed with epigenetic effects, find the inexplicable reaction of no reaction as effective. We see this so clearly during the trauma at birth where the baby heavily anesthetized has to withhold breathing deeply to conserve oxygen. These are the later breath holders.

I have seen and helped catatonics at the mental hospital where I worked; most suffered from what is known as “waxy flexibility.” We put their arm up in the air and it stays there. We twist their hands in a certain direction and it remains in that position. They cannot manage any voluntary action. At the time no one, including me, knew what it was. Now we know. And I shall explain it.

Let’s go back to our three levels of conscious; the first line is basically brainstem and ancient part of the limbic system—the amygdala. This is our most ancient brain that has its beginnings millions of years ago. It is a mass of impulses but no feelings; here is where the primitive parts of the hypothalamus exert their dominance. And depending on many factors determines whether there will be either anxiety reaction with aggressive responses (the sympath); or whether there will be anxiety responses held in immediate check as bodily reactions freeze (in the parasympath). These response tendencies get stamped in and engraved so that it directs our characteristic reactions thereafter. The parasympathetic nervous system activates the freeze response everywhere in the system, not just in behavior. Think of the frightened reactions of a deer or rabbit. So something in the human triggers off fear, which then may resonate with first line terror which provokes the parasympathetic system into action—freeze. “Freeze” is a reaction to something that really happened, not a chance or whimsical caprice.

An example: some years ago I was napping in the backseat of the car. The driver looked back to make sure I was comfortable. By the time she looked back to the road she was in a culvert heading for a major steel signpost. She froze. I reached over grabbed the steering wheel and guided us back on the road and to safety. The imprinted reaction governs our life forevermore. My basic tendency was sympathetic but with a lot of parasympathetic reactions as well. The “freezer” usually has low blood pressure and low body temp; she is in the constant conservation of energy mode. She is not a self starter and needs constant direction and guidance. One has to “breathe life” in them to get them going. And why? Because something could have happened during womb-life or birth that diminished oxygen to dangerously low levels. They go on acting as if the imprint is now— current. They go on in a passive mode; go on as if they had no more energy to fight.

Freeze and paralysis is a reaction to anxiety and terror, remember. It doesn’t happen without reason. It is the alarm system that signals the response; we must suss out what the danger is that provoked that alarm reaction. Then we can treat it. And what is the danger? Nothing external; something internal…..sensations (of suffocation) or feelings (something closing in). When the patient who is coming into our therapy gets provoked she goes into the freeze—catatonic response first, for an hour or five. Then slowly as the defense weakens and body lets go of its tension/defense she develops an anxiety state. This is what the freeze response is defending against….not enough oxygen, which produces terror. Then after more time, she seems to be flooded with feelings which causes great frustration. But she doesn’t know what is flooding her. It is now a mélange of feelings liberated. So it is literally the freeze response we see where the person cannot move or speak because she is locked into the deep, brainstem imprint where there is no emotion, nor speech. Her nervous system is moving up the chain of pain, up to higher levels of brain function.

Friday, August 23, 2013

Why Is the Unconscious So Mysterious?

I know why. As one blogger put it: the body keeps fighting to tell me what happened in my life but my brain/cortex keeps fighting back and refuses to hear. It is not a willful refusal. The cortex just whips into action when pain levels get too high. And it reaches over and down into the limbic structures to keep them at bay, spritzing chemicals here and there to make sure feelings don’t get out of hand. Sometimes, that doesn’t work; feelings do get out of hand, and what do doctors do? They reach into their pharmacy for more of the very same chemicals (SSRI’s) that are lacking in the person, dosing him up so that feelings are again in control. Never seeing that those feelings, when under proper care, are liberating. All the person knows is that she is anxious; what the doctor and she do not know is that it comes from deep in the brain and needs exit in slow methodical ways. If they both only see anxiety then they are both lost. If they understand what it is, then they are on the track for proper resolution of the problem.

Generally, it is often the troublesome first line brainstem memories/ imprints that fight their way to the top, only to be put down again. And these memories rise with no words to them nor any scenes from childhood. They emerge from the dark depths where no words exist nor ever existed. They are pure forces, amorphous, no recognizable shape or sound, but they want out. They remain mysterious just because there are no verbal accompaniments with them. They need to connect to the prefrontal cortex. They “speak” of what happened to us at the start of our lives, impressions so vivid and strong, so menacing of death and so catastrophic and painful as to be overwhelming. A carrying mother drinking or smoking or going on crazy diets, all endangering the baby’s life.

