Psychotherapies Without Feeling

by Dr. Arthur Janov

Posted June 2005 on

Chapter 16: Conclusions

Years ago I said that next to mental illness, mankind's greatest affliction is the treatment for it.  I still believe that statement.  Psychotherapy today is a tangled mess of approaches, philosophies, opinions, and personalities at war with each other. There are therapies that deal with ideas and mental adjustments, other therapies that champion here-and-now self-expression, others that focus on abreaction and catharsis but in a historical vacuum, others that attempt to manipulate the mind through rearranging the muscles, and still others which attempt to change one's physiology through drugs and chemical alterations.  These therapies are usually on one side of the dialectic or the other, suppressing symptoms or talking patients out of them, but never working within the dialectic; never understanding the dynamic interplay of internal forces that transform a normal system into a neurotic one. Each therapy attacks the problem on a different level without recognizing the totality of the processes involved.

I believe that there is a cure for neurosis and a role for psychotherapy in it, but not a "psycho" psychotherapy; rather, an experiential one.  That cure means addressing the basic conflict between the forces of suffering and their antagonist.  The aim is to help someone who is blocked from feelings become a feeling person; to help a person gain access to herself or himself so that they no longer have an unconscious that weighs preponderantly against consciousness, driving one to do things beyond one's control.  None of the mainstream psychotherapies can do this, because no theory recognizes the central fact that neurosis is based on early trauma which remains in the system for a lifetime, no therapy has as its main goal the attack on imprinted Pain.  As we have seen, most psychotherapies either ignore the dialectic and Pain or manage to shut it down.

The problem with psychotherapy today is psychotherapy.  The illness is defined as mental, so the patient goes to a therapist to have his psyche rearranged.  Hypnotherapy helps him dissociate, psychoanalysis gives him "insight," humanistic psychology bypasses over trauma and Pain en route to so-called self-realization and peak experiences, RET helps him identify and change his beliefs and philosophy, Gestalt leads to "awareness" and random discharge of feeling, and so on.  The psyche is targeted, confronted, managed, conquered, and altered, but the patient leaves therapy with exactly the same set of encoded Pains he had in his body when he entered treatment.  Yet he "feels well" -- that is, he thinks he feels well, because all the cerebral insights offered by the therapist provide him with a defense that better separates him from his suffering.  He is  more alienated, and that is why he feels better. He no longer feels his suffering, which has got to be there, otherwise he probably would not have come for psychotherapy, in the first place.  His Pain is now just a distant echo.  And the defense which keeps the Pain far away can last for years.

Can a therapy help you if you think it does?  Does wishing to be better make it happen?  If you imagine little hammers beating cancer cells to a pulp, as in directed daydreaming, are you really well?  There is evidence that it helps some people.  Are they well? If the Pain remains, no.  Their symptoms are better, which is important.  But by imagining health you get imaginary health.

Symptoms get better in biofeedback, psychoanalysis, and religion.  Beliefs unleash the chemicals of repression so that suffering is diminished.  But beliefs do not heal.  In my opinion, you can think you feel better -- by wishing, by imagining, by believing, by "changing your attitude."  But truly feeling good is a state of being that encompasses the body.  If there are signs that the body is processing Pain even when a person thinks he is feeling good, then there is a split between what one is aware of and how one really feels.  Then you can think the opposite of what is being processed in the body.  So, yes, wishing can make you better, but only to a small extent, and only for a time.

As long as mental illness is defined as mental and as long as therapy remains on that level, patients will remain neurotic.  Or if neurosis is defined as a muscular state the treatment will ignore everything except that musculature.  The whole person is left out of the equation.  This is what has happened with most of the main currents of psychotherapy.  Although patients may think they're well, it's obvious that they do not really change in any profound way, regardless of their ostensibly improved self-awareness or the new cognitive patterns they have painstakingly learned.  Psychotherapy today may enable you to get better in your head, but it doesn't help you get well.  Over time, the body will pay the price.  And the deleterious effects that repression and alienation cause will eventually break down the physical system.

In the last generation, with the realization that psychoanalysis and other psychotherapies do not really work, and with the rise of the New Age movement, a new notion has emerged:  that it is neither necessary nor possible to cure neurosis.  Thus, some years ago, in A Complete Guide to Therapy, Joel Kovel wrote, "The model for therapy is not the cure of a disease but the growth -- more specifically, the education -- of a person."[1]  My view is that if you want education, go to school.  You don't need psychotherapy for that.  But for Kovel, who has abandoned the medical model and believes that neurosis is only in your head, one's psychological state is reduced to a matter of learning.  If one doesn't feel well, all one must need do is follow a certain formula in order to feel better.  Does this mean that neurosis is something one learns? One is born fully conscious, spontaneous, joyful, and then unlearns how to be this way?  Which then requires that one must grow back into what one once was?

If therapists are going to talk about "growth," as Kovel does, they ought to speak of real biological growth, the growth of the total person, not some mystical notion of psychological or metaphorical growth.  This is because neurosis is in the blood, bones, and tissue, which means that removing it ought to result in physical growth changes as well.  In our therapy there are important changes in growth hormone after one year.  There is growth of soft tissue among some of our patients.  That is real growth.

