Psychotherapies Without Feeling
by Dr. Arthur Janov
Posted June 2005 on primaltherapy.com
Introduction: The Dialectics of Consciousness
We in clinical psychology today are in a strange position. We see people, both in and outside of our practices, suffering from some insidious condition that cannot be seen, tasted, touched, or pinpointed in any single location. The condition is often called mental illness or neurosis. A few question whether the suffering is real, describing the experience as a "trip" to be savored, and terming mental illness a "myth." Others see mental illness as merely a function of distorted thinking, something that will disappear with new thoughts. Among schools of psychotherapy that do admit the existence of mental illness, each one has very different ideas about neurosis and its genesis. Indeed, in no other area of medicine is there such disagreement about the nature of a disease, what its symptoms are, and how it manifests itself, not to mention its causes.
In short, the field of psychotherapy today is nothing less than chaotic. Why?
First, I believe, events that may cause mental illness or neurosis begin so very, very early, and remain so barricaded in unconsciousness, that the notion that early trauma affects how we act at the age of, say, 45, is beyond ordinary imagination. Second, we react with incredible diversity to early trauma, and we may imagine that phobias, migraines, compulsions, obsessions, depression, addictions, etc. must all have different functions. Third, psychologists themselves have blind spots of a function of their own neuroses - they cannot see, cannot bear to see, their patients' deepest pain - and find themselves gladly distracted by symptoms and by ideologies that do not directly address pain.
As a result, the field of psychotherapy may be characterized by a remarkable absence of cohesion, and patients' pain is addressed diffusely at best. Some psychotherapists will consistently prescribe anti-anxiety and antidepressant drugs for varying neuroses, in essence trying to kill patients' pain, but not identifying the pain or where it comes from. Others may manage symptoms through various techniques associated with different schools of psychotherapy: They may have the patient "dissociate from" a symptom in hypnotherapy; cognitively "analyze" it into oblivion; "act out" the symptom symbologically in gestalt-type therapy; beat it back with mild shock as in conditioning therapy; chalk it up to "faulty beliefs" which simply need to be willfully changed, as in rational-emotive therapy; "control" it in biofeedback therapy; or reroute it in directive daydreaming and imagery therapy.
The myriad approaches in psychotherapy are treatments rather than cures. They all focus on the symptoms of neurosis instead of probing for its cause. It is possible that they all help somewhat; they do not cure, however.
The only hope for cohesion, and lasting help for patients, is to address the generating sources of neurosis or mental illness. What and where are these sources? I believe that the conflict between the imprinted Pain of early trauma and its repression is the central contradiction that generates neurotic reactions both internally (physiologically) and externally in the form of behavior. Repression, or the loss of access to feelings and sensations, is an evolved function that allows us to survive unmitigated pain early in life. The pain, however, stays in the body, unavoidably - as unavoidable as the experiences that originally caused the pain. And the pain will perpetually fuel a dislocation of mental and physical functioning to keep itself unfelt, for as long as it remains unfelt.
Therapies that do not address this original, central conflict at the root of neurosis may succeed in reconfiguring a symptom pattern, but cannot eliminate the fundamental illness. In this book I will explain why I believe that nearly all available psychotherapies - including EMDR, OR hypnotherapy, Freudian psychoanalysis, gestalt therapy, behavior modification, rational-emotive therapy, body therapies, and drug therapy - are doomed to fail. To understand why this is so, it is necessary to first understand one of the fundamental properties of all natural phenomena: the dialectical process of change.
A Brief History of the Dialectic Concept
The concept of dialectic has been around in various forms for centuries. Socrates used it to describe his method of argument involving question and answer. Plato used it to describe a kind of supreme knowledge. Aristotle used it to denote a specific method of reasoning. Hegel used it to describe the process of movement underlying the nature of thought, and Marx used it to describe the process of movement underlying the nature of human, social, and historical development.
