This article originally appeared in the Winter, 1986, issue of L'Orientation Professionnelle. The author, a primal therapist, will soon relocate from Los Angeles to Montreal and plans to open a private practice there.
Réal Beaulieu believes that the article has historical value and can encourage healthy discussions. Since it was written, he has undergone five years of
training at the Primal Training Center under Dr. Arthur Janov's supervision. Mr. Beaulieu is no longer employed at the Primal Training Center.
"To prevent permanent withdrawal to the past or vegetation, we need to face squarely each unfinished issue while we still own our sensory skills and our cognition capacities. We need to uncover the dust that we swept under the rug during our lifetime. We need to let our feelings out of the bottle that we have corked up. If we wait until old age, we wait too long."
-- Naomi Fail from The Journal of Humanistic Psychology, Vol. 25, No 2, Spring, 1985
In the seventeen years or so that Primal Therapy has been around, I have seen a lot of controversy about what it is and what it is not. In this article, I will try to clarify the situation, based on my experience at the Primal Institute of Los Angeles, my many discussions with therapists trained by Janov and the reading of his latest publications. I emphasize the word "latest" because a lot of the controversy has been fueled by his very first book: THE PRIMAL SCREAM: Primal Therapy: the cure for neurosis.
This title caused Arthur Janov a lot of trouble, although it attracted him a lot of clients, especially in the beginning. For one thing, it caused the public at large, including many psychologists, to equate Primal Therapy with "Primal Scream Therapy," which it is not. Second, because of the magic overtone and the absolute meaning of the word "cure," in combination with Janov's polemic style, a lot of professionals felt rejected. In that way, I believe that Janov discredited himself. I heard him say lately that if he were to start again, maybe he wouldn't write The Primal Scream. One thing is for sure: He would write it very differently.
This being said, I can now proceed to try my best at giving a description of the essence of Primal Therapy. It is a challenge for me to write in a few pages about something so simple and so complex at the same time. If we want to understand how a medicine works, it helps to understand first the nature of the illness. In this case, the name of the illness is neurosis, assuming that psychosis is a more advanced state of mental illness.
A few years after the publication of The Primal Scream, a young neurologist, Michael Holden, M.D., joined Janov and became the medical director of the Primal Institute, in a common effort to give primal therapy its scientific and biological basis. Together they published a book that became the bible of primal therapy: Primal Man: the new consciousness.
In my opinion, one of their greatest contributions to the field of psychology is their description of how neurosis develops, affecting the development of the entire brain, and how it is possible to reverse the process to a certain extent.
Janov had already described how we are all born creatures of need. As infants, we needed to be fed, to be touched, to be attended to when crying, etc. Later on, those needs take a more sophisticated form.
We need to be listened to, to be reassured verbally, to be encouraged, and on and on. My aim here is not to provide a complete list of needs but to show how needs, generally speaking, are at the basis of human development. All those needs can be summed up in one general statement: We have to be loved, in order to become healthy individuals and be fulfilled.
When our needs are not met, we become neurotic and unhappy. I suppose that most psychologists would agree so far. The difficulty arises when we try to determine scientifically what neurosis exactly is. Many theories have been brought forward, but very few are satisfying, seeming to rely on abstract concepts more than on scientific facts.
Most of us, in the helping professions, suspect that being neurotic has something to do with being repressed. Even the psychopath, traditionally regarded as the antithesis of the neurotic, must be terribly repressed in order to perform his most reprehensible acts. But what is it exactly that is repressed? Is it impulses or desires, as was suggested by Freud? Janov's answer is this: Pain is repressed.
Each time we open up a neurotic, we find Pain; it is our continuing observation that Pain is central to neurosis. Even for those neurotics who had no idea they were in Pain, the finding is the same.
When a child's needs are not met, he hurts. If the pain is not too overwhelming and can be expressed at the time of the deprivation, because the parents allow the child to do so, the damage may be minimal. But if a child is beaten, for example, or realizes "They don't love me" or "I'll never get what I need", then the child is in agony and has no choice but to shut off that realization from consciousness. He becomes repressed and defensive. He doesn't defend against his impulses or desires, but against Pain with a capital "P" as Janov likes to emphasize. He becomes neurotic in order to survive.
But those same defenses, that helped him survive when he was small and totally dependent on his parents will keep him neurotic a whole lifetime and eventually kill him, not only psychologically (his real self), but physiologically as well (tension, cancer, heart attacks, etc.). Janov goes to great lengths in his books to show that all of this happens on a biochemical and neurological level.