Nearly every school of psychotherapy discards the notion and possibility of cure.  Which is paradoxical.  If you really believe that you are not treating a disease, but the disease exists, then you are treating something else, Lord knows what, and the disease remains no matter how much "growth" there is.  The disease remains, but because you are not treating it, of course cure is not possible.  The field of psychology is left chasing its conceptual tail.  It is then that "cure" becomes suspect, and that those who use the word become pariahs.

Why has it come to this impasse after a century of theory and practice?  Because neurosis is not considered a biological disease. Even though there are hundreds of biological changes correlated with neurosis, the field of psychology by and large still clings to the simple "mental aberration" concept.  It conceives of neurosis as simply a question of dysfunctional thinking.  Yet when the lymphocyte or immune cells undergo a radical change as a result of depression, or when in autopsy of schizophrenics, one finds systematic rotation of brain cells in the limbic system, it should tell us something about the body-mind unity in mental illness.

When early traumas are fully relived and not only anxiety and depression vanish but so do longstanding somatic symptoms such as allergies and aches and pains of mysterious origin, should this not also tell us something about the pervasiveness of neurosis throughout the organism?

Most people would certainly like to get well, but they don't really want to change.  They want to get well in the most comfortable way possible, without significantly disrupting their habits and routines, their ways of seeing themselves and their lifestyle in general.  This is why they select therapies that fit their psychological mindset.  And there is an abundance of such therapies out there -- therapies that exhort you to change your ideas, show you how to creatively visualize yourself free of anxiety and meditate away stress, help you manipulate the tension out of your muscles.  Therapies that basically remain on the surface of the problem and which attempt to redress effects rather than target deeper causes.

Today we basically have two different approaches to psychotherapy:  therapies that support some kind of emotional expression and therapies that zero in on cognition and analysis.  It is very much like the family setting in which one parent lets the children feel and express themselves a bit while the other parent doesn't even want to know about what the children feel.  When therapy bypasses feeling and targets cognition, the therapist is pressed into service under certain theoretical philosophical guidelines, with the objective of helping patients stop looking like they're sick, because even the appearance of Pain is evidently an affront to the therapist and to the efficacy of his therapy.  Many conventional therapies, even those that champion here-and-now expression, deny the need to acknowledge the existence of Pain, much less talk about it, in the service of improved social functioning.

Repressive cognitive therapies such as behaviorism, conditioning therapy, and RET fit into a broader social environment in which regulation and discipline have high import.  These therapies are well funded by the federal and state governments because they meld with the prevailing zeitgeist:  they are able to carry out society's demand upon its citizens to repress and get on with it, adapt, adjust, and produce.

Nearly every psychotherapy involves some kind of manipulation of the patient by the therapist.  Even insight given by the therapist is a form of manipulation because it subtly changes the power base from patient to therapist.  Telling someone about himself means there is a stronger, more knowledgeable soul about. Patients are often fearful of therapy because they don't know where the therapist will take them.  Given the nature of repression, this makes a certain amount of sense; although patients want to feel better, they do not necessarily want to feel the deep down sources of their neurosis.  In any case, most psychotherapies do not facilitate this kind of healing-feeling.  Instead, patients usually have to fit into the preconceived aims or goals of the therapy, stated or not.  When the goals are set by the therapist, we already have the first problem.

The new 45-minute therapeutic hour is a continuing part of the authoritarian mechanization of psychotherapy.  There seems to be no time for anything -- no time for delving or searching, no time for slow, compassionate, warm, rich human interaction.  Everything is by the minute.  There is no leisure for the patient to feel his feelings, to reflect back on how he has felt, a process that requires hours, not minutes.  If feelings exceed those allotted minutes, that's just the way it is:  the session must begin and end on time.  The patient either resolves his predicament in 45 minutes or waits until next week. If she is in the middle of tears and great sadness her time is still up.  Of course the very structure of psychoanalysis does not permit deep, deep feeling, so as to minimize that eventuality.  With just a small change in its structure, so that sessions are up when the patient says they are, as in our therapy, deep feelings could be arrived at.

As I said, most psychotherapies are extensions of the parental system.  They continue what neurotic parents do to children when they say you have to get organized, you have to get yourself going, decide you're going to do better, try harder, dedicate yourself to studying more and getting good grades.  Later in life, another authority figure urges you to stop thinking and behaving in certain ways, tells you there is no logical reason to feel the way you do, it's just the product of distorted thinking, and that it's time to take control of your thoughts and get your life in order.  This is given the heading of therapy but it is really just parental exhortation dressed up under a new title and moved to a different setting.  You are told that your problems are the result of choices and decisions you have made and which you can change.  Getting well simply requires you to set goals and dedicate yourself to pursuing them.  It is all in your mind, a question of intellectual "understanding" and coming to new conclusions.  Whatever has happened to you in the past no longer matters.

The objective of most therapies is not consciousness but current functioning.  And the result is reinforced "self-control," also known as repression.

Decision-making -- like resolving to learn different patterns of thinking and behavior -- may be an intellectual activity, but many decisions are the result of unconscious forces which have not been felt.  Decision, assertion, or any human endeavor must be seen as the outgrowth of historical processes.  Decision therapy helps people make decisions and get over their ambivalence, but they are in the nature of "I'd like to make a decision if I could make a decision to make a decision."  This is not to say that no one can ever make a conscious decision.  But the idea that a rapist will decide not to rape again, or that a person who is cold and distant will decide to be warm and connected, is about as ridiculous as expecting a migraine sufferer to decide never to have a migraine again, or exhorting an epileptic to decide to stop having epileptic attacks.  There are massive forces at work in the brain and nervous system, forces which must be understood as the sources of neurosis and its somatic effluvia, and which must be addressed if any kind of real healing is to occur.