Hegel's writings on the dialectical principle as it is manifested in thought and in nature constitute one of the most far-reaching systems of philosophy ever conceived by one man. Indeed, Hegel's philosophy was an attempt to comprehend the entire universe as a systematic whole. He saw this "whole" arising out of patterns of contradiction and reconciliation which ebbed and flowed with cosmic regularity. The dialectical process led man through multitudinous stages of development - mental, moral, aesthetic, religious, and philosophical - to the point where man at last knows himself as one with God, possessing Absolute Truth. Dialectics, for Hegel, was the means by which God created "nature and finite spirit"; it was also the means by which "nature and finite spirit," now made manifest, would be reunited with the God that created it.
Living in the same period, Karl Marx was deeply influenced by Hegel's method of dialectical thinking, although he strongly rejected Hegel's ontological assumptions regarding the nature of the universe. Put simply, Hegel saw mind (thought, spirit) as primary, with matter being created out of mind. Marx saw matter as primary, with mind emerging as the latest evolutionary development of matter. Despite such opposing views regarding the ultimate nature of reality, Marx found Hegel's formulation of several dialectical laws of nature to be of much value in understanding the nature of social evolution.
According to Hegel's concept, the universe exhibits certain patterns of growth and change which constitute basic laws of nature. Four of these laws are particularly applicable to this discussion:
(1) The Law of Contradiction or The Law of the Interpenetration of Opposites.
(2) The Law of Emergent Phenomena
(3) The Law of the Negation of the Negation
(4) The Law of the Universality of the Particular, and the Particularity of the Universe.
The essence of these laws may be summarized as follows:
(1) Change results when two opposing tendencies interact quantitatively.
(2) This change will reach a critical point where a qualitative transformation occurs.
(3) Reversal of the circumstances that caused the original contradiction will undo or reverse the transformed state.
(4) the nature of any phenomenon can be discovered either through the particular (specific) or through the universal (general). Universal laws are contained within particular elements, and the particularity of elements can be discovered through examining the universal law.
What does all this have to do with psychology? Since its early beginnings psychology has floated in a stepchild position from one affiliation to another. From religion to philosophy to the social sciences, its history doesn't seem to belong anywhere. Only recently has its basis in the natural sciences been established, thanks to the advancements in technological capabilities (e.g., psychometrics, psychophysiology). Yet many still view psychology more as a province of the soul - of an ethereal, nonphysical mind - than as a tangible, quantifiable science.
Ultimately, it must be recognized that the test of efficacy for any therapeutic system or psychological theory requires reference to our nature - a nature mediated by, or made possible by, a complex but knowable system of biological processes. Understanding the biological processes that compose our human, psychological nature is to understand the building blocks of health and illness. Understanding the dialectical principle that directs the movement and evolution of those processes is to understand the means by which that health or illness came into being.
The following sections cover the laws behind that process, and their connection to neurosis, in detail.
Law 1: The Law of Contradiction or Interpenetration of Opposites
This law explains that change and movement in all phenomena are brought about through the underlying principle of contradiction. As the sine qua non of change in the universe, contradiction is the cornerstone or starting point of the dialectical process. Without the interacting forces of contradiction, there would be no dynamic alterations - no movement, change, or growth within or among phenomena - only a kind of static, mechanistic rearrangement of them.
The dialectical concept of contradiction originally developed in opposition to the mechanistic view which had arisen during the 18th century. The mechanistic view was, naturally enough, a product of mechanics, which was then the most developed of the natural sciences. Since mechanics consists of the basic step-by-step procedure of turning Knob 1 to release Hammer 2 to strike Bolt 3, it was also natural that a mechanistic viewpoint of the world would see all phenomena as results of this mechanical paradigm. Thus it was believed that even the most complex phenomena of nature, including human life and mind, were reducible to a kind of linear, non-dynamic arrangement and rearrangement of parts.
In mechanical mixtures, component A and component B remain side by side. This contrasts with the dynamic interaction that occurs in chemical combinations, whereby the two components merge to form something entirely new. With the advent of chemistry and physics during the nineteenth century, mechanism as a scientific viewpoint was no longer tenable. It remained, however, as a philosophical and phenomenological framework - a kind of world-view or orientation - which has not only persisted into the present, but as we shall see, characterizes most contemporary psychological theories and therapies.