The recent discoveries concerning endorphins indicate how extensively human behavior is dominated by the compounds that deal with Pain and repression. Endorphins are morphinelike substances, internally produced, which function as analgesics; that is they "handle" pain.
What is important to note here is that for the first time in the history of psychology, repression is not an abstract concept, but a biological one, a common ground around which scientists and psychologists can agree. Furthermore, the old distinction between mind and body doesn't exist anymore, making things so much more simple.
In Prisoners of Pain, Janov offers convincing evidence that emotional pain and physical pain are basically processed in the same way by the nervous system. When there is too much pain, repression has to occur and it does occur. Repression works on the principle of overload. Too much electrical stimulation of the brain automatically triggers the production of more endorphins, making the pain tolerable and allowing the individual to keep on functioning.
Janov's understanding of repression seems to get more and more validation, as the science of neurology progresses. For example, the official textbook for a class entitled "Physiology of Behavior" (given at the University of California at Los Angeles) offers some similar insight into the process of repression, without using the word as such.
First, let us consider the effects of unavoidable pain. Several experiments have shown that analgesia can be produced by the application of painful stimuli, or even by the presence of nonpainful stimuli that have been paired with painful ones. For example, Maier, Drugan, and Grau (1982) administered shocks that the animals could learn to escape by making a response. Although both groups of animals received the same amount of shock, only those that received inescapable shocks showed analgesia.
That is, when their pain sensitivity was tested, it was found to be lower than that of control subjects. The analgesia was abolished by administration of naloxone, which indicates that it was mediated by the release of endogenous opiates [endorphins].… The results make good sense, biologically. If pain is escapable, it serves to motivate the animal to make appropriate responses. If it occurs whatever the animal does, then a reduction in pain sensitivity is in the animal's best interest.
Directly linked to the concept of repression, the concepts of consciousness and unconsciousness also take a purely biological meaning in Janov's and Holden's theory of neurosis. In Primal Man they describe three levels of consciousness, each one with its own specific location in the nervous system. In the true sense of the term, he did not discover the physiological existence of those three levels.
For that, they rely heavily on the work of neurophysiologists such as Wilder Penfield, Paul McLean (A Triune Concept of the Brain and Behavior) and R. Melzack, to name only a few. McLean, for one, originated the concept that the brain consists of three major parts, the reptilian, old-mammalian, and new-mammalian.
Nevertheless, Janov and Holden are masters at putting two and two together, and they profusely demonstrate the relationship between those three parts of the brain and their own observations that certain of their patients could remember events as far back as their own birth. Based on that observation, they describe three types of memories, that go along with the three levels of consciousness: an intellectual memory (new-mammalian), an emotional memory (old-mammalian) and a visceral memory (reptilian).
According to them, even if we did not remember an early trauma intellectually, the body remembers. For example, in Primal Man: The New Consciousness (Appendix D), a photograph shows the reappearing bruises on the thigh of a 56 year old woman, after she re-experienced being periodically beaten with a riding crop, from the age of 5 to age 13.
Such phenomena vividly illustrate the principle that each body cell can feel and register pain and thereby contribute to the totality of consciousness.Pain of such magnitude cannot be fully integrated and experienced by a child, for whom it is overwhelming. Primals have full access to those early overwhelming Pains, and allow adults to re-experience and finally integrate them. If such Pain is not re-experienced in Primals, then the individual must exert a constant metabolic effort in opposition to the Pain. The hypermetabolic state created in response to many childhood Pains is neurosis. Only Primals can reverse the neurotic state.
And this is the essence of primal therapy. In short, pains that are blocked from consciousness are stored in the body as neurophysiological memories. That pain is waiting to be expressed and the body is crying to do so. The role of the Primal therapist is to help the patient to re-experience and express the pain that was repressed, with full connection to the source of the traumatic event or painful prolonged situation that caused the repression in the first place.
Talking about it is important, but not sufficient, because the stored energy of the primal pain is not released and keeps reverberating in the neural circuits of the brain. According to Janov, if not expressed in a Primal, the pain is at best rechanneled and gives rise to different symptoms.
It is the role of the defenses (a defense can be any behavior) to keep the pain repressed. It is the role of the primal therapist to see beyond the defenses and favor the expression of the buried feelings. In my experience, Janov and his therapists don't use any dramatic super-technique to go beyond the defense system. If they did in the past, they don't anymore. Generally, simple questions or remarks will do the job. The closest thing to the "empty chair" technique of Fritz Perls, for example, would be to have the patient talk to his/her "mom" or "dad" or any relevant person, for that matter.