Some years ago, there was a book on the market about early experience which highlights for me the kind of problems and erroneous conclusions which arise when one tries to arrive at an understanding of emotional illness through ahistorical theorizing and "objective" statistical analysis.  Early Experience:  Myth and Evidence, edited by Clarke and Clarke,[2] presents the perspectives of many of the biggest names in child therapy and research.  They include Urie Bronfenbrenner, Professor of Human Development at Cornell University; Wayne Dennie, Professor Emeritus, Brooklyn College; Michael Rutter, Professor of Child Psychiatry, Institute of Psychiatry, London; Jerome Kagan, Professor of Human Development at Harvard.  It seems that these prominent professors have all come to the same conclusion, based on serious and scientifically-organized research projects:  that early life experience does not have much to do with later neurosis.

"The consistent picture of substantial recovery (of severely early isolated babies)," the editors write, "coupled with the absence of evidence suggesting potential genetic superiority, calls seriously into question the possibility of an early period in which the organism is irreversibly vulnerable to environmental influence."[3]  In their conclusions, Clarke and Clarke state the following:

Without exception, the authors whose work is cited are aware of the importance of genetic variables; they are sensitive to the possibility of environmental effects; a majority have, sometimes to their own surprise, produced evidence suggesting that events occurring in the first few years of a child's life are not necessarily of any great significance for later development.[4]  [Italics added]

The only way anyone could come to that kind of conclusion is by being totally disengaged from his own childhood.  Not to mention how the research cited by the authors mentioned flies in the face of myriad studies indicating the contrary.  Battered children, for example, are 10 times more likely to become battering parents. Children from broken homes are far more likely than children from intact homes to suffer nervous breakdowns, alcoholism, and drug addiction.  Statistical indices can be useful; they can also dehumanize.  You can end up with "statistical truths" rather than human realities.  In any case, you do not have to study other people to recognize the power that early events play throughout a lifetime.  If you could remember your childhood experiences and feel what they have done to you in later life, there is no way you could call these experiences insignificant.

The Clarkes are saying that the Freudians and neo-Freudians have overemphasized the importance of early childhood events.  They are also saying that when therapists assume neurosis derives from what happens early in life, they end up seeing only what they want to see:  the harmful effects of early experience.  These editors refer to researchers who assert that to focus in psychotherapy on an adult's childhood is a convenient way to avoid discussing current problems.  Those who stress the impact of childhood, they say, "unwittingly act as mutual reinforcers in discovering anomalies in early life."[5]

I would say the opposite:  those who do not stress the impact of childhood unwittingly support repression.  In this way, therapist and patient mutually reinforce neurosis.

Some of the authors anthologized in Early Experience:  Myth and Evidence provide evidence that children from very bad orphanages who moved to other institutions and later to adoptive homes made good adjustments in adulthood, and that their adjustment depended on "later changes" rather than on early trauma.  How do they come to this conclusion?  One index they use is the I.Q.  If early traumas do not alter I.Q., they assert, then early traumas are insignificant, and play but a minimal role in later intelligence. The truth is that we have seen some very intelligent psychotics in Primal Therapy, and the most disturbed patients we see are invariably those who grew up in institutions.

Statistical studies finally come down to the scientist's subjective judgement as to what to use as criteria for measurement. For instance, in the Alfred Kadushin study included in the Clarkes' book, two criteria are utilized to judge the "wellness" of children who had had traumatic early lives and were subsequently placed in adoptive homes.  One criterion is parental satisfaction and dissatisfaction of the adoptive experience.  The other criterion is the ratio of discrete satisfactions to dissatisfactions expressed by parents in interviews with the investigators.  A high level of satisfaction expressed by parents meant successful adjustment in the children.  But what if the parents are neurotic?  Then we have neurotic satisfaction with neurotic behavior of children who may fit in well by being obedient, quiet, unexpressive, passive, etc. A study of refugee children used I.Q., "general competence," and "average health" as criteria for how well they had adjusted. Another study used grades in school as determinants.

Nowhere is feeling discussed; the word itself does not even appear.  Pain is not among the topics discussed here.  Amid all the attention paid to intelligence and grades and parental satisfaction, has anyone ever asked the children how they felt about all of their "adjustments"?  No.  What about the misery index?  The physical and behavioral offshoots of imprinted trauma?  The neurotic ideation?  Where are the statistics for that?

Since a large part of the country is being tranquilized and Prozac-ized, it must be assumed that tens of millions of Americans are suffering from unacknowledged Pain.  You see a lot of ads on TV for over-the-counter medications like Tylenol and Bayer and Nyquil and Tums and the rest of them, but do these ads ever discuss the "whys" of headaches, stomach distress, insomnia, or anxiety?  The point is to wipe away the distress, not to figure out where it comes from.  Just take the pill and experience a little bit of magic!