That is why after a time in therapy when these sensations begin to rise up in therapy they can be severely disturbing to the whole system. And this is how we know how devastating they are, enough to cause serious ailments years later. We can see and measure their force; how it raises amplitude of the brain waves, how it speeds up the heart and raises blood pressure, and how when these sensations threaten to intrude into awareness, the person sometimes feel he is going crazy. And in cults, where they have no idea what is happening, they can go crazy. That terrible confusion is what the fetus feels— disoriented.

Now we have an idea why a person under constant stress can get very sick. The person imprinted with first line trauma can get sick because he has suffered chronic imprinted stress from the start of life that never leaves and never lets go. It is tenacious because it needs connection, to be integrated and be done with; the sensaton/ feelings needs connection so that it no longer stays an alien force. So in their infinite wisdom many shrinks help them stay unconscious by drugging them and repressing the early experiences. They do that because they have no idea that there are such deep forces hidden and barricaded by neuro-chemicals as strong as prison bars. This means that they think there are results with no ultimate cause; that symptoms just come out of the air. Why? Because they cannot see that mysterious deep unconscious.

And it is these aleatory, primal imprints that can cause massive drug addiction; and so we see the heavy use of painkillers to calm the symptom, but not what is driving it. Calm is not cure. And it takes a strong drug to hold down these pains because they are massive; they are nearly always life and death—a pregnant mother taking drugs or seriously depressed. These maternal habits are catastrophic for the baby and often result in equal and opposite catastrophic illnesses down the line. And sadly, they are a mystery in our field. The reason they remain a mystery is that the professionals have no idea of how to approach or get to these early imprints. Worse, they don’t know they exist. Even though the field of epigenetics should tell us something about it. So if I as the doctor spend a life-time repressing my pain, and it happens automatically, then I have no idea that anything is there.

 Of course I don’t put anything in question, I believe that there are only childhood memories and that’s it. This is as if there is no 9 months of gestation and absolutely no experience that affects the fetus during that period. And yet, in our research in many articles in the last few years and in our therapy, those first line imprints are critical.

If we want to change the world we better be aware of gestation and how to manage it, we must be conscious of the first line. Above all, we must change the birth practices. Automatic cesarean by appointment is a no-no. So is cutting the cord prematurely, so is bad diet and drinking. In the NY Times Sunday in the Science Section, for Christ sakes, there is a shrink saying it is OK to drink while pregnant. This counters everything we know. And what if she is wrong? Imagine the damage that can happen. My guess she is exculpating her own drinking while pregnant. How on earth can a major newspaper cite such nonsense. It is one thing to be fair but quite another to run pieces that can be dangerous.

We cannot see first line unless we are in a therapy that aims for it. We do see the results. Do we go on ad nauseam beating down the symptoms to make them disappear and then pretend they do not exist? What does cure in these cases mean? Certainly not beating the symptoms down. It means getting at the generating sources—the imprints. It is that simple and that complicated. Otherwise, it is whack-a-mole all over again. The symptom pops up again, and we smash it again with drugs and surgery and shock. Or the weakest of all—talk it to death.

In our field the first order of business is to help professionals be aware of the deep unconscious. They need to learn how we get there. It can be a protracted trip but it is a sure one.

Monday, August 19, 2013

What I Don't Understand

You may wonder why I  don’t understand this, but I really don’t: why, out of 200,000 shrinks in America very few reach into science to prop up their theories.  Why is it that every time we read about a new theory, such as mindfulness,  it is concocted out of whole cloth by the therapist?

I was thinking about that today in reading about research  starting in Science 1997 about stress hormones, which activate  us.  And what makes their rise?  Lack of love in animals, lack of licking and grooming.  In humans not enough kissing and hugging.  I  will take a simplistic notion here—cortisol.  It is a complex matter but one thing we do know is that lack of warmth in humans raises those levels; that is why my beginning patients are uniformly high in cortisol levels.  And after they feel deeply unloved their levels lower radically…..because they feel, and  feelings lower levels.

But here is the point; lack of love activates us and that means faster metabolism, more brain activity, faster heart rate and higher blood pressure.  We go to a doctor and he cannot see the “lack of licking,” so he prescribes drugs to stop the activation.  Usually the drugs that slow down the neural message from one synapse to another. Meanwhile the child is now eight years old and he is diagnosed as ADD. He cannot concentrate or sit still in school.  He is activated, and if therapists know their science they would look right away at what is causing that activation.  They need only look at animal  studies to find the answer. Everything is souped up when we are not loved enough and we are activated to find it where we can.  There  are myriad of other factors but this alone should help us understand an overactive brain.

