A Psychiatrist's View of Primal Therapy and the Medical Profession

An Interview With Warren Baker, M.D.

Dr. Baker was in private practice specializing in family and adolescent therapy when he became interested in Primal Therapy in 1972. Initially, he cautiously tried some of the techniques with a few selected patients. He was one of the founders of the Denver Primal Center. He returned to private practice in 1978.

DPJ: I'd like you to start out by telling something about your background.

Warren: I've been in practice for about 15 years. I did my psychiatric residency and was trained psychoanalytically at the University of Colorado. I got interested in group therapy at the V.A. Hospital where I worked for a couple of years. Doing a practice with individuals and group therapy I then went to work at Fort Logan, (Colorado state mental health in-patient facility) worked in a family research project there, went to Esalen, had workshops with Virginia Satir and Fritz Perls, and got involved in the humanistic, psychological movement.

I did family therapy for quite a while but I found after a time that the groups and family therapy, and even some of the individual therapy I was doing, didn't feel as if people were really progressing the way I thought they really ought to. Then I read the book, The Primal Scream, and got involved with Primal therapy with friends in 1973. The Primal therapy has certainly influenced how I do individual therapy, but I'd say I've become more conventional in the last couple of years.

DPJ: What was happening to you - why did you go from the psychoanalytic model to Esalen to Virginia Satir to Primal?

Warren: I felt the psychoanalytic model was very intellectual and didn't get down to feelings. When I went to Esalen and got involved with Satir and Perls it just seemed that their approach was far more meaningful - they seemed to give greater freedom to the individual there, were a great deal more feelings expressed, and those feelings seemed to be much more therapeutically effective than the kind of intellectual therapy I'd done before. When I got involved with primal therapy it seemed this was a deeper, much more profound approach.

We live in a society where feelings are something you have to control. In standard therapy they must be limited and tolerated; it's not the usual goal in therapy to have you reexperience feelings. I think Primal therapy has demonstrated that feelings can be a very powerful influence in therapy.

Science has held for some time that man has no real control of his behavior. Most of the studies with animals show that an animal can limit his aggressiveness by certain built-in, instinctual cues, but that man seems to be free of that. I think they've missed the boat. If a person were really connected with his feelings and had had a lifetime of experience with them, I think you'd see an entirely different kind of human race, which would not be aggressively out of control.

DPJ: You're saying then, that connected feelings actually are the biological cues to limit destructiveness?

Warren: Yes. Take Germany and the War, for example. I think it was because they were out of touch with their feelings that they allowed such Nazi craziness to go on. They rationalized the super race, etc., by intellectualism. When you're really in touch with your feelings and have been all your life, you're open to a sensitivity about other people that just wouldn't allow you to permit or participate in such inhuman behavior.

DPJ: One of the things people would say is that you just can't go out and hit a person when you get mad, or tell people what you think of them when you feel like it. There have got to be social conventions.

Warren: I think that's one of the misunderstandings about Primal. I think sometimes even the patients here use "feelings" to justify their actions - "I'm doing my own thing, I'm having my feelings." Those aren't the feelings, they're still act-outs.

If you're really in touch with your feelings and have experienced them, you don't act inappropriately. You don't have to dump them all over somebody else. If you're triggered, angry about somebody who's done something to you, you're far more apt to be appropriate if you get in touch with your feelings.

I think it's unfortunate that Primal therapy has been labelled "the scream therapy" or that people are screaming a lot and express their feelings at the drop of a hat. Those are not feelings. They're frequently act-outs of deeper feelings they haven't gotten to.

DPJ: Can you give an example?

Warren: Let's take a Bronco football game. Everybody's screaming their heads off and it seems appropriate there because it's accepted, but I don't think that that is really being in touch with their feelings.

What they're doing is ventilating a lot of unfelt feelings that they've had during the week. The feelings that they are expressing at the football game are really irrelevant to the deeper feelings that the game has triggered. The critical issue is that so often people are afraid of and try to control what appear to be feelings but are actually disconnected feelings.

A person who's always showing his feelings can be as disconnected to them as, the person who's very passive and never cries or shows any emotion. It's another way of acting out. One person may hit somebody to act out a feeling, another person may withdraw within himself and become very passive, and another person may scream and cry - all those three things are not truly connected feelings. A person who is reacting with truly connected feelings is more often than not very appropriate and seems connected in a realistic way to what's going on.

DPJ: So many people say this society's crazy, "I just can't live in a crazy society." What do you feel about that?