Prior to Hegel's recognition of the basic process of contradiction inherent in all natural phenomena, the notion of contradiction was viewed as a purely logical relationship between two elements of thought. It was not yet understood as a primary directive principle operating within and between all things, processes, and events in the natural world.
The phenomenon of contradiction exists at the most fundamental level of particle physics. A particle, having certain mass and lifetime, is counteracted by its "anti-particle." The antiparticle has "symmetrical characteristics" equal but opposite to its brother-particle. Its mass and lifetime are identical to the mass and lifetime of the particle, but its charge and magnetic moment are exactly reversed in sign. That this relationship between particle and antiparticle is dynamic rather than mechanical in nature is evidenced by the "annihilation process" resulting from their clash. The energy released by the clash of the particle with its antiparticle results in the annihilation of their mass and its conversion into raw energy.
To apply the dialectical law of contradiction to the study of neurosis is to finally understand the elemental building blocks of the neurotic process: Pain, and its counterforce, repression. Pain brings repression into being. You cannot have repression without first having something painful to repress. That the intrusion of Pain ( I sometimes use the capital "P" to denote primal pain; something too overwhelming to be integrated) into the human system generates its own counterforce is now established as a biological fact: Pain triggers the production of pain-killing neurotransmitters known as endomorphines, or endorphins. Moreover, Pain and its repression produce biological changes that can be life threatening.
Animal experiments have revealed that when endomorphines are released in high enough quantities, catastrophic disease such as cancer may result. Researchers have suggested that cancer is the ultimate new quality resulting from the release of the high levels of endomorphines - levels commensurate with the amount of Pain being experienced by the animals. In another set of experiments, stressed rats developed tumors in the areas of the brain where both stress and repression were organized. Experimenting with one-celled animals, Joan Smith-Sonneborn exposed paramecia to ultraviolet radiation, damaging their DNA. The damage was then removed with the use of short-wavelength visible light. She next discovered that the original intrusion of radiation had stimulated the release of repair enzymes. She concluded from her work that "ultraviolet damage induces DNA repair processes. In other words, the damage had activated the reverse process of healing.
The point is that Pain alone does not account for some diseasse. It is the interplay of Pain with its counterforce, repression, that ultimately alters the organism.
Law 2: The Law of Emergent Phenomena
This law is closely connected with the principle of contradiction. It says that new phenomena result from the quantitative build-up of contradictory interactions which, at a certain critical point, are then transformed into something qualitatively new. The transition to the new quality is not gradually observable; rather, it emerges suddenly. It is not reducible to its parent-qualities; it is greater than the sum of its parts.
There are countless examples of this transformation in nature. The simplest example can be found in the kitchen. Water boils and freezes only when it has reached certain critical temperatures. The steam and ice which result are qualitatively different from the parent-quality of water from which each emerged. A fundamental change occurs in the water at the critical point at which the quantitative accumulation of heat or cold is sufficient to render the qualitative transformation. This phenomenon of critical transformation levels dominates both chemistry and physics. In the course of chemical combination, one chemical substance suddenly transforms into another. There are critical melting points for metals, the transformation of mechanical motion into heat, and so on.
In humans what this amounts to is that the deprivation of need in early childhood (e.g., the lack of affection, love, or acceptance; physical trauma; oxygen deprivation at birth) causes an accumulation of Pains. These Pains are coded and stored until some critical point when they can no longer be smoothly integrated. In compensating for the input of Pain, the system of repression reaches a critical level, at which point the organism makes a qualitative leap to a new kind of organization, producing a cascade of changes found everywhere.
When this qualitative leap is made, you have a new system, a new biology, neurology, and biochemistry--neurosis. The Pain is an alien force not allowing us to be natural, not allowing us to be ourselves. Stress hormone levels, for example, are permanently heightened in neurosis. When repression falters, such as in the reliving of Pain in Primal Therapy, the person runs a fever. His system is attempting to thwart the alien presence known as Pain. Feelings here become a danger, something to be fought by all systems of our body.