In the past generation, the use of drugs for so-called psychological problems has spilled beyond the walls of mental hospitals and pervaded the larger society.  Drugs are automatically given to not only 90% of schizophrenics, just about anyone who is considered suicidal, and most of those admitted for emergency outpatient psychiatric treatment; one-third of American adults have taken tranquilizers at one time or another.  The widespread use of tranquilizers (prescribed to millions of people every year) is an index of the failure of psychotherapy.  Psychiatry is taking a back seat and the driver is the drug business.  It's a matter of the tail wagging the dog.

If psychotherapists are not going to root out causes of neurosis, they have no choice but to treat its manifestations. Then they must rationalize that the treatment of manifestations is the apotheosis of psychotherapy.  If they don't understand that imprinted Pain from early deprivation of need is the cause, or don't know how to address it, then they are going to be on the outer margins, repeatedly beating back symptoms.  The weapon of choice to make this magic happen used to be Valium.  Today it's Prozac.  Electroshock is having a renaissance and may be the choice of the future.  It certainly is the most effective repressor.

Being in pain, conscious of not, practically demands the need for magical ways to avoid more Pain.  If one doesn't know about the existence of buried Pain, and most people don't, one is forced to focus their need for help in the present:  weekend seminars, lectures, inspirational talks, etc.  These actually change nothing, yet convince people that they are indeed changed.  Lifespring, est, spiritual guidance, etc -- it's voodoo by another name.

Of course, it is very attractive to seize upon medications or enter into therapies that are magically and painlessly transforming.  Isn't that what medications are about?  Painless change... magic.  Therapists take part in this because they too want a magic formula where the patient is ecstatic with his change in therapy. It can be satisfying not to put people in Pain, the Pain that exists nevertheless, and to receive the gratitude of the patient for the help received.

Many people know better, yet they hope against hope.  But in my opinion, any therapeutic system which does not address itself primarily to need creates false hopes, and is unresolving and ultimately reactionary.  Any system of therapy not directed toward need must become a compensating one; that is, it must deal with symptomatic expression of the pathology rather than the source of the pathology itself.  Since the symptomatic expression of individual pathology takes a myriad of forms, the task of reactionary treatment is not only formidable, it is finally fruitless.

Social Need and Personal Need

Let's look at society for a moment.  Social systems which are not constructed with need in mind must frustrate and traumatize their inhabitants.  On a social level, the symptoms of unfulfilled need are many.  High crime rates, mental illness, increasing drug use, and increasing chronic disease rates are but a few examples. It is no accident that in the neediest segments of society, one can find the most pathological symptoms, the highest incidence of murder and rape, wife beating, child abuse, alcoholism, drug abuse, and so on.  One can also find in these sectors more hyperactive and antisocial children, made that way by the deprivation of need.  The existence of gangs is itself a reflection of need.  Needy young people forge groups in opposition to other such groups, all of them to gain identity, meaning, a sense of belonging.  Gang activities, substance abuse, and religious observance may take different forms, but they are all usually compelled by the Pain of deprived need.

Most societies are based on gain rather than need.  When this is the case, the society must develop compensating subsystems to handle the symptoms of this central contradiction.  Thus more mental hospitals and prisons are constructed, and there are calls for more discipline in the schools.  More opiates are produced to quell "problem children's" hyperactivity and antisocial tendencies and to tranquilize highly-anxious people so they can continue functioning.  A competitive society based on acquisition rather than geared toward need fulfillment does not produce jobs for everyone, but perhaps it doles out unemployment as a surface remedy.  It produces cities asphyxiating in air pollution and is impelled to channel enormous amounts of energy and funding toward treating the respiratory, ocular, and heart afflictions which result.  When symptoms, not causes, are targeted, such resources are wasted.

Take Los Angeles.  Instead of reducing the amount of automobile traffic by building a viable mass transportation system, three giants of industry (dealing with oil, tires, and automobiles) bought up the city's rail lines and eventually destroyed the streetcar system.  These companies have needs too, the need for profits, needs which conflict with basic human need.  And they are going to look out for these needs, regardless of the needs of the grand majority of the people and the planet they inhabit.

Are they at fault?  Perhaps not.  They, like needy people, are trapped in a system which constructed itself in the same way the human brain constructs itself, out of the warp and woof of experience and adversity.  Once the system is set in motion, all else is secondary.  The needs for profit, expansion, and market domination take precedence over human needs.  The same occurs within the personal system.  The neurotic chases after money, success, prestige, esteem, and power.  He is in constant pursuit of symbolic fulfillment which has nothing to do with real biologic need.  His unmet needs make him ambitious.  Some people who are so needy for recognition and adulation end up with control over others.  Need is what drives Hitler, Stalin, Pol Pot, not to mention Jim Jones and David Koresh, to seize and wield authoritarian power.  Government itself is a frighteningly effective tool for repression and abuse; who but a needy sociopath would want the power it confers?

If a society doesn't feed its inhabitants and doesn't offer them proper shelter, and if they protest, they risk being killed by the forces of repression, also known as the forces of order.  The authorities do not want any reminder that people need.  It is also true of the psyche.  Someone acts dependent and needy and requires drugs to make it in life, their needs are further suppressed, perhaps by electroshock therapy, and they are made to take their place in society.  Or they are depressed, with serious deprived need lying just below the surface.  They are being drugged and told to function.  Is it any different than the starving peasants in South America who chew on coca leaves to drug themselves while they work at a killing pace producing drugs for the druglords?  Once need is repressed, in society or in the individual the work involves suppressing the secondary symptoms.  There is more crime and mental illness -- put them away.  More depression -- shove it down with drugs.  More mental breakdowns -- put them away.