Warren: I feel that a lot! My inclination is to withdraw somewhat from society, and I'm sure that's partially unfelt feelings. I think about going to a small town some place or another country and living a relatively isolated life. I don't think that's absolutely necessary, though. I think everybody can find a place in society that is less insane, surround themselves with a situation that is less insane, and cut off the impact of the craziness as much as possible. There are a lot of neat people out there - they're not all crazy. So I think it's possible to live in this society. I'm not sure it's possible to change it.

DPJ: I agree. I think there's a lot to be offered, if you can pick and choose. I don't pay a lot of attention to my surroundings, but I do notice, and it's discouraging to me that when I'm in a group of people I'll tend to pick up on the crazy ones as opposed to the healthy, or less crazy ones. That's what I'm conditioned to respond to.

Warren: You can learn to discriminate, and take people as they are, ignore the craziness - although that's hard for me to do because as a therapist I've always been so attuned to it.

* * *

Warren: We're just beginning to understand how sensitive, how reactive, a fetus, an infant, are. We do irreparable damage without ever knowing we do it. One of the analytic theories is the infant is protected by a pain barrier, and that's just hogwash. I think researchers are beginning to be aware of this. But they don't have the foggiest notion about how sensitive an infant is to feelings, the capacity that infant has to absorb and experience them.

DPJ: Why do you think you do? You've come from a medical background . . . you've got a broad scientific background. . .

Warren: Yes, I also majored in chemistry in college, and was intrigued by physics.

DPJ: How did you arrive here, when apparently the rest of the scientific community scoffed at Primal.

Warren: I think probably the amount of pain I had forced me to look for something more satisfying. My six years of initial therapy did very little for me, psychoanalytic psychotherapy twice a week for six years. After going to Esalen I sensed that there was something entirely different that therapy had to offer me than what I'd experienced in psychoanalytic-oriented psychotherapy.

It was another world. Part of that was by chance. I got sent to Esalen to work with Virginia Satir when I was working at Fort Logan. It was a purely fortuitous circumstance but I responded to it. I was very aware of my body pain, and my experience at Esalen seemed to touch the pain in a way that the head trips in psychoanalytic psychotherapy just did not.

DPJ: You read The Primal Scream in 1972. It must have impressed you because you started trying it out on your patients. . .

Warren: It impressed me at two levels. One, it seemed a continuation of the kind of thing I was already doing. Secondly, it aroused so many feelings that I cried while reading the book. I felt a great deal about the people they were describing, And although Janov's messianic style turned me off, I could still read that he had touched something very basic. One of the frequent criticisms I hear is that Primal theory is simplistic. It's about time we got something that's true, that is a little simpler than psychoanalysis.

Scientifically, when you find something that explains a lot of phenomena in a simpler way, you may be touching something very basic, and so to say that Primal is simplistic is not a valid criticism.

DPJ: If you talk about its probable neurological underpinnings, you've got a very complex theory. I think you explained why it appears simple.

Warren: In the first book it sounded simple. We've found out since that it isn't. But I still think when you're looking at feeling and reexperiencing pain from a feeling reference point, it's a very simple and very important perspective, even though putting it into action is very delicate and tricky. Primal has a much more significant effectual model than psychoanalysis has, or a lot of other therapies that don't really touch that core of feeling.

DPJ: I remember very clearly some of the things that happened in the early 70's, because I was there. You started working with a couple of patients, then you took on a few more, then you actually started a Primal practice. Has anything changed for you since then?

Warren: It was really exciting to start with. Then I think we got overwhelmed because first of all, we didn't know enough about what we were doing.

Secondly, it tapped so much stuff in us that we hadn't felt ourselves, that it made it increasingly difficult. In the excitement of this new approach I think I forgot about all the material that I had learned that was still legitimate. There wasn't anything unsound about a lot of what I had done, but the Primal approach added a dimension to it.

Unfortunately, when I started out I just paid attention to the new dimension and didn't add in the things that I had done previously. In the past two or three years I've reintegrated a lot of what I used to do. I think it has a greater effectiveness and richness because I also know more about feelings, and feel more. So that my practice now is really not Primal therapy - it's not that at all. But it has a depth in it because I've had that Primal experience.

DPJ: How would you label yourself then? I know you take on some people to do Primal, and you also have more standard kinds of patients.

Warren: Unfortunately it depends somewhat on the insurance companies. We are being dictated to by Peer Review (A board of psychiatrists who review and pass judgment on their peers) to limit my practice in some degree to what my patients' insurance will cover. It's a realistic thing. I am very concerned about the effect Peer Review is going to have on advancement in our field.

I'm afraid it will discourage innovation and may deprive many patients from getting the kind of therapy they think they want. For example, Peer Reviews have allowed bypass surgery, which is questionable at best - they allow payment for that, but something like Primal, where they say there's no good solid evidence, they say people shouldn't get it. So the Peer Review and the government is determining what kind of therapy is allowed to progress. And that's an incredible restriction on the growth of medicine and the freedom of choice of a patient.

