Psychotherapies Without Feeling
by Dr. Arthur Janov
Posted June 2005 on primaltherapy.com
Chapter 1: EMDR
A hot new therapy for a wide variety of afflictions is Eye Movement Desensitization and Reprocessing (EMDR). It is subscribed to by many therapists and a good number of specialists in neurology and psychoneurology. EMDR is a set of techniques that borrows elements from hypnosis, behavior therapy, guided imagery, cognitive therapy, and insight therapy. The central feature of EMDR is its use of "bilateral stimulation." The bilateral stimulation typically involves enjoining a client to watch and track a finger or a wand moving back and forth in front of her eyes. While eye movements gave EMDR its name, other modes of bilateral stimulation, such taps on alternating hands, or sounds in alternating ears, are considered effective substitutes (David Grand, Emotional Healing at Warp Speed: The Power of EMDR, New York: Harmony Books, 2001).
EMDR is claimed to have success with phobias, depression, anxiety and stage fright. Thousands of therapists have been trained in EMDR world wide. It has been adopted by some insurance companies and HMOs because it is quick and theoretically efficient. EMDR therapists claim good results with such shattering events as incest. The claim is that individuals can come to terms with great trauma without being re-traumatized, a very attractive proposition.
One study funded by Kaiser Health Group found that after three sessions of EMDR patients felt better than those who were in standard therapy. Conclusion: EMDR is more effective, or so it seems. In a short time period 77% of the EMDR group no longer met the criteria for post traumatic stress syndrome, while only 50% of those in conventional therapy met those criteria (Los Angeles Times, March 25, 2002. “Trauma Therapy’s New Focus.”)
EMDR treatment involves a precise protocol, and – like primal therapy – requires careful training and supervision for its legitimate practice. A rough description of the main steps in EMDR is as follows: Early in the treatment, a client is asked to identify a painful memory; a negative, irrational cognition associated with the memory; a physical sensation associated with the painful memory; and a positive, rational cognition that may be used to replace the negative cognition. Bilateral stimulation is then administered in three phases: desensitization, installation, and body scan. For desensitization, the client is asked to focus on the memory, the negative cognition, and the physical sensation, while being subject to the bilateral stimulation. During installation, the client is asked to focus on a combination of the positive cognition and the memory, while again being subject to bilateral stimulation. In the body scan phase, the client scans her body for sensations, while bilateral stimulation is used to enhance positive sensations, or dissipate negative ones (Steven M. Silver and Susan Rogers, Light in the Heart of Darkness: EMDR and the Treatment of War and Terrorism Survivors, New York: W. W. Norton, 2002).
EMDR was created by Francine Shapiro, who first discovered an ameliorative effect of bilateral stimulation in 1987. In her book, EMDR (2001; New York: Guilford Press), Shapiro states: “The rape victim may begin by feeling intense fear and shame. She may have constant images of the rape intruding on her present life and may experience negative thoughts such as ‘I am dirty. It was my fault.’ After the clinician has worked with her using EMDR procedures to focus on specific internal responses, the rape victim may be able to recall the rape without feelings of fear and shame” (p. 2). This then empowers the patient who can say, “I did very well…I managed to stay alive.” According to Shapiro, the patient now has a positive change in her thoughts and beliefs and will no longer have intrusive thoughts of rape. The belief she has now internalized is “I am a strong, resilient woman.”
The rationale here is that negative beliefs become less valid and become linked with more appropriate information: “The patient learns what is necessary and useful from the disturbing past experience and the event is restored into memory in an adaptive, healthy, non-distressing form.” (p. 2) The patient learns from negative experiences in the past, is desensitized to present triggers, and incorporates "templates for appropriate future action that allow the client to excel individually and within her interpersonal system" (p. 2).
In another book by Shapiro, and Margo Silk Forrest (1997), the authors discuss trauma and pain: “Entering the world of trauma is like looking into a fractured looking glass” (p. 49); there, a “strange new world unfolds.” The authors cite the case of a woman of sixty two who suffered all of her life with panic and fear as a result of sexual abuse by her father. Shapiro and Forrest claim that as the memory was processed the person could live in peace. They say that there was rapid response with EMDR. The therapist asked the patient, “What events do you remember that made you feel worthless and useless?” (p. 51). The authors then say, “That is all the information the therapist needs to identify and target the event with EMDR.” What Shapiro believes is that the negative beliefs we carry around (e.g., I feel sad) are often the inappropriate residue of trauma. The patient is then directed to positive attitudes. Shapiro and Forrest state: “EMDR goes beyond quieting the pain…there are reports of success of EMDR in clinical work with alcoholics and drug abusers. It can rapidly pinpoint and reprocess the underlying causes of the distress” (p. 177). Shapiro's clients use coping skills to learn how to handle stress without drugs or alcohol.
One case described in the Los Angeles Times article concerns a social worker who remembered an event from years back that was still painful: A professor had interrupted her during a practice interview. She was instructed to think about the episode while watching the therapist’s hands as he waved them back and forth “like a metronome.” “The therapist then told her to think about how she would like her mental picture to change….All of a sudden the professor’s head got as big as a balloon and then it popped into pieces and he wasn’t there anymore.” Within five minutes her shame and resentment evaporated. And now she is free of it.
Neurologist and trauma researcher Bessel van der Kolk describes the post-traumatic stress disorder (PTSD) sufferer as someone who cannot integrate memories of earlier trauma and instead gets mired in “a continuous reliving of the past” (1994). He states that those PTSD individuals suffer from persistent activation of the biological stress response. Part of this reaction is decreased serotonin levels, or a deficit in inhibition. This translates into an inability to modulate general arousal; hence impulsivity, irritability and hyper-excitability.
According to van der Kolk, early trauma is imprinted into the neurophysiologic system and produces repetitive or “neurotic” behavior. There is often a decreased serotonin response and therefore faulty inhibition. The imprinted trauma “uses up” serotonin supplies and produces lifelong deficiencies. I call it a faulty serotonin pump. There is just so much repression the system can produce. van der Kolk suggests that drugs that inhibit serotonin uptake, which keep higher levels of serotonin in the brain, help keep the past in the past, allowing the person to function in the present. This is not entirely true. Drugs help normalize the system artificially and, above all, temporarily, but the imprint is implacable and immutable, and does intrude into everyday life; hence migraines, high blood pressure, phobias, etc. These are the sequelae of the early trauma. They are part of the memory.
But suppose we could raise serotonin levels by purely natural means. Would not that be preferable? We do just that in primal therapy. We have done a double blind imipramine binding study on our patients and have found that levels normalize after one year of our therapy. Our rationale for the imipramine study is that we can consider it an analogue of serotonin; that is, what happens in the blood platelets would be mirrored in the brain. In addition to imipramine binding, we have also studied salivary cortisol (stress hormones). We have seen cortisol levels normalize after one year of primal therapy. (See research on imipramine platelet binding, done in conjunction with Open University, Milton Keynes, England, cited in The Biology of Love by the author).
van der Kolk (1994; 2002) believes that we need a high level of arousal to heal a patient. He is right; not any level of arousal but the same as inherent in the original trauma (and we must remember that one of the greatest traumas of all is not being held enough during infancy). Further, when any situation, including sex, reaches the arousal level of the original trauma, it sets off the prototypic reaction of survival and hijacks the sexual act. Thus, if at a certain level during the birth trauma there was a total shut down due to a lack of oxygen, when the sex act reaches a certain level of stimulation there may be again a shut down and inability to achieve an orgasm. The sexual dysfunction will not be cured until that original trauma with the whole panoply of physiologic responses is reawakened in context.
EMDR proponents note that experiences that are too painful (traumatic) have never been sufficiently "processed." Among other effects, trauma in our history can color our perceptions and actions in similar circumstances in the present. A crucial quote from Shapiro: "When an event has been sufficiently processed, we remember it but do not experience the old emotions and sensations in the present. We are informed by our memories, not controlled by them" (p. 3)
We in primal therapy agree with this except that our concept of "processing" is very different from the concept of "processing" in EMDR. I posit that EMDR is basically a cognitive approach, changing attitudes and ideas and thereby strengthening repression. Primal therapy seeks to carefully remove repression (or defenses), allowing pain to be relived and, at last, felt fully. A full, conscious reliving – and I believe only a full, conscious reliving – finally relieves the person, and her body, of the need to repress in the first place.