The sick society and the neurotic individual, once they have been formed, generate unreal needs and ideologies to justify them. A high material standard of living is what everyone pursues, thinking that this is the key to happiness, but is it?  When social problems are merely bandaged and personal problems are not dealt with in a meaningful way year after year, the symptoms insidiously increase.  What is to prevent millions of nervous breakdowns and the breakdown of society?  Prozac and religion, ideology and psychotherapy.  These are the glues that hold the country together. So many people are so emotionally deprived that without these Painkillers there would not be enough doctors and hospitals do deal with the madness.

For a great number of people, psychotherapy is the new religion, the new means to salvation.  The essence of any religion is hope -- the hope of transformation and salvation.  The patient has spent a lifetime in the unconscious search for fulfillment and redemption, and these, no less, are what he wants from therapy. What does every psychotherapy promise?  Fulfillment, redemption, salvation, happiness.  So the patient expects and the therapist offer the same thing:  magic.  This is certainly understandable. Desperate people want their suffering to end.  They really don't want to know why they're so miserable; they just want an end to the misery.  They want to be cured, quickly and painlessly.  And psychotherapists want to help.

People want simple solutions, rapid cures, and resolution of their problems, but they do not want to go through the turmoil of change.  Psychotherapy fits into this ethos, partly because many psychotherapists are themselves defended against their own Pain. Therapeutic approaches that deny the need to search into one's past and root out original causes are going to have more success in a relatively young country like the U.S., with fewer traditions than European countries, and not at all geared to its own past.  And for some time now a shift has been underway in this country's psychotherapeutic currents, a shift away from past reflection and onto the here and now.  Therapeutically this means treating the patient as if he had no history, no past -- a misguided approach doomed to mistake symptoms for causes and to leave neurosis intact.

There is an old axiom, from George Santayana, to the effect that he who does not understand history is doomed to repeat it. This is undoubtedly as true for patients as it is for countries.

The solution -- on a societal and personal level -- must ultimately lay with the organization of the society and the individual around need.  For this to happen there must be a consciousness of need.  Such a consciousness of need is essential for resolving the central contradictions between citizens' needs and the needs of those who control the means of production and distribution, between a child's needs and a parent who is in charge of fulfilling them.

Contrary to what many psychotherapies purport and practice, such a consciousness of need helps one deal with causes rather than effects.  It begins with an internal experience, a consciousness of personal self.  This then evolves into a social consciousness.  To be aware of one's own childhood needs means to be aware of what children need in many areas.  Going further than that, to experience the agony which occurs when such needs are deprived -- having lifted the barriers of repression decades after the trauma occurred -- makes it less likely that one is going to inflict such trauma on one's own children.  To be in touch with one's biological rhythms and feelings also means to understand the kind of living and work situations one needs; life settings based not on society's organization around conformity, productivity, and statistical indicators of economic growth, but on the needs of individuals to grow in the realm of consciousness.

The resolution of the conflict between personal needs and the needs of those in the position to fulfill them would result in the existence of fewer neurotic people and a less explosive society. Individuals would no longer be needy, hyperactive, antisocial, no longer driven toward alcoholism or substance-dependence or on symbolic need fulfillment:  success, wealth, influence, and all the rest of it.  Likewise, the society would no longer expend pell mell without regard to the natural environment and its limited resources.  Once needs were fulfilled, the amount of total energy expended in the social and personal spheres would be radically diminished and also used more efficiently.  If rapid transit systems were built for the needs of the people, there would be fewer automobiles on the road, less gas burned, less pollution, healthier air.  This in turn would reduce the number of those hospitalized for lung conditions and heart disease, so that there would be less need for medical attention, medications, hospital beds, and so on.

Once we are able to consciously connect with our own Pain (unfulfilled needs), we will no longer try to quell it with Painkillers, and we will stop thrashing around anxiously in an attempt to gain attention, be approved of, appreciated, validated, and loved.

Is it possible to change the system?  Can we change people's minds?  Let's take the lessons we have learned in Primal Therapy.

Addressing Need:  The Logic of Consciousness

Since unfulfilled need is at the root of neurosis, my therapy addresses itself primarily to need.  Primal Therapy offers not surface remediation nor symptom tranquilization but the Pain that actually occurred.  We do not discuss the neurotic's ideas.  Nor do we attempt to alter them.  Instead, we help the patient feel his early needs in all their unfulfilled agony.  It is this experience, we have found, that is resolving.  We "change" a person's mind without ever dealing with it directly.

Similarly, in the social sphere, once the key contradiction is resolved -- once the means of need fulfillment are not in the hands of private individuals whose interests are in conflict with those of most people -- ideologies will change automatically.

The resolution of the contradiction between the forces of need and the forces of repression will facilitate the restructuring of the entire social system.  As social symptoms recede, as violent crime and gang activity, substance abuse and child abuse are dramatically reduced, repression will no longer be the response of choice.  Law-enforcement and penal authorities will stop resorting to force and repression to resolve every problem.  Doctors in mental hospitals will not immediately use drugs to repress patients' symptoms.  Schools will find more constructive ways than repression to respond to hyperactive children and others who create problems.  And psychotherapists will not aid in the repression of their patients by drugging them, dissociating them, or inculcating them with an ideology which ignores need.

