Wednesday, April 27, 2011

Primal Therapy and science

by Bruce Wilson
What is science? A simple definition is offered by George Orwell in his essay by that name. He defines science is either: “(a) an exact science, such as chemistry, physics, etc. or (b) a method of thought which obtains verifiable results by reasoning logically from observed fact.”
By this simple definition, primal therapy might be defined as a science. Arthur Janov developed his theory through observed facts by watching his patients descend into deep feelings, gain insights, and get better. He then reasoned logically from those facts and developed a therapy that obtained verifiable results. He then went further to find supportive evidence for his theory from physiology and neurobiology, both exact sciences (or close enough to it). Throughout this process, he developed a theory of mental illness based on early life trauma and a conclusion that primal therapy can be the one and only “cure for neurosis.”
Throughout his work, Janov also tried to follow the scientific method, which is required for any study claiming to be a science. The scientific method is derived from the hypothetico-deductive model of inquiry, which occurs roughly as follows:
1. Make an observation.
2. Develop theory about that observation.
3. From the theory, develop a testable hypothesis.
4. Test the hypothesis and observe the results.
5. Use the results to modify your theory and retest. Continue revising and retesting your theory until it becomes robust. This often requires tossing out the original theory.
Applied to primal therapy, this translates as follows:
1. Make an observation: Janov observed his patients regress into deep feelings. This was not new – Freud, Janet, and others had observed it and called it abreaction, but had abandoned it as untherapeutic. But many of Janov’s patients obtained relief and insights after these regressions so he decided to take a deeper look.
2. Make a theory: Borrowing some ideas from Freud, Janov came up with a new theory about human suffering: If the needs of a child go unmet, the result is overwhelming primal pain which the child cannot feel because is so devastating. Thus, the child represses and stores that pain in the brain where it remains in the unconscious. This became the core tenet of primal theory.
3. From the theory, develop a testable hypothesis: If one were allowed to regress into those early memories, primal pain can be felt in small increments and eventually resolved.
4. Test the hypothesis and observe the results. Primal therapy was the test for the hypothesis. According to Janov, most of his patients have became well by doing primal therapy and continue to remain well today.
5. Modify the theory and retest: Primal theory has been refined for more than forty years, and according to Janov, the core theory has held up to the test. However, fetal and perinatal experiences are now recognized as being far more important in creating neurosis than earlier thought.
But something crucial is missing in this process and that is the attempt to falsify your hypothesis, not just seek evidence that support it. This is the gold standard for any scientific process.  A famous essay by physicist Richard Feyman describes difference between good science, bad science, and pseudoscience. Feynman says that in order to do good science…
Details that could throw doubt on your interpretation must be given, if you know them. You must do the best you can—if you know anything at all wrong, or possibly wrong—to explain it. If you make a theory, for example, and advertise it, or put it out, then you must also put down all the facts that disagree with it, as well as those that agree with it….  In summary, the idea is to try to give all of the information to help others to judge the value of your contribution; not just the information that leads to judgment in one particular direction or another.
In other words, you must report your experimental failures as well as your successes. And you must make sure that your successes are truly explained by your hypothesis and not some other factor. You must not become so in love with your hypothesis–no matter how beautiful it is–that you neglect other explanations or observations that don’t support it. You must never jump to conclusions beyond the data, and you must never cherry-pick data that fits your theory and ignore data that refutes it. You must test, test, and test again, always with the attempt to falsify your theory, rather than prove it. You must invite others to try and prove you wrong.
Feynman described this attidute as…
…a specific, extra type of integrity that is not lying, but bending over backwards to show how you are maybe wrong, that you ought to have when acting as a scientist. And this is our responsibility as scientists, certainly to other scientists, and I think to laymen.
So in my mind, for primal therapy to truly be considered a science, those working in the area need to heed Feynman’s advice and do the science right!
There is evidence that conflicts with Janov’s claims. For example, many people do not respond to the therapy and yet we rarely hear of them. Why do they not respond?
And might there be other explanations as to why people get better in primal therapy? Comparative studies of other psychotherapies have shown no significant benefit of one approach over another. In fact, the skill of the therapist and the strength of the therapeutic relationship between therapist and client were more relevant to outcomes. Also, you cannot ignore the fact that the therapist’s and client’s belief in the therapy can have a big effect on outcomes. Also, significant changes in life circumstances (e.g. getting into a relationship, finding secure, well-paid work you like, financial security, etc.) may be more important to getting well than the actual therapy itself.
To anyone who has access to their deep feelings, or who has read Janov’s books and experienced the primal process, it is obvious that Janov has hit upon a fundamental truth about human suffering and its treatment: Primal pain is real and feeling that pain under the guidance of a skilled therapist can lead to enormous relief and healing. For those of us who have received benefit from primal therapy, it is clear that there can be no deep healing without deep feeling. Everything else is personality adjustment. People who do well in primal therapy don’t need science to know it works; they are convinced by their own experience.
By to gain respect in the scientific community, primal therapy must follow the accepted standards of good science. With all due respect to Janov’s deep insights, he fails to recognize this fact and denigrates it the scientific method as a search for “statistical truth” rather than “biological truth.” He writes in Primal Healing…
“..we should not lose track of the overarching truth—feelings are their own validation. We can quote and cite all day long, but the truth ultimately lies in the experience of human beings. Their feelings explain so much that statistical evidence is irrelevant. Cognitive therapy seeks statistical truths to corroborate their hypotheses and theories; these theories are too often intellectual constructs that do need statistical validation. We are after biological truths beyond mathematical facts.”
On one hand, he is right—one cannot fully understand the inner experiences of human beings through scientific analysis. Science can only observe exteriors, such as changes in behavior and physiology, and not the mind itself. Even reports of “I feel better” is an exterior. If one holds to statistical evidence alone with criteria for getting “well” that lack depth, then you’ve missed the mark. The many studies showing the “efficacy” of cognitive behavioral therapy fit into this category. Changing thoughts and behavior may make you feel better, but for how long? Has it solved the deeper problem? Evidence suggests that CBT fails in this regard.
But following what I wrote earlier, you cannot eschew good methodology in making conclusions, and that usually involves gathering statistical evidence in the form of outcome studies. Statistics alone are not the end-all and be-all of explanation—they do not constitute truth, as Janov says. But they are an indispensable tool in the scientist’s tool kit to determine whether or not the results of your testing are true and not the result of wishful thinking. In other words, biological observations may determine your hypothesis, but statistical studies are still the the standard for confirming or rejecting those biological observations.
As yet, we do not know how many people respond to primal therapy and how many don’t, why people respond or not (is it access to feeling? Skill of the therapist?), or how long the results last. What does it mean to be “cured” of neurosis? Testimonials and reports from responders are not enough.
So in answer to the question, “is primal therapy a science?” I would say…not yet. It is more of a protoscience, which Wikipedia defines as, “a fringe science that has limited acceptance in the mainstream scientific community but is nonetheless rooted in established scientific principles and thus has potential for being more widely accepted.”
It is my belief that primal therapy is rooted in established biological principles, especially with regard to affective neuroscience and I hope someone in the primal community who has the required resources decides to give it the scrutiny it deserves.