I believe it is physiologically impossible for the techniques of EMDR to erase the effects of early trauma, and it is potentially dangerous to suppose otherwise. What EMDR seems to do is take the beginnings of a reliving of trauma and give the patient a very effective distraction, through the use of bilateral stimulation. So instead of making it safe to consciously relive a trauma – which is not necessarily going to be a speedy process – EMDR seems to cause the brain to push trauma further away from consciousness. The result is that people will indeed feel relief – they will feel better in a way and for a time, just as they may through certain drugs, or religion. Unfortunately, the imprint of trauma, I believe, remains untouched by EMDR. And there is a risk that this imprint is going to continue to wreak havoc on the victim's body.
The Los Angeles Times stated that after several instances of bilateral stimulation, patients report that “they are able to distance themselves from the traumatic experience.” Indeed, distancing seems to be the linchpin of EMDR. Success in EMDR occurs when the patient says she feels better and reports that her memory/feelings are dimmed and no longer troublesome. Parnell in Transforming Trauma: EMDR® (1997) states, “Many adult clients have been referred to me by other therapists because they believed the clients had been sexually abused as children. Many of these clients have indeed been abused and the trauma surfaces in our work. However, I found it interesting that in using EMDR, despite strong suggestions of possible abuse from the referring therapists, in many cases no imagery or memories of sexual abuse have emerged” (p. 180). Also: “There is a major belief embedded in our culture that once you have experienced a trauma, you are damaged for life. However, what is different with EMDR is that the feeling of being permanently damaged disappears” (p. 95) Erroneous beliefs cease, Parnell claims. She says that in many cases the trauma disappeared in one session.
It seems, to me, that what disappears in EMDR is conscious-awareness. That is, information from the sensation and feeling parts of the brain has been prevented – for a time – from impinging upon the parts of the brain that comprise consciousness. The trauma and its associated physiology go nowhere. They are still there. They are just covered up better. In fact, ironically, I believe that EMDR, and other forms of distancing from feelings (e.g., cognitive therapy, hypnosis, guided imagery, religious therapy) may have long-term problems as a side effect: The energy of the trauma is kept from consciousness, thus leaving the energy intact, and thus keeping the person vulnerable to physical and psychological distress. A waving wand may distract one's neocortex, bolstering defenses, for a while, but the imprint of trauma in the lower parts of brain still seethes below.
Primal therapy involves a careful procedure – paced by the patient – toward bringing sensations and feelings from trauma in one's history safely into conscious experience. The apex of this procedure is total reliving of a traumatic experience. Unlike EMDR, primal therapy avoids distracting or interrupting the patient in this process. We seek to draw attention to sensations and feelings, and allow the patient, when he and his body is ready, to go into the pain, and fully relive it. This time, in contrast to the time of the original trauma, the patient can finally experience the feelings, and finally be relieved of their neurotogenic energy.
The reliving that occurs in primal therapy may be hard to imagine by those who have not seen it. In reliving incest, for example, not only are the vital signs exceptionally high, often into lethal levels, but the physical posture reflects what happened in the original event, the wrists bound together behind the back, for example. Why, one would question, do we allow these dangerous levels to exist in therapy? The patient, on the lip of feeling a great trauma, runs a fever. One hundred three degrees is not unusual. We don’t desire it except that without it there is no healing. Secondly, these lethal levels were the reason for the repression, in the first place. Sustained blood pressure in hypertensive regions would have killed the newborn. What the neuroinhibitors such as serotonin/endorphin do is keep reactivity within survival bounds and thereby save one’s life; a key function of repression. Now as an adult the individual is stronger, and may begin to relive the trauma, if only in small titrated doses.
Who decides the dose for an episode of reliving? The neuro-physiologic system of the patient. She relives to a certain point and stops for the day. No one tells her to stop the session; she knows when she has had enough. Again, the next session, more of the feeling is relived. Post session vital signs indicate some degree of integration and resolution. They usually drop below baseline after the session. If they move either up or down sporadically we are dealing with abreaction—the discharge of the energy of a trauma without proper connection. This is never curative.
Reliving yields insights and cognitive changes automatically. Reliving never being touched as a child makes immediately clear the reason for one’s nymphomania. It puts the need for touch in the past so that it is no longer acted-out in the present. The patient does not need to be told how to appreciate the trauma; everything is understood within the feeling, provided it is a full reliving. We seem to think that nymphomania is some kind of sick symptom, rather than seeing it as a survival mechanism; trying to be touched to make up for a terrible early lack. Almost every symptom may be considered a compensatory mechanism that should not be altered without regard to roots. Symptoms are anchored in those roots.
When I say a “total reliving” it can mean the reappearance of the original bruises from an early beating, or the forceps marks from the birth procedure. We have photographed these marks. The whole system must be involved in reliving, because it was originally. That is why, it is being recognized more and more, that simply discussing the past trauma will not get the job done. Discussion the past trauma is, by and large, a cortical operation that remains in the area of thought. It is the inordinate pain portion that is stored in the brain's limbic system and held away from conscious-awareness. And that is what constitutes the unconscious. It is that portion of pain that must be relived. Waving a wand in front of the eyes is most certainly never going to help a girl get over being raped by one’s father over and over again for four years starting at the age of ten. In my mind, that is voodoo, not science. It is magical thinking to believe that being abused by an alcoholic mother for ten years of one’s childhood can be eradicated by waving a few fingers in front of the eyes of the patient. If the reader could see the amount of pain this engenders he would understand right away how impossible this is.
EMDR theorists believe that after moving the wand or hands the patient needs a different solution to the trauma. Instead of having a patient relive totally an event as it happened, they provide a different, and therefore a symbolic, solution, not recognizing that the solution lies in the imprint itself, not a different ending. The proferred solution can only be imaginary, a false one, because it never happened.
One way we at the Primal Center verify this is that the vital signs move from very low to normal after a reliving – the physiologic sign of the resolution of hopelessness. The patient reports feeling more hopeful, at the same time. We have treated thousands of patients over the decades and have seen beneficial outcomes through the five year follow-up studies we undertook (see Primal Man by the author). In contrast to EMDR, in primal therapy, no one has to help a patient integrate; the neurologic system does that all on its own. The lower level stamped-in feelings move to frontal cortex for connection and integration when that feeling is not such as to inundate the neocortex. That is why integration takes place over months or years as the neocortex allows more and more pain to connect to conscious-awareness.
When we liberate pain we liberate a whole system of consciousness and thus produce feeling/aware human beings. Experience is organized on all three levels of consciousness. To help someone become a conscious/feeling person we need to engage those levels.
The therapy selected by the individual is often a reflection of the problem. The head trippers choose insight therapy, while the passives who want magic go to hypnosis. One must select a therapy where the power and wisdom reside in the patient. Where what is real inside is addressed primarily; addressed on a timetable set by the patient’s physical system and her tolerance for pain and feeling. Where what to feel and how much is determined not by the therapist but by the one who has to undergo the feelings. The old saying by Eldridge Cleaver, the Black Panther: you are either part of the solution or you are part of the problem. Imagining the solution still makes you part of the problem.
Dr. van der Kolk describes the PTSD sufferer as someone who cannot integrate memories of earlier trauma and instead get mired in, “a continuously reliving of the past.” (page 3) He states that those PTSD individuals suffer from persistant activation of the biological stress response. Part of this reaction is decreased serotonin levels, or a deficit in inhibition. This translates into an inability to modulate general arousal; hence impulsivity, irritability and hyperexcitability. He suggests that serotonin uptake inhibitors which keep higher levels of serotonin in the brain, help keep the past in the past, allowing the person to function in the present.
van der Kolk gave a lecture on a conference about attachment at Omaha, Nebraska and again at UCLA (March 2002). He emphasized that conventional therapy for PTSD is not effective; that our goal should be to help people be here and not always “there” (in the past). The problem is that the past is imprinted in our neurologic systems and is not subject to any desire or will to be “here.”