The application of this principle to psychology and the study of neurosis is particularly valuable, for it indicates that neurosis involves a total, systemic alteration - that it is, in fact, a qualitatively new state of being. Pain brings repression into being and the dynamic interplay of the two continues quantitatively until there is a qualitative leap to the new quality known as neurosis. We may soon be able to measure the critical point at which the normal human system is transmogrified into a neurotic one. We know that in autopsies of psychotics some the nerve cells (neurons) in the limbic system of the feeling brain were either out of place or inverted completely.
Is there any scientific evidence as yet to indicate that neurosis is a systemic disease, a new state of being? Yes. Research in neurology indicates that the structure of the brain is itself altered in response to Pain. Neurophysiologists Morpugo and Spinelli found in their animal experiments that painful events "spread" and take up more space in the brain than neutral events. Furthermore, imprints of Pain result in perceptual alterations such that neutral stimuli are perceived as painful. "New circuits become engraved by the ongoing painful experience," write Morpugo and Spinelli, "so that more and more of the neuromachinery is prepared to recognize as painful stimuli that would go completely unnoticed in a normal subject." In other words, the environment (trauma) constructs a new brain system, which in turn produces a new internal environment. Cells affected by Pain are altered and become part of the neuromachinery processing Pain. The alteration down to the cellular level changes one's perception and alters the way one sees and reacts to one's environment. A new environment is constructed in accord with one's internal state, such that neutral events become painful and are reacted to accordingly. "Can I help you?" becomes, "Do you think I'm helpless or stupid?" "I disagree with you" is interpreted as "I think you're a loser," which provokes an anomalous reaction. This is because, in this state, any neutral event can trigger off the old imprint. We know from the work of Martin Teicher that the connecting "cable" between right and left hemispheres of the brain is weakened or thinned due to very early trauma.
The fact that neurosis involves a qualitative, systemic alteration has only recently been recognized by a few researchers and clinicians in the field. The "bits and pieces" framework, described earlier, where a phobia is a phobia, an obsession is an obsession, and symptoms are symptoms, unfortunately still remains more common.
Law 3: The Law of the Negation of the Negation
The Law of the Negation of the Negation indicates that the reversal of the circumstances that caused a contradiction will both resolve the contradiction and undo any qualitative transformation that resulted from the contradiction. The Law of the Negation of the Negation indeed holds the key to the end of neurosis: The opposite of the experiences that set up the Pain/repression contradiction will resolve the contradiction, and end the neurotic state the contradiction caused. In early trauma, repression is required for the organism to survive, creating a contradiction between Pain and repression (Law 1). The Pain/repression contradiction may lead to the qualitative new state of neurosis (Law 2). Taking Pain as a given, repression may be reversed by bringing a patient to fully feel the original Pain - which he or she could not possibly have done at the time it happened - as in primal therapy. As a result, the Pain/repression contradiction is no more, because repression is no more; and as the foundation for the neurotic state disappears, so does the neurotic state.
The condition called "deprivation dwarfism" provides an excellent example of the "negation of the negation" process. Injurious input in the form of harsh, unloving surroundings prevents some children from growing physically. There is a biochemical suppression (negation) of growth hormones which is activated psychogenically; there is no known organic cause. But if the input is changed to a loving and safe environment, there is a negation of the negation within the child's body whereby growth processes are resumed and the body veers back toward health.
Another example of the negation process in stunted physiology is the blocking of the evolution of the genetic code through repression. Repression can prevent or delay the proper synthesis of organ systems by rearranging brain neurotransmitters such that the normal genetic program is altered. Interestingly enough, as patients progress in Primal Therapy, we have observed this genetic blocking reverse itself. We have seen men in their thirties develop chest and facial hair for the first time, and women's breasts increase in size, as the individuals progressed in Primal Therapy. Reversing the blocking of their genetic unfolding (negating the negation) was apparently achieved through their experiences of the central contradictions involved in their neurosis. Feeling formed the negation of the negation, which in turn freed their physiological processes to proceed "as planned."