With the lifting of repression, the need for a therapeutic ideology will disappear.  This is because ideology is the handmaiden of repression, both on an individual and society-wide basis. Without repression, there will be no longer be an emotional stake in keeping an unreal ideology, particularly one that counters one's best interests.  For example, in some therapies such as in Jungian and Freudian analysis, hour after hour is spent analyzing dreams. Part of the theory is that dreams are the "royal road to the unconscious," according to Freud.  The patient adopts this value and notion and brings in reams of dreams to each session.  They are gone over with a fine tooth comb, and nothing happens except that the patient is convinced that progress is being made because he has wonderful insights into his dreams.  But his life does not change. Nor could it.  It is game playing, avoiding the central realities that could really liberate the patient.

This point itself -- that ideology inimical to one's well-being can be inculcated into people -- is the most interesting of all.  Why is this possible and so prevalent?  It can only occur when the individual is shut off from his own being.  Repression and Pain are a unity.  Each begets the other.  A society that is not repressive produces less Pain, and that is a society which centers itself around need.  But a society or personal system which denies need must become repressive and must develop ideologies to justify itself:  such as the idea that you are the architect of your own neurosis and that you can make it go away by an act of will.  Or, the idea that drug addicts and alcoholics must get their act together and start making a productive life for themselves, which of course is true.  But how?

It is an inexorable dialectic.  If you do not address imprinted need, you end up reinforcing the individual's need to repress Pain in whatever way he can.

There are those who say Primal Therapy disintegrates the psyche.  This critique is based on a demonological view of the psyche, a supposedly rational extension of the ancient religious notion that we are inhabited by evil forces we must beat back. This is also the Freudian view:  that the unconscious is full of destructive impulses and instincts, that it pushes us towards temptations we must forever resist.  True, if handled incorrectly, lifting repression and feeling Pain can leave people in pieces. But those who criticize Primal Therapy as disintegrative do not appreciate what the unconscious is really made of.  The other problem we have is that there are some five hundreds clinic throughout the world using my name or the word "Primal," practicing all manner of therapy over which I have no control.  They give my therapy a bad name.

Today we know a great deal more than we used about the  role of different brain structures and chemical processes in repression of Pain and integration of feeling.  Based on a large body of research, we know that the brain is designed to stop painful messages from reaching consciousness.  Neuroreceptors mediate this process.  For example, Pain excites brain neurons to secrete endorphines, serotonin, Gaba, and other chemicals which help protect the psyche from overwhelming information.  This internal Painkilling system desensitizes the brain; it blocks neurological channels so as to protect the individual from Pain.  We know how repression shunts information away from the cerebral cortex and other parts of the brain.  We know about the role of the thalamus in human consciousness and in relaying information to the cortex for connection.  We have a brain researcher on our staff whose role is to help us understand all of the brain structures, processes, and chemicals involved in repression of Pain and its integration.

Because we are aware of the processes which occur in both shutting down feeling and opening it up, we can open the brain channels slowly, so that the patient's system is not overwhelmed. The psyche must not be flooded with shattering Pain; it must be allowed to gradually integrate long-repressed messages.  This requires feeling less Painful experiences first and the more Painful ones after that.  We start in the present; a divorce, a death, an emotional trauma, and over the months retreat to childhood events, finally, after many months or years we arrive at traumas at the beginning of life.  It is an inevitable sequence. It is not my caprice but a biologic hierarchy that must be followed.  Pain has its own evolutionary logic and order, which we must be attuned to and respect.

It took us almost 30 years to perfect the techniques we use. The result is that patients do not leave our therapy overwhelmed and in pieces; they are able to both feel their Pain and integrate it.  With our brain mapping procedures, we are now able to "see" that this integration has taken place.  We can verify this by looking at vital signs and other clinical criteria.  The truth is that our patients are getting well, and that "disintegration" is a myth concocted by those who have inordinate fears of the unconscious or who have a stake in not having Pain as central to neurosis and psychotherapy.

When we consider how far we've come from the days of Freud, we realize how antiquated the Freudian psychoanalytic system is.  It is a system based on fantasy; its ego, id, and superego are constructs which in reality do not exist.  Many psychotherapies are busy strengthening one's ego, yet there is no precise definition of what the ego is, nor any idea where it might be located.  Freud's ideas and therapy may have been valid in his own time, almost a century ago, but science has leapt forward.  The unconscious is far from the hideout of shadow forces and demons.  It is a friendly place, nothing to fear, nothing to run from.  People do sometimes run; this happens when they are forced to face Pains they are not ready for.  If one trusts the biological processes and knows how to work with them, this premature event will not take place.

Beware of Mock Primal Therapies

The greatest problems in a feeling therapy occur when people go through the motions of feeling without feeling or when they relive Pains out of sequence.  As noted earlier, this is known as abreaction.  It occurs when the therapist does not understand the characteristics and functions of the body's defense system. Abreaction can leave people in pieces, and then they blame Primal Therapy.