He stated that, “If you are stuck in old memories, you can't have new behavior. Only changing the outcome of past events can result in new behavior in the future because the purpose of memory is to prepare you to deal with future events. In addition, traditional therapy focuses on talking about or playing out conflicts, which accesses the left side of the brain, while traumatic memories are stored in the right side of the brain. If the traumatic memories and experiences are to be resolved, the therapist must engage in activities that access the right side of the brain. Traumatic memories are often stored in the limbic system, which is responsible for attention, arousal, and attachment, but are usually stored as somatic (body sensations) memories. Traditional therapy does not even begin to approach the limbic system to resolve the trauma, so a therapy that accesses body memories (like attachment therapy does) is much more effective. EMDR is useful for resolving many traumatic memories, although it is not at all clear why it works.”
Dr. van der Kolk suspects that it works because doing the eye movements distracts the person from the traumatic memories and allows the brain to be changed. He thinks that any physical activity a person does while recalling trauma will work just as well. Once the right side of the brain has been triggered to produce traumatic memories, the focus of therapy then needs to shift to triggering the left side of the brain, as it has the ability to help children resolve trauma, while being stuck in the right brain only results in staying stuck in the trauma. The therapist then needs to help the child use language (a left brain function) to provide a meaningful scheme for the traumatic memories so that mastery can be gained over the memories.
Dr. van der Kolk also noted that for therapy to work there must be a high level of arousal for the client (since the traumatic memories were stored in conditions of high arousal, resolving them can only be accomplished when high arousal is present). Traditional therapies usually focus on reducing arousal, so they don't help at all to change the results of the trauma.
I believe that, grosso modo, I have outlined the basic tenets of EMDR therapy. I will begin with van der Kolk’s work first. What I think he is onto is many of the basic tenets of primal therapy but in a less organized fashion. For example, he states rightly that for trauma to be resolved there has to be a high level of arousal since the trauma was stored under conditions of high levels of arousal. He emphasizes that traditional therapy focuses on reducing arousal either through the use of tranquilizers or in attempting the calm the patient’s arousal level, also known as anxiety. The question is can his therapy produce the same arousal? Bereft of reliving the trauma, I don’t think so.
During a reliving of the early trauma, and that means pre-birth and birth, which is not in the parlance of EMDR therapists, we see body temperatures climb several degrees (F) in minutes; systolic blood pressure over 200 and heart rate exceptionally high, as well. We have done salivary cortisol studies (stress hormone) on before and after therapy with reduction in levels after one year of therapy; plus four separate brainwave studies where we found, inter alia, changes in the power distribution between left and right, which is what Kolk wants to achieve. We control every session in terms of vital signs.
van der Kolk says that the child never made the proper psychologic assessment of the trauma and therefore never prepared for the future. I submit that the assessment is inherent in the trauma itself. Reliving never being touched as a child makes immediately clear the reason for one’s nymphomania. It puts the need for touch in the past so that it is no longer acted-out in the present. The patient does not need to be told how to appreciate the trauma; everything is understood within the feeling, provided it is a full reliving. We seem to think that nymphomania is some kind of sick symptom, rather than seeing it as a survival mechanism; trying to be touched to make up for a terrible early lack. Almost every symptom may be considered a compensatory mechanism that should not be altered without regard to roots. Symptoms are anchored in those roots.
When I say a “total reliving” it can mean the reappearance of the original bruises from an early beating or the forceps marks from the birth procedure. We have photographed these marks. The whole system must be involved in reliving, because it was originally. That is why, it is being recognized more and more, that simply discussing the past trauma will not get the job done. That is, by and large, a cortical operation that remains in the area of thought. It is the inordinate pain portion that is limbically stored and held away from conscious-awareness. And that is what constitutes the unconscious. It is that portion of pain that must be relived. Waving a wand in front of the eyes is most certainly never going to help a girl get over being raped by one’s father over and over again for four years at the age of ten. In my mind, that is voodoo, not science. It is magical thinking to believe that being abused by an alcoholic mother for ten years of one’s childhood can be eradicated by waving a few fingers in front of the eyes of the patient. If the reader could see the amount of pain this engenders he would understand right away how impossible this is.
Another point by van der Kolk: As I pointed out, he describes the PTSD sufferer as someone who cannot integrate memories of earlier trauma and instead gets mired in, “a continuous reliving of the past.” (page 3) He states that those PTSD individuals suffer from persistant activation of the biological stress response. Part of this reaction is decreased serotonin levels, or a deficit in inhibition. This translates into an inability to modulate general arousal; hence impulsivity, irritability and hyper-excitability.
What he says is true. The early trauma is obviously imprinted into the neurophysiologic system and produces repetitive or “neurotic” behavior. There is often a decreased serotonin response and therefore faulty inhibition. The imprinted trauma “uses up” serotonin supplies and produces lifelong deficiencies. I call it a faulty serotonin pump. There is just so much repression the system can produce. He suggests that serotonin uptake inhibitors which keep higher levels of serotonin in the brain, help keep the past in the past, allowing the person to function in the present. This is not entirely true. Drugs help normalize the system artificially and, above all, temporarily, but the imprint is implacable and immutable, and does intrude into everyday life; hence migraines, high blood pressure, phobias, etc. These are the sequelae of the early trauma. They are part of the memory.
But suppose we could raise serotonin levels by purely natural means. Would not that be preferable? We do. We have done a double blind imipramine binding (an analogue of serotonin) study on our patients and have found that levels normalize after one year of our therapy. The rationale for the imipramine study is that what happens to it mirrors the serotonin processes; i.e., what happens in the blood platelets would be mirrored in the brain. It is not only imipramine binding that we have studied but also salivary cortisol (stress hormones). Cortisol levels normalize after one year of therapy. (See research on imipramine platelet binding, done in conjunction with Open University, Milton Keynes, England, cited in Biology of Love by the author).
van der Kolk believes that we need a high level of arousal to heal a patient. He is right; not any level of arousal but the same as inherent in the original trauma; and we must remember that one of the greatest traumas of all is not being held enough during infancy. Further, when any situation including sex, reaches the arousal level of the original trauma, it sets off the prototypic reaction of survival. For example, total shut off or repression in response to being strangled on the cord. This is the “freeze” reaction that Kolk describes. It continues on into sex, and the frigidity (the freeze response) will not be cured until that original trauma with the whole panoply of physiologic reactions be reawakened in context. But van der Kolk has a conflicting message; he states that we must relive with the same intensity as originally, yet using EMDR tends to block a full reaction, hences cut off the healing process.
Again, no one has to help a patient integrate; the neurologic system does that all on is own. The lower level stamped-in feelings move to the right and then left frontal cortex for connection and integration. When a therapy is done methodically and not too much pain is released all at once, that can take place. That is why integration takes place over months or years as the neocortex allows more and more pain to connect to conscious-awareness.
There is a point where all of the EMDR theorists merge. They believe that after moving the wand or hands the patient needs a different solution to the trauma. van der Kolk stated that, “If you are stuck in old memories, you can't have new behavior. Only changing the outcome of past events can result in new behavior in the future because the purpose of memory is to prepare you to deal with future events. There are a few problems with this: it is basically non-dialectic. Instead of having a patient relive totally an event as it happened, they provide a different solution, not recognizing that the solution lies in the imprint itself, not a different ending, which when we think about it, can only be imaginary, a false ending, because it never happened. It is an ending the mind and imagination of the therapist.