The migraine headache provides an apt, biological paradigm for understanding the law of negation. First we see the negation of Pain through vasoconstriction. The vasoconstriction is an automatic physiological attempt to block or contain the Pain. Then the vasoconstriction has a counteracting tendency towards an overproduction of vasodilating elements in the bloodstream, which produces the throbbing symptom called migraine. A migraine headache is the synthesis of these two opposing tendencies of vasoconstriction and vasodilation. The symptom-synthesis is reversed by negating the negation of vasodilation: Pain levels are reduced via feeling so as to permit the blood system to operate normally. In traditional medical treatment, vasoconstricting drugs are given to block the symptom temporarily;. That is not a cure, however.
Another biological example is a type of cancer which has abnormal surface antigens on it called "tumor associated antigens." Antibodies form against these antigens. If the story stopped there, the immune system would normally cure the cancer through the formation of these antibodies. Unfortunately, these antibodies are most often "blocking antibodies" which are not tissue-destructive. Instead, they occupy receptor sites on the tumor-associated antigen, thus hiding the cancer from those portions of the immune system which could actually destroy it. In order to break the sequence, you need a negation of the negation: You need a chemical to block the blocking antibody, thus exposing the cancer to the destructive antibodies which can produce the cure.
Achieving health for the neurotic means negating the past as an energy source so that one does not have to work against one's history continuously. Originally, to protect the system against feeling too much Pain, repression was activated in order to protect the organism. The negation is itself negated by the ascendance of the original feelings into consciousness - that is, by definition, repression is reversed by feeling Pain. And in the absence of a Pain/repression contradiction the neurotic states crumble.
Law 4: The Law of the Universality of the Particular, and the Particularity of the Universe
According to this principle, the laws of the universe are contained in the most minute of particles, and within the workings of every particle one can begin to understand the universe. The general is always found in the specific. To understand a single brain is to understand all brains. To understand one neurosis is to understand the dynamics of all neuroses.
Universality and particularity are inseparable aspects of the dialectic. The deeper we delve into a single individual, the more universal laws we discover about the psyche. The more we understand Pain and repression in one person, the more we understand all its aspects. To understand all the differing neuroses is to understand the commonality of a single neurosis.
Our Primal research shows that diverse emotional traumas produce the same internal changes. In other words, though different neuroses may manifest in different ways, they are all really a single neurosis. The more our patients feel their traumas, whatever they may be (e.g., humiliation, abandonment, rejection, criticism, the more their bodies move toward a biological mean of health. Against this homogeneity emerges a new heterogeneity - the natural diversity that results when people are free to become themselves.
By contrast, the standard psychiatric diagnostic manual (the DSM-IV) laboriously distinguishes multiple neuroses from each other, betraying a mechanical approach. Similarly, at the National Institute of Mental Health, there is a building or a bureau for each separate neurotic problem - alcohol, drug abuse, sex deviation, migraine, ad infinitum. One could say that the treatment of neurosis reflects neurosis itself: both are characterized by dysfunctional fragmentation. I think we need but two buildings: neurosis. Psychosis. These are matters of the quantity of pain. If repression falters we get overt symptoms or drug addiction and alcoholism. If the pain level is exceptionally high we may find psychosis.
The key is that body does not differentiate among Pains inflicted upon it. Emotional and physical Pain are processed in pretty much the same way. That is why it does not help to focus on the nature of each and every outer sign that something is wrong. We need instead to refer those particular symptoms back to the central processing mechanisms involved in all neurotic disorders, back to the original contradictions that generated them. To favor the particularity of neurotic symptoms over the universality of the mechanisms mediating them is to take a unidimensional approach toward an ever-elaborated nomenclature and an ever-insufficient understanding.
The Limitations of Non-Dialectic Therapies
What all non-dialectical therapies have in common is a one-sided focus on half of the problem. There are two aspects to any phenomenon: its appearance (the phenotype) and its essence (the genotype). Non-dialectical therapies deal with appearances rather than with essences. When such a therapy "works," it works on the surface - on one side of the contradiction - while the biologic system continues to manifest the systemic dislocations of neurosis. Thus a sex problem becomes a matter of technique, a kiss or a caress here, a few words there; a psychosomatic symptom becomes a matter of a needle (acupuncture), a machine (biofeedback), or words (hypnosis). Treatment is applied to the patient from the vantage point of a preordained and pre-packaged framework. Phobias are "conditioned" out of a person by use of a pre-established program called desensitization. "Ego adjustment problems" are "resolved" via the application of a psychoanalyst's or psychotherapist's insights.