Primal Therapy spawned a lot of imitators, the whole "rebirthing" industry.  Over the years, numerous clinics have claimed to have therapists whom I trained.  Often when I do a TV or radio show, people come up to me and tell about their "Primal Therapy," usually at clinics and with therapists I have never heard of.  Some of my ex-patients have gone into practice without a day's training. This is why abreaction is rampant.  Without a doubt, it is what every mock therapy group does in the name of Primal Therapy.

These mock Primal Therapies used and use a range of techniques in order to get their patients into birth Primals.  Some have immersed their patients in tubs of hot water, naked, induced panic, and then encouraged the patient to get in touch with birth feelings.  Another technique is to have patients read a story about birth, which supposedly gets them into the proper frame of mind to relive the birth trauma.  Some rebirthers have used the breathing techniques first described in The Primal Scream, techniques which we rarely use anymore.  We have discovered that artificial techniques are not necessary, and usually occur when sufficient information is lacking.  These techniques tend to bring up Pains in the wrong sequence and can be dangerous.  We do nothing mechanical. The patient is not a machine.  She needs human techniques, biologic approaches.  We don't strobe the brain as we did in the early Seventies, nor use body armor techniques, such as with bioenergetics.  It is completely natural, as it should be.

All of the mock or rebirthing approaches have something in common:  they try to get a patient to relive birth as soon as possible, even in the first hour of therapy, on a schedule set by the therapist and not according to the patient's inner time clock. While for some people it's impossible to go into a birth Primal very quickly, regardless of how it's attempted, others can do it. But the results are almost always deleterious.  Why?

Birth Pains are registered in the innermost depths of the nervous system.  They are also the Pains with the highest valence, or electrical charge.  They must be reexperienced at the end of a systematic continuum, after a series of lesser Pains are relived. When they are experienced at the beginning, as in rebirthing, they can be quite disintegrative.  The patient is flooded with an accumulation of early Pain for which there is no conceptual handle, no way to understand or integrate them.  He may become immediately mystical as the cortex reaches for something to hang onto.  If the therapist believes in the mystical the patient will be getting sicker under the guise of mental health.  The patient in these cases will be the last to know what is happening.  He feels good because he has fled to his head and is totally out of touch with himself.  Sooner or later, he will pay the price.  The rebirthing therapist, often not a trained psychologist or psychiatrist, chooses to ignore these harmful effects.

In another variation on rebirthing, Stanislav Grof gave his patients large doses of LSD.  He claimed that the drug enabled many patients to go through rebirth and to come close to death feelings at birth.  Only by using "a whole series of high-dose LSD sessions," Grof theorized, one could experience and transcend "existential despair, metaphysical anxiety, murderous aggression, abysmal guilt and inferiority feelings and the agony  of total annihilation."   And he reported that nearly everyone who managed to ride the vehicle of LSD to the verge of death achieved some kind of spiritual "transcendence."  When these terrible feelings are experienced, Grof went on, one is opened to "orgiastic feelings of cosmic proportions" (whatever those are), "spiritual liberation and enlightenment, a sense of ecstatic connection with all creation, and mystical union with the creative principle in the universe."[6]

In my opinion, it is just these high doses of LSD that convert anxiety into "cosmic" and "ecstatic" experiences while assuring that the subject can never come to full conscious terms with his agony.  Indeed, Grof maintained that many of his subjects transcended space and time and experienced eternity and infinity.  How a physical human being does all that from a birth experience is not made clear.  Consciousness is one thing; all these lofty flights into spirituality are another.  I'm not sure what Grof's overblown words means, but I have seen patients begin to conjure up ideas when the Pain is too much to handle.  As I have said in an earlier chapter, this is what the "born again" experience is usually about. People who are too close to their Pain embrace "God" to be saved from it.  The say, "I have been saved!"  And they have -- only they don't know from what.  Ideas are both a product of and a refuge from Pain.  When people approach birth during an LSD experience is when they often get "born again".

Grof, however, made something positive out of the conversion of Pain.  It became into "transcendence", and it was -- transcending the Pain.  His patients were not just dealing with a material, engraved birth experience.  It was an experience that took them beyond what we mortals know and experience to another plane where time and space no longer exist.  The reliving of birth, said Grof, leads to "cosmic engulfment."  He also spoke of how the subject "experiences powerful currents of energy streaming through his body...followed by episodes of explosive discharges and feelings of ecstatic release."  After this, visions occur, of atom bombs, scenes of war and destruction, volcanoes exploding, etc., not to mention "union with the Great Mother."  One of my new patients years ago did a rebirthing session during a weekend, unbeknownst to me.  On Monday it was immediately apparent when she discussed her "transcendent" experiences, her phony smile, and glazed look.  It took weeks to undo that weekend event.

In my view, uniting with the Great Mother and the rest of it are just symbolic ways of saying that people had been engulfed by internal Pain, not liberated from it.  It is no wonder that Grof's patients scramble into mysticism and spiritualism.  They have been summarily catapulted into an out-of-sequence experience which lies imprinted in the innermost depths of their brain, for which they have no preparation, no frame of reference and no ordered descent over time.  Flooded with the force of a catastrophic experience, they are impelled to flee into their heads.  And in a mad flight from Pain the human mind is capable of incredible and creative flights of fancy.  But Pain is not transcended; rather, because it has built to intolerable levels, it is converted into "cosmic" ideation.  The rational mind conjures up explanations for this explosive, inexplicable experience.  It decides there must be some unknown, mystical force behind it.  Problems are not solved; they are symbolized.  This is the essence of abreaction.