The deeper one plunges into the agony of the imprint the less pain there is to deal repress. The person is then free to deal in the present. The deeper one feels one’s very early hopelessness (someone who did not have a nourishing mother right after birth) the more real hope there is. One way we verify this is that the vital signs move from very low to normal after a reliving—the physiologic sign of the resolution of hopelessness. The patient reports feeling more hopeful, at the same time. We have treated thousands of patients over the decades and have seen beneficial outcomes through the five year follow-up studies we undertook. (see Primal Man. Janov, a. Holden, M. for results) The symptoms do seem to remain resolved.
van der Kolk states that If you are stuck in old memories you can't have new behavior. True, but new behavior is not something one superimposes onto a patient. New behavior emerges dialectically out of the reliving of the past, for one simple reason: the agony portion of the past imprint has not yet been lived. It has led an underground life manufacturing ulcers, migraines and high blood pressure. When I say agony, I believe that until one sees it or feels it there is no concept of the depth of that pain; something that can elevate brainwave amplitude by hundreds of percent. (Hoffman, Eric. Long-term Effects of Psychotherapy on the EEG of Neurotic Patients. Res. Comm. Psychol. Psychiat. Behavior. Vol. 8, 1983 pages 171-185. See also, “Hoffman, E., Goldstein, L. “Hemispheric Quatitative EEG Changes Following Emotional Reactions in Neurotic Patients. Acta Psych. Scand. Vol 63. 1981 pages 153-164)
Reliving anoxia or hypoxia at birth, the patient turns red and struggles for breath as if it were a life-and-death matter, which it was and is. An imaginary ending would be to feed the patient oxygen at a critical moment, which would inter alia, abort the memory and stop the healing process. The patient is beginning a dying sequence, as dramatic as that may sound, and needs to complete it; she did not die originally, and she will not die in the reliving. But with a thermister, an electronic thermometer, inserted rectally we see the temperature drop by many degrees as the patient approaches “ground zero”. Why is this necessary? Because the trauma and the ensemble of physiologic reactions form a template for survival—a prototype which guides future behavior. Again, so-called neurotic behavior are attempts at survival. Why would we want to change that survival mechanism. First, we must see and address it for what it is. To change the prototype one must descend to its origins. Out of the original trauma evolve numerous ramifications, directing diverse behavior and diverse symptoms, from colitis to heart problems such as frequent palpitations. Until the prototype is relived the best we can do is treat deep problems symptomatically. Generally, the deeper in the body the symptom the earlier the trauma, not always, but often.
Feeling the terror in the birth canal reduces and eventually eliminates phobias of elevators, (enclosed places) for example. No one has to take the hand of the patient and help her enter an elevator. That is Behavior Therapy and makes the mistake of taking the ostensible problem as the real one; taking the symptom and making “it” well instead of the person. The deeper one feels and integrates the terror the less there is to deal with.
To reiterate van der Kolk: ”If the traumatic memories and experiences are to be resolved, the therapist must engage in activities that access the right side of the brain.” That is something that I have been writing about for thirty years, and is something we do. We know that the very earliest memories impact the right hemisphere more than the left because it is developed earlier; that it is some time before the corpus collosum is mature enough to translate memories from right to left; further that early trauma impairs the functioning of the corpus collosum so that information later on is not easily transferred to the left side. Martin Teicher has written about this recently. (“The Neurobiology of Child Abuse.” Scientific American. March 2002. Page 68-75) He points out, as have many other investigators, that early stress reconfigures the molecular organization of areas of the limbic system. He found that early maltreated individuals were notably more developed in the right cortex rather than the left. It was and is the right hemisphere that was activated when recalling early painful memories. And in children who were abused or neglected there were areas of the corpus collosum that were noticeably smaller. A number of researchers in the field agree: “early stress is a toxic agent that interferes with normal, smoothly orchestrated progression of brain development.” (page 75)
Retrieval of early memory activates the right hemisphere more than the left. When our patients are deep into reliving early trauma the limbic system is fully activated, and we believe the information is then transferred to the left hemisphere for final integration. In our brain research there is a shift of power from right to left hemisphere.
Dr. van der Kolk suspects that EMDR works because doing the eye movements distracts the person from the traumatic memories and allows the brain to be changed.
There is a basic contradiction here. If eye movement therapy distracts the person from memory it defeats the ability to fully access that memory; it then cannot be integrated. He is right; eye movement is a distraction that aids in the process of repression, which is exactly why the person feels better. Prayer can do it, “om” can do, thinking other thoughts can do it, directive daydreaming can do it by offering other images instead of the real one, etc. The fastest way is a good dose of Paxil.
Let us discuss what integration means. First let us see what disintegration means. Feelings stored on lower brain level, and this is where pre-birth,` birth and post-birth traumas reside, due to their valence of pain cannot rise to the frontal cortex for connection and integration. They are inhibited by various neurotransmitters and kept below the level of conscious-awareness. This is disintegration; the higher levels do not know what is going on in the various lower levels even while they are being driven by it. Paranoid ideation can help be quelled by tranquilizers that work on deeper brain levels, indicating the provenance of the higher level ideas. The person is not aware of the deep-level imprint but is driven to develop strange ideas by it. He does not need to feel a bit of it, say being abandoned in infancy, or living in an institution for the first year of life, and then told to change his ideas or her behavior. The patient needs to relive the early traumas bit by bit over many, many months or years until the ideas driven by them evaporate. And they do. Solutions provided by a therapist are his solutions, not the patients’; therefore not real. Reality lies in the reality, as banal as that may seem. Reality lies in the truth of the memory and only there; certainly not in someone else’s brain.
We can only heal where we are wounded. The seeds of cure lie in the problem. We [at the Primal Center] do not teach people how to live or how to manage in the future. Once free of their past they can figure it out themselves.
Let us now turn to the other authors: Of course, Dr. Shapiro is key since she is the inventor of this method. One of her techniques is to have the patient hold a memory of a painful event and then watch the hands of the therapist move in front of her, and then to think of a different solution to the event, something more desireable. Therein lies the rub: first, for real traumas it is rare that a patient can easily remember them. In fact the more painful the more repressed and the less likely it can be retrieved. My patients may take many months of reliving before they can even approach incest, for example. The pain is ineffable, and no one begins to resolve and integrate it before many, many months of reliving. But assuming they can remember it. Part of the solution for Shapiro and her cohorts is to help the patient imagine other solutions; in short, to produce imaginary resolutions. We must keep that in mind because it will remain imaginary. It hearkens back to the technique of directed imagination therapy or directed daydreaming.
I cite Ellen Curran’s work: (Guided Imagery. Beyond Words Publishing. Hillsboro, Ore. 2001) “Healing imagery is a way to use one’s imagination in a focused way to help the mind and body to self-heal.” (introduction) She claims it makes one more open to the unconscious mind, “making it possible for the inner self to be heard and therefore to be healed.” These are wonderful, liberal thoughts, but lack a bit in the science department. We have treated many imaginative artists who have no real access to their feelings other than what they paint. Using their imagination doesn’t given them access to deep inner feelings because no act of will, a cortical function, can offer access to feelings. Access works from the bottom up, not the reverse; it operates in terms of evolution. It means to descend down below the cortical control mechanism to enter into a different brain; that is the meaning of access. We have developed the techniques over thirty years to accomplish that.
If we imagine a solution we get symbolic resolution, not a real one; and we do not get radical changes in vital signs that we do with real resolution. We see this in our therapy when patients in mock primal therapy (the practice by untrained individuals) come to us from past lives therapy (an oxymoron, if there ever were one) and trip off into wildly imaginative ideas. Here they come close to a real event, the birth trauma, which we have researched and measured, and then skip over it and fall into fantasyland. The left frontal cortex rushes to the rescue as the person is inundated with heavy imprints. . In every case the valence of pain is so high as to make the real experience impossible. It does not offer access to feelings; quite the opposite. It is a sign to us of lack of access and of a disturbed personality. That is why we proceed slowly in small pieces of the feeling at a time. We begin in the present with feelings that can be integrated and then ride the key feeling down to the past in ordered fashion until months later we arrive at the key underlying sensation/feelings. Take hopelessness. The person has lost her job and feels hopeless, but more than that, deeply depressed. We allow that present context with its load of feeling to occur and then take the patient back slowly to the next level down where a deeper part of the same feeling resides.
Curran states that imagery is thought. Thought is thought, a cortical function. Imagery is subcortical, often limbic. Dreams are full of imagination but they happen when thoughts have been put to bed for a while. Now this whole idea of changing images and/or thoughts runs through a wide gamut of therapies, including Behavior Therapy, Ego Psychology, Rational-Emotive Therapy, and many others. They believe that you must change your ideas to change your behavior; or, vice versa, change your behavior to change your ideas. Thus, you go into an elevator where you are phobic and imagine very relaxing images—you are floating on a cloud, for example. It is as true in hypnosis and in EMDR. You can imagine being relaxed but the imprinted memory is anything but, so that the frontal cortex, is playing mind games on the rest of the brain and body. It is fooling itself, thus cannot be a real, permanent solution. The left frontal cortex, with its unlimited ability at self-deception, is an expert at this game. But is that cure or healing? It is repression and anti-healing. If you are tense due to a lifetime of neglect, does imagining that you are floating on a cloud change that? It is another quick fix, and like all quick fixes, it must be temporary, at best.