What the Science journal was emphasizing was the long term effects of deprivation.  And how is  this done?  By methylation.  Now, just this fact and no more than that should inform those treating ADD sufferers about why children are so activated.  And that in turn should tailor a therapy toward dealing with this activation.  Up to now that has mean medication to slow down neural impulses so the message of pain cannot  reach higher brain levels.  But surely we can do more; we can go back and find the imprint and the origins of methylation and stop the activation in its tracks, which is what we have done.  Doesn’t that seem logical, an overly active child  is revved up due to a cause.  We don’t just look at the end product, the excitation, but the generating source.  Lo and Behold!  We find the answer.  And it never is about pushing back the activation/pain

All I am trying to point out is that there is simple science out there that can give us so many answers.  We can learn from neurologic science and we can change our treatment based on their findings. Alas, too often the research remains left brain and cannot inform the right of how to apply it to therapy.  So what the therapists know cannot be applied to their work.  The patient gets more of the same-- repression and repressive drugs to hide the source.  Is that therapy?

Thursday, August 15, 2013

More on Suicide

I was discussing the difference between self destructive behavior and suicide with a colleague.  They are quite different, although you would think that suicide is destruction of the self, but it is not at all like that.  Let’s go back to the imprint as so many of my suicide attempts have done.   In most of these situations, there is an oxygen deficit, perhaps a heavy dose of anesthesia to the mother or being strangled on the cord. And after an agonizing attempt to get born, death approaches and there is a sense of impending relief.  That memory of possible relief is sealed in so that later in the face utter hopelessness, an impending divorce for instance,  death becomes the answer.  And attempt at suicide follows.  It is a memory of possible relief, stamped in, engraved that endures for a lifetime.   It is the end of the chain of pain, as it were, the logical denouement when current hopelessness can set off the primal, primordial hopelessness and death lurks.

You may wonder, how is it that hopelessness today sets off the same feeling during birth?  It is again the chain of pain, the links between levels of consciousness.  One way we see that link is through resonance; the current feeling sets off the same  deeper feelings until the whole system is engulfed in utter hopeless feelings; and worse, there is no scene attached to it as it is pure feeling, naked and unadorned, the exact same  feeling rising again to smother the person and make her suicidal. It is the most profound hopelessness. The current feeling, in short, has triggered off its progenitor with sensations of approaching death becoming paramount.

Let’s put it differently for clarity.  That early hopelessness is later expanded and ramified as the whole system and brain mature.  As each new brain system comes on line, it adds its emotional weight to the feeling.  But it is the same feeling with increased maturity and neuronal development.   It is that feeling that is the essence of depression; it  is the system’s effort to suppress the feeling that  produces depression.  So depression is not a feeling; it is what happens as that feeling is blocked from higher level  access. And when we unravel depression that is what we find: utter, unarticulated hopelessness. And  as it is felt and experienced with all of its pain, the depression begins to leave, at last. This is not done in a day because it is very deep, the end point of the birth agony, a cord around the neck, for example. This means that we must not trump evolution and feel it soon in therapy. We can only feel it as the body and brain allow, current hopeless feelings first, then the childhood compounding  and finally, the first line, brainstem component where the deepest  feelings always lies.  I use the word “compounding,” because these are not different feelings; they are the same feeling compounded.  The child just seems unhappy and sullen and no one knows  why. And certainly the child has no idea at all, nor do his teachers.  He is in the grasp of that early primordial, devastating feeling that no one can say or name.  It is literally “ineffable.”

What has this to do with self-destruction?  Let’s take literal destruction, cutting oneself.  This  is  a later ploy, making  hurt obvious.  It is a plea for help; “Please see my hurt. See that I hurt.” This in lieu of screaming out that hurt. And the cutter is not often aware of what she is doing or why.  It was never acknowledged by anyone because perhaps the parents had no idea of that hurt or even that such emotional hurt existed.  There are many aspects of this.   Her feeling was, “I’m trying to let the hurt escape,” even when she had no idea what is was.   She just knew  it was inside and it had to come out. She found out that it was exactly what we do; letting  it out in methodical  ways, so she no longer had to  cut herself.