All the thrashing, screaming, and writhing as a result of the birth experience under LSD may look like a real birth Primal when in reality it is just a release of raw energy and becomes another defense against Pain.  We know this happens because there are not the characteristic changes in vital sign measurements that there should be.

Like the mock Primal Therapies, Grof's approach to rebirthing -- which, incidentally, sometimes was funded by government agencies and psychiatric institutions -- ignored the dialectic.  Under the therapist's authoritarian direction, the patient is made to skip over many smaller Pains in order to zero in artificially on the birth trauma.  Consciousness is not integrated; it is tampered with.  On theoretical grounds alone, it should be clear that in reversing neurosis, one must deal with the most recent, less severe Pains and work methodically toward the deeper, highly-charged ones. This is in accord with how the brain is developed and organized.

Each one of us has thousands of crucial post-birth experiences that help make us neurotic.  To think that some kind of randomly-induced "rebirthing" experience can erase all that is to believe in sorcery.  But mock Primal therapists do not know how to, or don't care to, distinguish between abreaction and true resolution. Unlike what we do in Primal Therapy, they do not monitor the biologic signs which objectively reflect what has happened. Moreover, when resolution does occur, there are no symbolic aftereffects, something we have seen with thousands of patients: no words and concepts, no explanation, no psychotic symbolism, just feelings.  The body simply acknowledges its Pain.  But when abreaction occurs, there is likely to be cosmic unions with the Great Mother and the like.  This is not surprising when you consider the tremendous power of the birth experience, with the rapid changes in core body temperature and heart rate and other vital signs that go along with it.

It is said that imitation is a form of flattery.  But we don't need flattery, and suffering human beings don't need to be guinea pigs.  Nor do they need to have "cosmic" experiences.  Many people have attempted to imitate Primal Therapy, but no one has managed to duplicate it.  Something as precise as Primal Therapy cannot be practiced correctly by dilettantes or charlatans.  Which is why a lot of those who go through mock Primal Therapy come out in worse shape than when they went in.  A license in psychology or psychiatry is no guarantee of competence in this precise form of psychotherapy.  Furthermore, there is no reason for those who want to do Primal Therapy to reinvent the wheel.  They do not have to go through all the mistakes we went through in our early years, due to lack of understanding of brain processes.  While most of our profits go into training and research, I have yet to see serious research amongst those mock Primal therapists who have capitalized on our work without really understanding it.

The rebirthers, like so many other therapies, are in the business of offering people the magic they long for, the immediate results and quick cures.  It is wrong to play with, practice on, and manipulate people in this way.  We have seen too many cases of mental breakdown and suicidal depressions as a result of it.  The flooded patient tries to repress with everything he's got.  If it works he is depressed; if it doesn't work, he's got blown gates and permanent anxiety attacks, nervousness, constant agitation, and lack of restful sleep.

One must understand what the body's self-defense is all about. Defenses come into being and exist precisely so that Pains will not overwhelm the system.  They are electrochemical wrappings stimulated by Pain.  To suddenly unwrap these defenses is to leave the system open to more Pain than it can possibly integrate.  Anything which artificially alters those defense mechanisms produces artificial and potentially dangerous results.  On the other hand, allowing the system to be natural produces natural results.  The unconscious of repressed Pains was built slowly, by the accretion of experience.  There are no shortcuts to it, and thus no shortcuts to consciousness.

Real Primal Therapy, as opposed to the poor imitations of it, is not a business.  It is a sacrosanct method for helping people get well.  Our methods may not be perfect.  Nor will they work for everybody.  But in my opinion, they are the most scientific extant.

Primal Therapy isn't neat and clean and it isn't intellectual. Many proper ladies and gentlemen are put off by the idea of rolling around the floor screaming and crying hour after hour, spending months in agony.  They want a controlled situation, the same control (imposed by others) that got them into the mess they're in, the same control and repression that is going to make them very sick later on.  This control is what is wrong with most therapies. In my view, the chaos within, not control from without, is the sine qua non for true, creative, curative psychotherapy.  The chaos of Pain, not the careful avoidance of it nor the conversion of it, is what ultimately heals.  A patient must feel the Pain in the proper sequence and react according to her specific internal responses to it, not in response to someone else's direction.  Pain itself, not the ideas and symptoms which are merely its offshoots, holds the key to the dialectics of consciousness and to the end of neurosis.

Primal Therapy creates new human beings, or human beings who no longer need to search for magical salvation, who will go back to their origins, when they were naive, innocent, hopeful, spontaneous, wondrous, generous, warm, open.  You cannot be this way again by acting grownup.  You need to return to your childhood.

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[1]Kovel, Joel, A Complete Guide to Therapy.  (New York: Pantheon Books, 1976), p. 46.

[2]Clarke, A.M. & Clarke, A.D.B., Early Experience:  Myth and Evidence.  (New York:  MacMillan, 1976), p. 34.

[3]Ibid., p. 34.

[4]Ibid., p. 259.

[5]Ibid., p. 259.

[6]See S. Grof, "Perinatal Roots of Wars, Totalitarianism and Revolution."  Journal of Psychohistory, 4(3), Winter 1977.