Comment to Bruce Wilson's article, April 22, 2011.

  • Thank you for your article ”Toward a True Science of Primal Therapy”. So far, this is among the best comments about P.T.  that I’ve read. I totally agree that PT is possibly a proto science. Arts and Michael Holden's ambitions to do research and establish a scientific approach unfortunately never took off. (As a neurologist Michael was of great help to me when I came to L.A. I think his scientific approach could have been of much help to Art. So for example, Michael helped me through my first MIR test at UCLA in 1978 when they just had received the newly developed equipment.) 
  • I have in my ”Epileptic Journey” a number of times stated that my great luck was not the fact I went to PT but that I embossed my total confidence in Art as my ”personal” therapist over 30 years. His skill and intuition (with many outstanding examples) as a therapist is what in combination with a deep tissue massage to restore the body’s naturalposture and structural integration (Rolfing) took me through sensational healing experiences and almost totally eliminated serious epileptic seizures and neurotic behavior, even if it took very long time due to circumstances of life.
  • However, in a group of >10 hopeful people who joined PT in 1978, I was the only one who eventually survived and was successful. A couple of them took their lives. All others died all to early.
  • Regards Jan

Saturday, April 2, 2011

Janov's Reflection on "What a world it could be."

What a World it Could Be

Today my children I am going to tell you about a world we could have, not for our children or grandchildren, but for us. And we can do it easily. But first in order to explore the subject I want to tell you about an article in the paper today. A man had a quarrel with his girlfriend. He left home and came back with a knife and stabbed her 50 times; this with their children in another room. No thoughts about those kids and certainly no thoughts that he was taking a life, savagely.

I thought to myself could I go out and get a knife and stab anyone 50 times? Of course not. Then I said, “Is he really from a different species than I?” And the answer is “yes!” What? Do I mean that? Absolutely. Now we have to go back to my three levels of brain development and revisit the first line. Remember we start out in the womb with a brainstem and little else. That brain structure is primitive, equal to the whole brain of the crocodile. It allows quick and immediate responses to get out of the way and save our lives. It allows impulsive reactions and is the base for the deepest aspect of feeling—hopelessness and helplessness. It organizes terror and above all, rage! When we need to fight to save our lives. When adverse events occur while we are being carried, it impacts the brainstem and first line.

When something happens as adults it can resonate with those first line reactions, unless of course there is adequate gating to hold down those primitive responses. But when a child is neglected, abandoned and unloved and untouched growing up, the pain grows and is compounded, weakening the gates between levels of consciousness. Gating is defective so that when there is resonance it reaches all the way down to first line. And rage ensues or other great pain hidden in the antipodes of the brain. Normally that reach does not trigger off first line reactions unless our lives are in danger and we have to react to save ourselves. Those with faulty gates are immersed nearly all of the time in first line. And that is what we often call the hysteric, who overreacts to almost anything.