You can imagine telling off someone at work who is bothering you. Or you can imagine floating in a pool while thinking of a troubling event. When you stop imagining who are you? The same old fearful human being, the person who is terrified of women because he lived with a mother who was a monster. No hand wave is going to erase that
The essence of directed imagination is that the “body listens to the mind.” If that were true then those who were anxious or depressed could “will” their way out of the problem. They cannot. The body does not listen to the mind; on the contrary, the mind, the prefrontal cortex is the obedient servant of the body or the imprints deeper in the brain. That is, I repeat, why drugs that work as low down as on the brainstem can prevent torturing thoughts from obsessing us. Why drugs such as clonidine that work on the locus ceruleus (brainstem), can inhibit phobias and other fears and stop us obsessing, an obsession that keeps us from sleeping. We call them thought disorders but they are not; they are disorders of the limbic system and brainstem which result in distorted and ruminating, obsessive thoughts. That is why some of the neural cells in the limbic system, the hippocampus, are found on autopsy of psychotics to often be reversed or upside down.
Curran goes on about directive imaging: “Our bodies react to the sensory images of the mind. …The practice of conscious, focused imaging can bring you to a deeper level of mind-body interaction, which in turn can produce wellness.” (introduction) That is a tall order—to imagine you are well and then get well. Imagery does use lower levels of consciousness but always in isolation; it does not liberate the pain registered on these levels. The opposite: it forces the attention away from real memories and toward imagined solutions. They remain imagined which is why hypnosis rarely has long term effects. It too uses the imagination, “you are tired and are floating on a lake where there are no cigarettes, and every time you see a cigarette you get nauseous.” The problem is that one smokes often because there was no love in one’s childhood. One is tense and needs relaxation because the memories, such as being abandoned just after birth by a sick mother, linger and require one to smoke. We don’t want to rip away something that soothes someone without regard to one’s history. Here again it is taking the apparent problem and thinking it is the only one. Imagining can produce all kinds of temporary changes by reinforcing unreality. What it cannot do is change history. You need to get real for that.
If a woman feels weak and powerless as a result of rape by one’s father, a memory that is impressed into the central nervous system, she can tell (fool) herself by repeating that she is really strong and not powerless but feelings are always stronger than ideas. We have measured reliving of childhood events and reliving of birth trauma and crying about the present. There is a hierarchy of valences. The vital signs are always highest with birth, less high with feelings from childhood and far less higher when thinking about the present. It is a biologic law for a very good reason. Traumas regarding birth are most often life-and-death matters and as such galvanize the system toward survival. Imagination in the present cannot and does not lower a body temperature of 103.5 back to 98 degrees after a session. Imagination does not permanently lower body temperature by one degree or drop the heart rate by an average of ten beats per minute, as we have demonstrated in our research.
Let us look again at the key assumption of EMDR: The theoretical rationale here is that negative beliefs become less valid and become linked with more appropriate information: “The patient learns what is necessary and useful from the disturbing past experience and the event is restored into memory in an adaptive, healthy, non-distressing form.” (page 2) Their belief is that the patient learns from negative experiences in the past and adopts new templates for appropriate future action. The patient learns a new template to take the place of the old “negative” one. She doesn’t resolve the imprint which can take a very long time, but rather papers it over with different “positive” ideas called a new template, which, unfortunately, is only cortex deep. Even a neurologist such as van der Kolk is not sure how EMDR works. I believe it works in the sense that 12 step programs for alcoholism works—so many months off the booze is considered a “cure.” But then they say you are never cured. That is true because they do not consider deep history and need. So long as childhood need remains unfulfilled and unfelt the danger of recidivism is always there.
The dialectic must be adhered to: the clash (contradiction) between need/pain and repression produces a new state—neurosis, together with its symptoms. If one takes only one aspect, the symptom, and tries to beat it back without regard to the other aspect of the dialectic, one is bound to fail.
The patient who has been incested isn’t plagued by negative thoughts; she is plagued by reality. It was terrible and she should feel terrible. Putting an optimistic face on it isn’t a positive step; it is a false one. That is truly negative. The way to be positive is to have a “negation of the negation.” That is, to feel those terrible aspects deeply enough until the pain is extirpated and the result is now positive. She can get on with her life because she has fully felt the past and left it there. Why? Because the feeling is in the past. Now the memory remains bereft of the feelings attached to it. During a reliving one is in the grip of an old brain, the cries are that of a newborn or of an infant that emanat e from the brain active at the time of the trauma, an event that cannot be faked. No patient in the past thirty five years of primal therapy has ever been able to duplicate those cries once the session is over. Another control: having one’s body temperature drop two to three degrees during a session in the case of feeling deep hopelessness can also not be faked, and it accompanies those infantile cries. That is the real meaning of reliving the past. Until that is done the past remains in the present no matter what we think or imagine. The way to empower a rape victim is to allow her to fully feel powerless; the deeper she feels the less she feels powerless, because that feeling is attached to a memory which is now laid to rest. She can react normally because her system has normalized as attested to by the radical change in blood pressure at the end of the session. The patient not only acts normal, but the whole system is accord with that behavior. It is therefore not an extracted, isolated mental event.
Parnell, above, claims it is false to think that an early trauma can damage you for life. Having seen thousands of patients in our clinics, having been traumatized myself, I can attest to its lingering for life. If you convince a patient otherwise there will always be the danger of falling back into the old behavior, whether of depression or drug taking. The power is in the pain, and the pain is the result of unfulfilled need. Parnell discusses all this as if it were a matter of erroneous belief; it is not. The pain is not a matter of belief; it is a real physiological state with changes in all manner of brainwave function, neurochemistry and vital functions; all of which we have measured often in double-blind studies. For example, we have normalized natural killer cells of the immune system after one year of primal therapy. No wand waving can do that. Instead of sticking pins in a doll to drive the evil away, one waves a magic wand; the evil is so-called negative thoughts. It is akin to driving away the evil spirits through exorcism, as if those spirits really exist.
Beliefs are neither negative or positive. They are what they are and follow logically from experience. If the experience was painful then the beliefs follow suit. Here beliefs are medicine for feelings of helplessness and hopelessness. They are not negative; they are real and often necessary. We can decide about what a positive belief is and inculcate it into the patient but it’s a “look on the bright side of things,” polyanna style. It usually means not looking at reality. You can get deceptively well, with positive beliefs but when one’s basic level of stress hormones remains high those beliefs are simple deception. I am not sure people want to be deceptively well, no matter how seductive that is. Getting well without pain, effortlessly and quickly, is hard to beat. The insurance companies are overjoyed. The patient thinks he is well. The company doesn’t have to pay out for months, the therapist believes he has done something successfully and everyone is happy except the subconscious of the patient, which is screaming silently from its agony. The subconscious suffers while the awareness level rejoices. The gap between the two accounts for later illness. The wider the gap the more serious the illness. There is an internecine battle going on with no winners; the neocortex imagines it has won but it is a pyrrhic victory. Eventually, we are stricken down by our own reality.
No one can rapidly pinpoint the focus of drug addiction, as Shapiro claims. Only the patient knows that, and only he will deliver it through slow, small accretions of reliving over a good deal of time. We are always surprised where the pain leads. No therapist would dare make the discoveries for the patient because the therapist cannot do that. He cannot know what is in the unconscious of the patient, particularly when even the patient has no idea and may not know for many months of therapy. From a patient:
“It was not until the past year that I was able to have access to my deeper feelings and come nearer to being able to tell the whole truth of my childhood. The reason was that I ignored and denied the importance of my early feelings I had as a child. I had a convenient amnesia about them. Amnesia of this kind protected me from the pain and trauma but it also made life a dead and depressing reality. These emotions underlie my neurosis and psychosomatic problems and, as I am able to experience them, life is becoming richer and more fulfilling.”
“I wanted only to try to live in accord with the promptings, which came from my true self. Why was that so very difficult ?” From Demian by Hermann Hesse.