Dealing with fragments of human behavior - working on the "mind" through psychoanalysis, working with the body through massage or bioenergetics, working on the skin or blood pressure through biofeedback - can render only fragmentary revisions. The dialectic shows us that it is not possible to separate symptom from source, biology from psychology, cause from effect. All are inextricably and dynamically interconnected.
Relatedly, a therapeutic system must not superimpose itself on the biologic nature of the patient, but rather should derive its theory, concepts, and techniques from the patient - from her experience and from her psychobiology. Leaving the dialectic behind means one no longer recognizes internal contradictions and their expression as the resolving factor. This means one must intend to call forth outside forces to explain what's going on inside a human being. Thus the patient will need insights from someone else on how to lead her life or find out about what's going on in her own body. This approach will not help the patient. Patients can only be helped on the field of their own phenomenologies, unencumbered by therapists' preconceptions.
Psychotherapy and Dialectics Today
What most psychotherapies are about today is the manipulation of people, of their ideas, their concepts, and their feelings. The patient's beliefs and attitudes are dealt with as if they were a separate universe of abstraction and discourse which can only be revealed to the intellect or by the intellect independent of the material world inside. Yet neurosis is not laid down intellectually, as an idea, but as an experience. It is to experience that we must address ourselves.
The central point of my argument is that contradiction is the driving force of change. If we want to understand the direction of change and control it, we must first understand the original contradiction. The important thing about contradiction is that there are literally thousands of contradictions on all levels of human functioning. The entire body is a mass of contradictions, of equilibriums, of balances. Nowhere is this more clear than in the immune system. More and more evidence indicates that individual cells in the immune system are related to psychological Pain and indeed secrete a form of neurotransmitter that deals with Pain. In these cells we see the unity of body and mind, the relationship of personality to cell, the relationship of the general to the particular and of the part to the whole.
Much of the field of psychology is still bifurcated by the mind-body duality, where mind exists as a separate state apart from the body. Any psychotherapy is, by its very nature, non-dialectical, for it neglects the interactive unity that exists between body and mind. Many therapies which appear to be "holistic" and which claim to reflect a unified approach actually are not and do not. A truly holistic approach to therapy means dealing with all the factors originally involved in the creation of the state of neurosis. Those factors form a historical-psychological-neurobiological constellation of forces continually interacting in accordance with the laws of dialectical evolution.
Dialectics is not a system to be superimposed onto nature but is derived from observation of it. Nature and natural forces thus become the ultimate test of dialectics. As part of natural law, dialectics is a system of ordering phenomena which can provide a framework for psychotherapeutic work. When neurosis is viewed in a dialectical framework, the apparent diversity of neurotic symptomatology suddenly shows an underlying cohesion and unity. This underlying cohesion and unity then throws a glaring light of insufficiency on the diverse treatment modalities now seen as legitimate approaches to cure. Applying the laws of dialectics allows us at last to legitimize our psychotherapeutic work by providing guidelines for a truly curative approach to neurosis. Neurosis, it is often forgotten, is but one disease generating a myriad of manifestations. Its cure, therefore, should involve only one approach.
I believe it is only a matter of time before the scientific relevance of dialectics is considered in the field of psychology. We will soon have measurable critical points of transformation whereby both the onset and the dissipation of neurosis will be pinpointed. We will have neurobiological data detailing the specific negation process. We will be able to predict precisely how much therapy (feeling) will be required by how much Pain is registered throughout the person's vital signs.
Today the field of psychology has an important choice to make. It can ignore the compelling evidence pointing to the dialectical basis of neurosis until science has fully verified it. Or it can take its own qualitative leap of vision by allowing the dialectical framework to provide the field with the first unified approach to the problem of mental illness in its history.
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