So mister killer got jealous, she looked at another guy and that’s all, and the rage bubbled up and he killed. He for the moment was a complete crocodile with no cortex or limbic system to help out. When he was enveloped in the crocodile brain there was no longer the adult human brain to control and think things out. He was no longer human; no longer part of us. He was a different species. A primitive species with no human thought or compassion. When he was no longer triggered he will be overcome with what he did and want to kill himself but that comes later when he can think and feel without being overwhelmed by first line.

I remember when my father got mad we knew to stay away because his eyes began to water and turn red; we knew something deep and terrible was lurking down below. We did not know what to call it but now we do. His first line, Lizard brain was on the march. Watch out! Because that brain has no control. The reason is that when adverse things happen while we are in the womb it literally diminishes the development of the neocortex, controlling, thinking/reasoning brain. There is damage to these developing cells, particularly during birth where there may be a serious lack of oxygen.

So now we grow up without all our cortical marbles and with serious imprints on the brainstem/limbic/feeling areas. And we begin to eat like there is no tomorrow; and literally for the first liner there is no more tomorrow. Eating becomes life and death; urgent! Because the drive behind it is so urgent. There may have been starvation during womblife. Or some other serious trauma. The same with violent act-outs. Here the idea of anger management is ridiculous, unless we expect the person to grow new cortical cells. What they do offer is a cortical/third line buffer against upcoming pain. It will hold only for a short while; better to let it all out in a safe environment with slow emotional steps in a methodical way.

Any extreme behavior is usually first line derived; suicide, overeating, oversexed, addiction, and so on. Certainly, we can include psychosis in all this. And we know now what it takes to treat all these symptoms and behavior.

Now suppose there comes along a therapy that deals with first line? Modestly, I say it is mine. What will that do? It will make a world without uncontrolled rage. A world without serious alcoholics and drug addicts, a world without suicides. Don’t forget that all of what I am describing is at base emanating from first line. I have seen it and my staff have treated it successfully. It ain’t easy but it can be done; slowly, methodically and carefully. But we can make a decent world we can safely live in. And we can do it now! It is no longer a mystery except to those who have no access, which is most of us. So now children, before you fall off to sleep let me assure you, we have it in our power to make a much better world right away.

Jan Johnssons comments on : What a World it Could Be

As always, I have read your article a number of times to be sure that I have understood it all. "Mas o menos".
The traumatic pain, which bubbled up, in ”mister jealous”, is an element of the brain's construction, and, of course, because nobody has been able to help him release or to live it (to use your own, even better, expression).
Why is that? As You say there are therapies around, which deals with the first line. I’m a living example what it means to have lived a horror filled trauma, as close to death, that anyting/anybody can get you. When I had lived that pain a few times, I became a ”different specie”. I understand the killer in your article, when pain of that magnitude leaks out, you are a threat to others and to yourself.
How do we find and identify these potential killers? It sounds so easy when You describe it; ”a few of your books, to study the construction of the brain and the interaction between the right and left side and the vital signs and with the help of a talented catalyst you will change into a new specie....”
Most of us love what You are telling us about Primal Therapy in theory. How come that it in practice does not spread rapidly around a world which needs it? When I read EMDR (whether it is Francine Shapiro, Laurell Parnell or Bessel van der Kolk) I see a number of similarities with P.T. They also reject cognitive talk therapies as a way to eliminate traumas. These traumas have to be experienced. 
On behalf of P.T. I feel jealous when I read ”A Therapist Guide to EMRD” by Laurel Parnell. No surprise that they are conquering the world in a short time and that governments, authorities and science support them and show appreciation for their efforts. They do not talk a lot about birth traumas: however, they are not surprised if they appear during treatments. In contrast to the talk therapies, they do not seem to be particularly dependent on the pharmaceutical industry.
I admire your courage to post a couple of the critical comments, like, for example, the email which talked about mental masturbation. That remembers me of when I was working in a Biotec company during a few years. The business idea of the company was to develop and market instruments to measure protein in the Food and Feed segment. In the research and development department, we had two constellations of stars/brains; 1. Those, whith left brain dominance, who understood and lectured about the theoretical parameters 2. Those, with right brain dominace, who turned their conceptual understanding into instruments (using either chemical or infrared techniques), which we could sell and conquer the world market and make a living. The people in 2. were often considered being ”difficult”. They knew and ”saw” connections they were not so talented at explaining. We needed both kinds of R&D-people to survive and put it all together, however, the intellectual stars seldom made things happen.
I am pleased that I of individual, psychological reasons, embossed my therapist confidence in Your person. This fact took me trough my all to long, wobbly, unorthodox treatment. (Mrs. Parmell, in her book, considers the importance of a total thrust in the therapist, to be crucial for a positive result in any trauma treatment.) Often in my life, I have understood a concept better than I have been able to explain it. The Primal Therapy is one of these experiences.
Jan Johnsson