In yet another work by Philip Manfield (Extending EMDR, W.W. Norton. N.Y. 1998) it is posited that EMDR offers a new meaning for the past experience of the patient. A new spin that is optimistic and esteem boosting. “By means of carefully orchestrated therapeutic instructions he or she spontaneously acquired new self-concepts and patterns of behavior." (introduction). For some reason therapists believe that they have to give patients new slants on events. It is believed that the patient has to be taught skills that will help her function in the future. For example, incest has a multitude of idiosyncratic meanings; we have treated patients where it led to anorexia, others to sexual exhibitionism, etc. Much depends on the original context and other familial factors as the child is growing up. If the adolescent, as is the case in one of our patients, can stave off sexual aggression by a boyfriend by immediately performing fellatio, then that will be her defense; something she learned originally when constantly attacked sexually by her mother’s boyfriend.
All the patient’s adaptive skills are already inside, once she normalizes. In the case above she will learn from her own experience and not someone else’s. She will know that it is no longer necessary to seduce men in order to disarm them sexually, for example. She doesn’t need to be taught new skills with men. When she fully experienced her early rape and learned about her prototypic behavior--becoming seductive as a survival mechanism, she could change. That defense was in the past and no longer necessary. Seductive behavior was over.
Manfield believes that insights are the cornerstone of EMDR treatment. Neurosis isn’t cured by insights and isn’t built by their lack. It is cortex deep; and unfortunately, we have a large hunk of brain below that which must be attended to. To know about one’s feelings is not the same as feeling them. Two different brain systems.
“I feel helpless” is theoretically one of those “negative” feelings. But if one was indeed helpless in a household with a drunken father who abused the children constantly, one should feel helpless. Here is how Manfield explains his approach to skeptics: “I ask them to think of a mildly disturbing memory. Once they have done this I ask them to follow my fingers with their eyes through 20 eye movements (passing my hand back and forth across their field of vision). Then I ask them to recall the memory again to check if anything has changed. Consistently, people report a distancing of the memory describing it as feeling less intense, less vivid, more remote. Common phrases are ‘now it feels like it is just something that happened.’” (page 4) Although they believe that it reflects a connecting up of the isolated painful memory to the larger informational system of the mind, it has nothing to do with connection. What has happened with the magic wand/hands is to distract and repress the memory.
Just the absolute illogic of it is beyond me; I use the voodoo metaphor, because that is what it is. The person who grew up terrified of an abusive, explosive father is not to be waved into wellness. No wand is going to transform the locus ceruleus with its load of terror into normality. The claim is that EMDR stimulates the processing of incompletely processed memories. This is critical because it does nothing of the kind. Let us think neurobiologically. The memory is not incomplete; it is intact, engraved down lower in the brain. The reason that it is fragmented is that originally the valence of the pain was such that only a small part of the experience could be felt; the rest was put in storage for later exploration and feeling. In the interest of survival the feeling was made decorticate. That is, feelings were disconnected automatically from conscious/awareness so as to diminish reactivity, a reactivity that would threaten the life of the organism. How do we know? When we disengage the defense system during a session the reactivity is enormous again until the feeling is felt and integrated, then all vital functions return to normal. Thus, a patient lying still, only in the grips of a memory has a body temperature of 104 degrees (F). Reactivity is again happening. A patient reliving the total lack of touch and caresses early in life runs a fever just as though a virus were attacking the system. She feels her desperation and deprivation, and comes out of it with the insight about her sexual promiscuity as a way of being held. No one has to supply insights; they are the cortical aspect of a feeling that arrive all on their own as a companion to feeling. As low level feelings lock into the frontal cortex there are immediate insights from inside.
There is the hypothesis that the waving hands enhances the efficacy of the connecting rod between hemispheres, the corpus callosum. EMDR therapists think that the waves seem to add to left hemisphere power, and it might indeed happen temporarily. But because the feelings have moved into better control by the thinking, repressing left prefrontal cortex for a short time is not to conclude that any radical physiological change has been made. It is always possible to condition one aspect of human life. Treating drug addiction and imagine that one has made a profound change. Or controlling high blood pressure with pills. One has only changed behavior. Sometimes that is important but it is not a cure. A fall-back is always in the offing.
To repeat what Manfield states: EMDR treatment is well suited for PTSD (severe trauma cases) because “traumatic memories are easily identified and vivid.” (page 7) Some memories are easily identified ; the great majority, weighted down by the shackles of repression, are not. Patients remember what they can remember, and do not remember what they don’t remember, as simplistic as that sounds. So a whole lifetime of trauma is sequestered in the brain that no one knows about. He says that these patients lack the emotional resources necessary to address painful memories and “reach an adaptive resolution.” Here we have again this idea that patients have to be taught adaptive strategies. They learn adaptation by adapting. Again, everything a patient is going to learn lies inside of her. We are naturally adaptive beings when pain isn’t strangling us.
Take a physiologic example. Pain causes a disruption or dislocation of function of natural killer cells. They are less effective, according to our research. (St,. Bartholomew’s Hospital, 1984. As reported in The Biology of Love.) This is critical when they are supposed to be on the lookout for newly developing cancer cells. With primal therapy those cells normalize. Did anyone have to teach those cells to act normally? Adaptation takes place naturally. It is also true in the psychological realm. Does a therapist have to teach a patient how not to be afraid of elevators? I just treated such a phobia. The person was locked in an incubator for weeks after birth. She made that connection, not I. And then she adapted very well to elevators all on her own.
Manfield states that many of his clients have no memory of being loved. When that happens to my patients they are in deep agony for an hour or more, week after week; no magic wand is going to erase that. Manfield discusses one of his cases:
PM: What do you want to say to that little boy?
Client: I feel that it is such a shame that this great misfortune had to happen and leave marks that would last a lifetime. I want to tell him, ‘I’m so sorry that had to happen to you…I think it’s been the source of every sad experience you’ve ever had.’ ” (clicking lights by therapist, part of EMDR therapy) The client feels great compassion for that little boy.
PM: “Again, the client spontaneously offers the child the nurturing adult perspective that was not available to him at the time the events took place.” (page 24)
The client comes in for more sessions. Therapist: “I concluded that the installation of positive cognition would be a beneficial way of ending the session.” (page 26)
The client now can adjust to his pain “without making a big deal out of it.” In the next session he was still sad but comfortable with it, “almost as if it happened to someone else.” He now has a good distance from his feelings; the opposite of what should happen if we want someone to become a full human being. If you are recounting a terrible lack of love during your childhood, it seems to me that the last thing you would want is someone waving blinking lights in front of your eyes. Why not let the feeling deepen without all the rigamarole? What each session accomplishes is more and more distraction, like the mother who says to her crying child, “Oh look at the birdie.” He looks and forgets the crying. Is he better? We can dress up the blinking lights in theoretical attire but it is still plain distraction. Attention is refocused elsewhere.
PM. “In the next session the client began by talking about his divorce, what had been bothering him most of the week. He had a desire to give up….he felt downcast and dismayed, as if he had no resources. His sensations were targeted with EMDR.” (blinking lights. page 33) The client then reported feeling more alive and expansive. The disturbance level fell to zero and he felt relaxed.
He was effectively repressed; and EMDR is one of the more effective repressive tools extant, even though some feelings are involved. What the therapist does with the feeling is distract, advise and reorient; none of which is necessary. The client reported that his mood had improved noticeably. This is what we see in those who come to us from mock primal therapy where they scream, cry and pound walls at the urging of the therapist with no context and no focus. They release tension, feel more comfortable (for a short time) and believe they have made progress. It is only after months of this that they understand that they are not making progress and come for proper therapy.
If you and I are having coffee and you say to me I feel sad, and then I start waving my hands in front of your eyes some 20 times, is that therapy? Or is it inhuman? Yet, you say, “I don’t feel so sad now.” Of course not. I have robbed you of your feelings. We can revet this process in a soft, safe therapeutic environment, talk psychologese, but the fact remains that the person is starting to feel and I am waving blinking lights in her field of vision at the same time. My guess you would want to swat that little apparatus away from your eyes and say, “Just listen to me. You don’t have to do all that mumbo jumbo. I just want a little human compassion.”