Where does Janov stand among the three major schools of psychology? His assertion that neurotic symptoms are the result of repressed pain rules him out as a behaviorist, since behaviorists work mainly on eliminating the symptom. On the other hand, Janov's approach has a lot in common with the psychoanalytic approach. His insistance on the past, the unconscious, repression and the defense mechanisms should make that obvious.
He could also be considered as a humanistic psychologist for the following reason: He sees the human being as basically good. Unmet needs and pain make a person develop all kinds of symptoms and behave in neurotic ways. Moreover, even if all patients have been victims of the past, they are responsible for their own growth (being able to feel
and connect gives them more of a choice) and they have to take charge of their own lives, in order to finally get what they need.
See important footnote
In fact, the main criticism that I have concerning Primal Therapy is not so much about the theory or the process itself, but about the way the Primal Institute was run when I was there. For example, it has been my experience that many patients did not get the personal attention and the follow-up necessary to make sure that they were doing okay with their lives.
Also, inherent to the nature of Primal therapy, there is the danger that the primal patient, having been promised a cure, puts too much hope and reliance on "feelings" alone. I must emphasize that this remark applies especially to the early days of Primal Therapy. In those days, the process was considered as potentially dangerous, even by Janov himself.
The process of getting in touch with one's feelings and expressing them is not dangerous in itself. It can only heal. The real danger occurs when the patient is confronted with more pain than he or she can handle and integrate (overload). This is likely to happen when one's quality of life is getting worse, or simply isn't improving. We all have a good understanding that a miserable present in conjunction with a miserable past can only lead to despair.
It appears to me that the process of Primal Therapy could be improved if the therapists paid more attention to the quality of life of their patients. In that sense, I would propose a reversal of procedure. Instead of initially focusing on the Pain, one should help the patient to get a better life first. In due time, the Pain will come up. When the therapy is applied in this manner, the patient cannot lose and the risk of an overload is practically eliminated.
I have other criticisms. For example, I always felt the cost of the three-week intensive to be prohibitive and even anti-therapeutic for that same reason. Let me explain. The intensive is only the tip of the iceberg. Some people have to work years or use up all of their savings in order to only “start” a process that may last a lifetime. This puts them under enormous pressure to “feel old feelings” (called primals here) and sometimes leads to abreaction or trying too hard to do the therapy. In other words, it becomes unnatural, therefore anti-therapeutic.
Once again, this is a discussion about how the Therapy should be applied, not a questioning of the theory itself. One can take a thousand trips around the world, become a famous writer or movie star, be admired by millions, and still feel miserable. The kind of pain we are talking about doesn't go away just because of a change in lifestyle. It eventually has to be dealt with and felt for what it is.
Finally, one sentence that Janov wrote in Prisoners of Pain sums up beautifully the essence of Primal Therapy, as far as I am concerned: "The history of psychiatric disorders is nothing else than the history of sadness; yet, no one drew the conclusion that sad people need to cry." All children are a testimony to the fact that
getting angry or crying spontaneously in response to hurt is natural and healing,
- IMPORTANT NOTE -
In this article, I was trying to classify primal theory historically in terms of Freudian, Cognitive-Behavioral and Existential-Humanistic psychology. The latter puts a strong emphasis on the client’s responsibility for his/her own present and future growth.
The danger here is to ignore the tremendous responsibility of the therapist in that growth process. A un-acknowledged mistake (especially an egregious
one) by the therapist or the people in authority (therapy-wise), especially when confronted by the client, can contribute to catastrophic overload in a primal client. This overload can last for a lifetime.
This is compounded even more, if in the name of clinical expertise, the mistake is endorsed by a whole group of therapists and people in authority. Then, the reality of the client is clearly taken away which may lead to dire consequences, including suicide and psychosis. For many primal patients, primal therapy represents their last hope. Where will they turn if the people who gave them that hope turn their back and deny the validity of their reality, perceptions and feelings in the same way their parents did?
We all have the responsibility to look at ourselves as therapists and face the consequences of our acts. It is human to make mistakes, but is is inhuman to deny them when there is so much at stake. The main quality of a good therapist is humility and non-defensiveness. It is a grave mistake not to be able to say: “You are right, I am sorry.”