Suicide, then, is a  deeper, earlier sensation/feeling with no behavioral possibilities.  And the hurt that some act out may have many different feelings involved.  They are, indeed, two different things.  Even though suicide attempts to destroy  the self it is not, oddly, self destructive like burning or cutting oneself.  And of course, it ramifies so that the destructive behavior takes on many forms.  Deliberate failure is one part.  Getting involved with crazy and violent people is another.  But it is not as direct as suicide.  Suicide means one final act.  It is not anything in the present that causes it; it is the result of a deep memory.    And yes,  if one could  then screaming it out could help temporarily; it would relieve the pressure.

There are some acts of suicide that are a cry for help; taking a certain amount of sleeping pills, for example.  And there are others that say, I really don’t want to live anymore; that is a jump off a bridge.  That is final, no call for help.  It all seems so helpless  and hopeless; they want to die for relief.  No more pain; that’s enough.

What we do is get patients, over time, down to those deep feelings that are so disturbing.  It takes time but when we get there it is pure relief, and it lasts.

Review of "Beyond Belief"

This thought-provoking and important book shows how people are drawn toward dangerous beliefs.
“Belief can manifest itself in world-changing ways—and did, in some of history’s ugliest moments, from the rise of Adolf Hitler to the Jonestown mass suicide in 1979. Arthur Janov, a renowned psychologist who penned The Primal Scream, fearlessly tackles the subject of why and how strong believers willingly embrace even the most deranged leaders.
Beyond Belief begins with a lucid explanation of belief systems that, writes Janov, “are maps, something to help us navigate through life more effectively.” While belief systems are not presented as inherently bad, the author concentrates not just on why people adopt belief systems, but why “alienated individuals” in particular seek out “belief systems on the fringes.” The result is a book that is both illuminating and sobering. It explores, for example, how a strongly-held belief can lead radical Islamist jihadists to murder others in suicide acts. Janov writes, “I believe if people had more love in this life, they would not be so anxious to end it in favor of some imaginary existence.”
One of the most compelling aspects of Beyond Belief is the author’s liberal use of case studies, most of which are related in the first person by individuals whose lives were dramatically affected by their involvement in cults. These stories offer an exceptional perspective on the manner in which belief systems can take hold and shape one’s experiences. Joan’s tale, for instance, both engaging and disturbing, describes what it was like to join the Hare Krishnas. Even though she left the sect, observing that participants “are stunted in spiritual awareness,” Joan considers returning someday because “there’s a certain protection there.”
Janov’s great insight into cultish leaders is particularly interesting; he believes such people have had childhoods in which they were “rejected and unloved,” because “only unloved people want to become the wise man or woman (although it is usually male) imparting words of wisdom to others.” This is just one reason why Beyond Belief is such a thought-provoking, important book.”
Barry Silverstein, Freelance Writer

Quotes for "Life Before Birth"

“Life Before Birth is a thrilling journey of discovery, a real joy to read. Janov writes like no one else on the human mind—engaging, brilliant, passionate, and honest.
He is the best writer today on what makes us human—he shows us how the mind works, how it goes wrong, and how to put it right . . . He presents a brand-new approach to dealing with depression, emotional pain, anxiety, and addiction.”
Paul Thompson, PhD, Professor of Neurology, UCLA School of Medicine

Art Janov, one of the pioneers of fetal and early infant experiences and future mental health issues, offers a robust vision of how the earliest traumas of life can percolate through the brains, minds and lives of individuals. He focuses on both the shifting tides of brain emotional systems and the life-long consequences that can result, as well as the novel interventions, and clinical understanding, that need to be implemented in order to bring about the brain-mind changes that can restore affective equanimity. The transitions from feelings of persistent affective turmoil to psychological wholeness, requires both an understanding of the brain changes and a therapist that can work with the affective mind at primary-process levels. Life Before Birth, is a manifesto that provides a robust argument for increasing attention to the neuro-mental lives of fetuses and infants, and the widespread ramifications on mental health if we do not. Without an accurate developmental history of troubled minds, coordinated with a recognition of the primal emotional powers of the lowest ancestral regions of the human brain, therapists will be lost in their attempt to restore psychological balance.
Jaak Panksepp, Ph.D.
Bailey Endowed Chair of Animal Well Being Science
Washington State University