About follow-up. Self-deception endures for a time. One can take any number of therapies and find patients swearing they are better. I did psychoanalytic therapy for 17 years and patients swore they did very well. It was only when I brought those same patients back and tried feeling therapy with them did we both realize how much pain we left unresolved in them. If you have an insight therapy and you explain to the patient why he does such and such, after three years he has built up a giant rationale for his behavior that makes him feel comfortable; a triumph of the frontal cortex over the limbic system. Often that rationale persists and one could never convince the person that his therapy was a failure. He got help, feels better and that’s all that counts. If the person understands that and doesn’t care, so be it. There are many who feel comfortable with St John’s Wort, Prozac, etc. And they are comfortable because the system is normalized biochemically for a time. If the patient doesn’t care, nor should we. We are not in the priesthood.
Having critiqued EMDR some might think “unmercifully”, I would now add that there is a place for it in cases of “quick fix.” I am told that those on skid row are receiving it and it helps them get up and get going, looking for jobs and moving out of skid row. They have no illusions about it and it helps like any therapy without a “why’ from hypnosis to acupuncture. This approach is more convenient, less troublesome and easily learned by therapists. It appeals to those who voyage on the surface of life. But there are those who prefer to do so, who do not wish to spend months and years feeling pain. A quick fix remains that. Smoking a cigarette is a quick fix. It helps someone feel more comfortable, face speaking in public, concentrate, etc. Cigarettes narcotize. The person feels more comfortable. There are many ways to narcotize not excluding tranquilizers; the result is usually the same, repression and diminished access to feelings. If old pain is continually bursting through, then anything that keeps it locked away is going to make us feel better.
EMDR is basically behavior/cognitive therapy with a bit of feeling thrown in. It contains directive imagination or daydreaming, and includes hypnosis and rationale-emotive therapy—stop using old rationales and adopt new ones. Anything that contains a melange of things is not science to me. Either a technique follows scientific methodology and a proper theory or it doesn’t; either it is based on science or it is New Age fantasy. In EMDR there is no trusting the feeling. Adding a plethora of approaches to how we treat patients doesn’t make the therapy any more valid; it just means the use of a potpourri of many invalid approaches, when combined they still remain invalid. The eclectic approach signifies the lack of a methodical attack on neuroses. It implies that there is no science of therapy, just an art form that can take many different approaches as in painting; a bit of Picasso, a little Miro, a touch of Renoir. We do not need a stew of ingredients each of which might be a bit true. Mixing them all together doesn’t make them any the more true. I would very much like to see serious neurophysiologic long term measurements of this therapy.
We don’t want to leave the body behind when we are treating human beings, unless we ask them to leave their bodies at the door when they enter the session. Implicitly, this is what we are doing with a whole host of therapies. Treating an isolated left prefrontal cortex, reinforcing its isolation, and reifying the disconnection. That is a recipe for disaster sooner or later.
This discussion of EMDR and the different approaches to mental problems harkens back to the days of Ludwig A. Feuerbach and his Logical Positivism versus Karl Marx and his dialectic; the primacy of mind over matter or vice versa. Logical Positivism evolved and was later embraced by Bertrand Russell and the contemporary philosopher, Ludwig Wittgenstein. (Previously known as the Vienna Circle, circa 1920. Now called the Cambridge Movement) This philosphical approach is favored by those who believe strongly in formal, intellectual and philosophical analysis that includes psychoanalysis. It comprises a belief in formal logic and in the utility of symbolic techniques for clarifying philosophical issues and psychological problems. Everything can be solved by logical analysis. Today we would call it a “head trip.” It is a belief in the primacy of language, hence insights and serious discussion with the patient. An example is dream analysis, another is EMDR. On the other side are a panoply of therapies and techniques with almost no intellectual discussion, as in the bioenergetic/body-armor schools of body therapy.
The nineteenth century philosophers mentioned above formed the underpinnings of the various psychotherapy schools—the rationalists versus the body therapies and the empiricists; whether mind or experience would dominate. When we take the intellectual approach to its logical end we get something like what appears in David Burns book (Ten Days to Self Esteem. Harper Collins. N.Y. 1993. Page 37) “You feel the way you think.” That says it all. Thoughts, he says, are primary over feelings and bodily sensations. Burns states: “You will discover that negative feelings like depression, anxiety, and anger do not actually result from the bad things that happen to you but from the way you think about them.” (page 37) It is a solipsistic offshoot of Rational-Emotive Therapy where your bad feelings come from illogical thoughts. All you have to do is change your thoughts. If it were only so easy…a kind of “think your way to health.” There is thus, no real experience; only how you think about experience, a reductio ad absurdum; A sort of endless intellectual labyrinth, looking for the meaning of meaning. An intellectual pursuit, twice removed.
The bodily system was in place long before the thinking apparatus, both in phylogeny (the history of mankind) and ontogeny (the history of individual man). Obviously, it has primacy. We must not neglect evolution in this regard, how sensations predated feelings; how feelings predated thought. It is also clear, if we follow evolution that sensations evolved and were elaborated into feelings which then became articulated into thoughts. All three form a complete feeling, but the strongest force are the sensations, then feelings and finally thought. Thoughts are no match for imprinted memories, particularly, life-and-death imprints. Here again, self-deception is recommended over reality and it is then called therapy. We feel bad because bad things have happened to us. To think that those events do not matter and that only how we interpret it matters, is an exercise in mental lucubration. Doesn’t being raped by one’s father count, or is it just how we saw and see it? Mind over matter? Or does real imprinted memory count; after all, that memory becomes part of the neurophysiology. The hippocampus shrinks in response to these kinds of trauma. (see Murray Stein’s work. U.C. San Diego). Does it shrink because we have the wrong attitude, or because a terrible crime against our humanity has taken place? Finally, can we change ourselves really with simply a change in thought? Can we change the hippocampus? The amygdala? Or levels of salivary cortisol? You cannot fool memory or deceive history. You can twist the mind to think different, disconnected thoughts but the body remains true to itself. And if you ask the saliva if the individual has made progress in psychotherapy it will tell you unequivocally.
It is always possible through mental trickery to produce temporary, transient change. But history is always the victor. We cannot conquer our physiology nor our history, nor should we want to. Again, a lie of the mind is a hurt of the body; an inexorable biologic truth. The problem is that even the choice of a specific therapy can constitute a symptom; the choice is made to reinforce one’s neurosis rather than to get over it. Those who choose magic too often want magical solutions to real everyday problems. Those who choose hypnosis want to get better unconsiously with no real effort involved. Those who were “done to” as children, whose lives were totally controlled by parents, now select a therapy where they are “done to.” They seek out an elderly wise man or guru who will give them the secret to life. The problem is that it doesn’t exist. No outsider is wiser than our own system; it contains the wisdom of the ages in its genetic makeup. It has built-in all of the adaptive mechanisms that have accumulated over the millennia.
I’ve seen Dr. Shapiro use a wand on a patient, and I thought it was truly an appeal to magic, no matter what the research results. Of course, in the short run patients will feel better with EMDR than with conventional therapy because the latter is not designed for quick action. So the research finds it more effective. So is prayer, so is acupuncture, and so is any ahistoric therapy that is applied to historic human beings.
To neglect history is to imagine that we spring de novo into this life; it helps us to avoid the one thing that can be curative. Why the symptom? Why the anguish and depression? No therapy without a “why” can be curative because it means the avoidance of history. It means neglecting the dialectic which is a key law of motion of life. Does anyone really believe that imagining a professor’s head popping into pieces can resolve a real emotional problem between two people?
After all is said and done there ought to be a diagnosis of the patient that includes her history, not just “anxiety with depressive features,” that I see so often in psychiatric reports. And the diagnosis should be able to make a simultaneous statement about the psychological state and the neurologic one. For example, anxiety, what we call first-line intrusion, emanates largely from very early brainstem imprints. It begins when the highest level of brain function was that which controlled the viscera. And anxiety is above all a visceral reaction—butterflies in t he stomach, cannot catch one’s breath, pure terror, pressure on the chest, etc. It helps to know that brainstem structures are activated during anxiety states, as well as some limbic areas. It is no longer mystical forces such as the id, dark, shadow forces, and the like. Each psychiatric diagnosis must eventually square with neurologic processes. Otherwise, one has unidimensional approaches that extract the brain from the process and act as though psychology was in some esoteric domain removed from the brain. There are neurologists who offer brilliant theories of pain based on animal research but there is a lack of a theory about “people in pain.” Most mental health professionals deal with pain every day but it is like the emporer’s clothes, it is never mentioned or treated as such.