Dr. Janov’s essential insight—that our earliest experiences strongly influence later well being—is no longer in doubt. Thanks to advances in neuroscience, immunology, and epigenetics, we can now see some of the mechanisms of action at the heart of these developmental processes. His long-held belief that the brain, human development, and psychological well being need to studied in the context of evolution—from the brainstem up—now lies at the heart of the integration of neuroscience and psychotherapy.
Grounded in these two principles, Dr. Janov continues to explore the lifelong impact of prenatal, birth, and early experiences on our brains and minds. Simultaneously “old school” and revolutionary, he synthesizes traditional psychodynamic theories with cutting-edge science while consistently highlighting the limitations of a strict, “top-down” talking cure. Whether or not you agree with his philosophical assumptions, therapeutic practices, or theoretical conclusions, I promise you an interesting and thought-provoking journey.
Lou Cozolino, PsyD, Professor of Psychology, Pepperdine University

In Life Before Birth Dr. Arthur Janov illuminates the sources of much that happens during life after birth. Lucidly, the pioneer of primal therapy provides the scientific rationale for treatments that take us through our original, non-verbal memories—to essential depths of experience that the superficial cognitive-behavioral modalities currently in fashion cannot possibly touch, let alone transform.
Gabor Maté MD, author of In The Realm of Hungry Ghosts: Close Encounters With Addiction

An expansive analysis! This book attempts to explain the impact of critical developmental windows in the past, implores us to improve the lives of pregnant women in the present, and has implications for understanding our children, ourselves, and our collective future. I’m not sure whether primal therapy works or not, but it certainly deserves systematic testing in well-designed, assessor-blinded, randomized controlled clinical trials.
K.J.S. Anand, MBBS, D. Phil, FAACP, FCCM, FRCPCH, Professor of Pediatrics, Anesthesiology, Anatomy & Neurobiology, Senior Scholar, Center for Excellence in Faith and Health, Methodist Le Bonheur Healthcare System

A baby's brain grows more while in the womb than at any time in a child's life. Life Before Birth: The Hidden Script That Rules Our Lives is a valuable guide to creating healthier babies and offers insight into healing our early primal wounds. Dr. Janov integrates the most recent scientific research about prenatal development with the psychobiological reality that these early experiences do cast a long shadow over our entire lifespan. With a wealth of experience and a history of successful psychotherapeutic treatment, Dr. Janov is well positioned to speak with clarity and precision on a topic that remains critically important.
Paula Thomson, PsyD, Associate Professor, California State University, Northridge & Professor Emeritus, York University

"I am enthralled.
Dr. Janov has crafted a compelling and prophetic opus that could rightly dictate
PhD thesis topics for decades to come. Devoid of any "New Age" pseudoscience,
this work never strays from scientific orthodoxy and yet is perfectly accessible and
downright fascinating to any lay person interested in the mysteries of the human psyche."
Dr. Bernard Park, MD, MPH

His new book “Life Before Birth: The Hidden Script that Rules Our Lives” shows that primal therapy, the lower-brain therapeutic method popularized in the 1970’s international bestseller “Primal Scream” and his early work with John Lennon, may help alleviate depression and anxiety disorders, normalize blood pressure and serotonin levels, and improve the functioning of the immune system.
One of the book’s most intriguing theories is that fetal imprinting, an evolutionary strategy to prepare children to cope with life, establishes a permanent set-point in a child's physiology. Baby's born to mothers highly anxious during pregnancy, whether from war, natural disasters, failed marriages, or other stressful life conditions, may thus be prone to mental illness and brain dysfunction later in life. Early traumatic events such as low oxygen at birth, painkillers and antidepressants administered to the mother during pregnancy, poor maternal nutrition, and a lack of parental affection in the first years of life may compound the effect.
In making the case for a brand-new, unified field theory of psychotherapy, Dr. Janov weaves together the evolutionary theories of Jean Baptiste Larmarck, the fetal development studies of Vivette Glover and K.J.S. Anand, and fascinating new research by the psychiatrist Elissa Epel suggesting that telomeres—a region of repetitive DNA critical in predicting life expectancy—may be significantly altered during pregnancy.
After explaining how hormonal and neurologic processes in the womb provide a blueprint for later mental illness and disease, Dr. Janov charts a revolutionary new course for psychotherapy. He provides a sharp critique of cognitive behavioral therapy, psychoanalysis, and other popular “talk therapy” models for treating addiction and mental illness, which he argues do not reach the limbic system and brainstem, where the effects of early trauma are registered in the nervous system.
“Life Before Birth: The Hidden Script that Rules Our Lives” is scheduled to be published by NTI Upstream in October 2011, and has tremendous implications for the future of modern psychology, pediatrics, pregnancy, and women’s health.