Without recognizing the fact that there are discreet levels of consciousness it is almost impossible to construct a viable theory and therapy. From the early days of neurology when Paul Maclean wrote about the Triune Brain there has been a recognition of the different levels of consciousness, yet it has been ignored in our mental health work. We always want to know on what level our patients are operating. Are they basically first-liners (operating on primitive levels of consciousness) with massive amounts of brainstem imprints surging forth to disrupt concentration, focus and sleep? We can tell by the nature of the symptom, as well, where the origins lie: migraine and colitis, for example, are largely first-line birth imprints. We know where the patient has to go for complete resolution.
Symptoms for us are signposts. They direct us to the pain; we do not attempt to eradicate them without an understanding of their roots. The neurologic pain theorists, by and large, are after controlling pain, not reliving it. They do not see the dialectic; that the deeper the pain is relived the more it is gone from the system. That nothing else can change that pain, neither encouraging the patient to imagine other solutions, using needles to control it, distracting the patient, hypnotizing him, and so on. The pain is embedded in the physiologic system and there it lies until resolved. There it drives behavior and symptoms no matter how strong the will power or the frontal cortex machinations with verbiage, insights and altered ideas. It is implacable and unrelenting. It has the force of basic early need and survival.
It is an important leap to understand that in psychology and psychotherapy we are always dealing with pain, and that the pain is lodged in the system, and is by no means a mental operation alone. It must be relived as it was laid down, same vital signs, brainwaves and hormone output. The cycle of connection must be brought about. There is a cortical aspect to feeling that must be locked in, even when that feeling/sensation has no scenes and no words. The feeling itself must be connected to conscious-awareness, the terror, weltschmertz, ineffable sadness, darkness, aloneness and alienation. All of these are imprints that occurred even before we had the scenes attached to them, before we had a working cortex to make sense of them. To re-experience means to experience for the first time on all three brain levels, sensation, feeling and ideas about them. That is connection. It means to bring the hidden pain up to conscious-awareness, the pain that heretofore could not be made aware due to its enormous valence of pain.
Pain and healing are a dialectic unity; there is no healing without pain, and no healing except where we were wounded. To feel the original wound, being left abandoned soon after birth, means to relive all of the original physiologic processes. That then turns into its opposite—lower vital signs, stress hormones, etc. When we cut our finger, healing processes are immediately set in motion. No different when we are hurt psycholgically. The problem is that healing is aborted by repression that stops the reactivity necessary for healing. When we are hurt early on it is as though a virus has attacked the system; lymphocytes are moved into action in preparation for the attack. The body does not distinguish between the alien virus and the alien feelings that cannot be integrated. That immune system becomes depleted in this battle until the reliving. Then, for example, the natural killer cells are again normalized. It is the same for the neuroinhibitor serotonin. It becomes depleted in long term depression, again indicating that depression is heavy repression; the serotonin system fails to measure up against the load of constant imprinted pain.
The more one descends into the pain the more one ascends out of it. The more one feels it the less there is. The key is that the laws of the development of neurosis has to do with the internal contradictions in each of us; of the relationship of pain to repression. To understand and bring out real change that contradiction must always be addressed; not the case with EMDR and other ahistorical therapies. We are, after all, historical beings. All real change must be related to that history. Thus there are ephemeral changes, illusionary changes that can occur with EMDR, but they clearly cannot last in a profound way. They may endure because of the reorganization of the ideational structure but that has to be illusionary. It is literally a holding action, holding back the pain with cortical effort. History is always the victor. Consciousness is the ultimate healing factor. There is no conscious awareness in EMDR, only isolated and disconnected awareness. EMDR provides new ideation to enhance the disconnection, whereas connection is the motor for healing. To feel a bit of hopelessness with the adult brain and then adopt new ideation in the name of “adaptation” is to leave behind the very thing that heals, full and deep pain. The depressed person feels, “What’s the use. There’s no point in trying. Nothing works or does any good.” These are past feelings erupting in the present. Once placed and felt in past context there is no more intrusion nor depression. That is why we are successful with deep and suicidal depression. The more we feel the past the more we are in the present. The more we focus on the present the more the past intrudes.
The implication of this is that from the central contradiction of pain/repression there is a radiation of it throughout the system causing dislocations of function in vulnerable areas, hypothyroid, immune system deficiencies, serotonin lack, and so on. Once the central contradiction is addressed we would expect changes again toward the normal in all of those dislocations occasioned, in the first place. This is what we have found, and what must be found if radical change is achieved. Of course, if there is end-organ damage then it is too late to make those changes. But failing that we should see changes throughout the brain and body.
The more one feels the less the repression. There is a new synthesis,--wellness, wholeness and normalcy. The system is righted, no longer the dislocation of function. We have negated the negation; undone repression and allowed the system to normalize on every level, cellular, hormonal, neuronal and psycholgical. It follows the law of transformation of quantity into quality. The patient feels every day for many, many months, a little of the pain at a time until there is a radical shift and the cortisol levels now normalize as does the vital signs such as blood pressure. That new quality represents the shift from neurosis to normal. Change is evolutionary, and evolution must be considered when developing a therapy of change. One cannot ignore the brainstem and limbic systems and the early pre-birth imprints lodged in those systems if we hope to produce real change. Illusion is the inversion of reality.
Let me offer an example of ignoring these basic facts. Adrian Raine, a well-known neuroscientist has been studying violence. (as reported in the Los Angeles Times, April 29. 2002. “Roots of Violence May Lie in Damaged Brain Cells.” Page S1) What has been found in all of the impulse neurosis, violence, suicide, etc., is that there are low levels of serotonin and in brain scans there is less prefrontal cortical activity than normals. But the implication is that these afflictions are caused by low serotonin. There is a host of research (see Allan Schore and his research) that indicates how the frontal cortical areas suffer and do not develop properly when there is very early trauma and/or lack of love. Thus, violent individuals are low in the neurchemicals of inhibition, something we would expect; but we expect it due to very early trauma that depletes serotonin levels for a lifetime. They also have enough deprivation in their lives to make them violent—an indifferent mother, an addicted, abusive father, etc. all of these factors, from pre-birth to birth and after must be taken into consideration where trying to understand adult behavior. Brain science alone cannot do it, nor can psychological science. It must all be in the mix and then addressed dialectically. To study the brain alone is still ahistoric; to study history alone leaves out the present. We need an all encompassing theory.
The reason that pain dictates consciousness is that it is not just another experience. It is the key to survival. Those bereft of the experience of pain do not last long. The development of man from the amoeba onward has included the capacity to shut out pain. In science it is called the avoidance of noxious stimuli. The way we learn to avoid pain early on even in the womb becomes a prototype that guides future learning. We need to study pain and consciousness, not individually but as a function of each other. Each brain system has its own particular memory bank, memorized in a way that is idiosyncratic to itself. Deep brainstem events are remembered in terms of physical sensations; coughing, gagging, pressure on the chest, choking and sensations of suffocation. There is only one way to remember being strangled on the cord, and that is relive being strangled, losing breath, gagging and suffocating. There is no alternative, no better ending we can concoct. It was what it was, is imprinted exactly as it happened and will be brought to conscious/awareness as that experience. It cannot be made conscious by an act of will. That is an oxymoron. Will is cortical. Feelings are subcortical. We also need access to the brainstem where very remote experiences are registered; that is the crucial difference. Once it is fully felt all behavior based on it will become obvious and eventually disappear. No insights or discussion is necessary. Therapists still are locked into the idea that we have to be omniscient. We don’t. Trust the patient. Their feelings are all the smarts they need. We don’t want them to lead our lives, or our conception of how life should be lived; we want them to lead their own lives.
When we liberate pain we liberate a whole system of consciousness and thus produce feeling/aware human beings. The therapy selected by the individual is often a reflection of the problem. The head trippers choose insight therapy, while the passives who want magic go to hypnosis. One must select a therapy where the power and wisdom reside in the patient. Where what is real inside is addressed primarily; addressed on a timetable set by the patient’s physical system and her tolerance for pain and feeling. Where what to feel and how much is determined not by the therapist but by the one who has to undergo the feelings. To repeat the words of Eldridge Cleaver: You are either part of the solution or you are part of the problem. Imagining the solution still makes you part of the problem.
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