DPJ: That's the medical model on the whole, isn't it? The doctor knows best, you don't really have a choice of treatment.

Warren: A patient can have a choice of physicians, but when it comes to a choice of therapy, that's another matter. That's the doctor's province.

I think the medical profession has to face it that the more informed the public becomes on medical matters, the more they take charge of their own therapy. A doctor assumes when you go to him you're in his hands, and he's going to choose the therapy and what should be done for you. People are becoming more aware of themselves, becoming more knowledgeable about medicine in a way that few people were 30-40 years ago. They're going to demand what they want.

For example, people who know about Leboyer have demanded that kind of approach when giving birth to a child. And so now General Rose Hospital offers that kind of birth experience. But it's still disputed and hotly contested by most obstetricians that it's worthless.

DPJ: You voluntarily made a presentation to the Peer Review Board. Was it in hopes of establishing some credibility for Primal therapy?

Warren: I hoped to get continuance of some kind of insurance coverage for people coming here.

DPJ: You got an essentially negative response?

Warren: Yes. For example, they felt people in Primal might regress and become so helpless they couldn't function, and that in a sense we were creating elements that weren't already there.

However, we see what we're doing not as regression but reexperiencing. I couldn't seem to get across to them that a person who is in the therapy session is very regressed, in a sense, and then when the session is over they get up and walk out in the world as an adult.

Sometimes in the past patients, myself included, got the idea that the best way to do this therapy was to sink into some kind of pit and stay there and not continue to live your life. I think that was a mistake. My most effective Primal patient was a person who came in once a week, went very deeply into her feelings, relived a good deal of her early life, and she always felt better after each session. She changed her life around. But she kept functioning the whole time.

There was a problem trying to explain to the Peer Review what they see as regression is not what we see as regression. We see the Primal experience as going back and reliving a given situation with the feelings that surround that situation that you've blocked off. And they see regression as simply going back to an earlier time and staying there, getting stuck back there.

The other things that we've never communicated is what feelings are. Basically, psychiatry has very little understanding of the nature of feelings. Feelings are a normal, healthy way of dealing with stimuli from the outside. They can be a pleasurable response or a painful response. To be free with those responses is really critical, and I don't think most people see that. They don't see the importance of it in the same way we do in Primal.

DPJ: Are you a renegade?

Warren: I like to think I am!

DPJ: You represent yourself very conventionally, but you must not be.

Warren: I am a renegade because there's no question that I don't think the way most doctors do. I don't know if renegade's the right word, but I'm seen as seeking different approaches, and yet within those approaches I'm seen as conservative.

Doing Primal therapy, I was seen by the medical establishment here as on the border of lunacy. And yet in the Primal community I'm seen as very conservative. So I'm caught right in the middle! What I look like depends on which side you are!

DPJ: How would you characterize the patients you see, and have seen? Are they any different from another clinician's practice or the practice you used to have years ago?

Warren: I think a good many of the people who've come here have a great deal more awareness of how crazy the world is, and much more awareness of themselves than most people who come for other reasons.

For example, I've been doing some hypnosis, and most of the people who come to see me for hypnosis come for specific, goal-oriented things like quitting smoking. But it's incredible how little sense and perception they have of themselves. They're very unmotivated people who function in the world with seemingly very little awareness of the kinds of feelings and interactions that go on.

Looking at it from a different standpoint, I think people who come to us are largely very severely damaged people. It's remarkable that we have treated so many people and had so very few hospitalizations. In some ways, the people I saw when I was at the Primal Center were just as damaged as most of the people I saw at Fort Logan.

DPJ: What do you mean by damaged?

Warren: I don't want to get into diagnostic categories, however popular that is at the moment in the medical profession. I see "damaged" as how terrible a childhood was, how their feelings were run over; they may have been abused physically.

Certainly at Fort Logan the patients were very severely damaged. And I think a good many of the people we see are equally damaged. Forty percent of the people we see have had extensive other therapies that really didn't benefit them very much. I think the fact that we've done as much as we have on an out-patient basis is really incredible.

A research program using Primal therapy in an in-patient treatment center with drug addicts was designed and never got off the ground largely due to sabotage by the medical community. I think it's sad, because a person with experience in Primal therapy could make very helpful suggestions about what kind of research would be most valuable.

In most of the infant research, researchers say you can't recall or reexperience your birth or your early childhood. So their experimental models are usually outward-directed, observing how the patient or the child responds to various stimuli. They do very little about trying to do research with what's coming from inside the child.

Somebody who'd been deeply in Primal could design some exciting kinds of research. I think it's too bad that the medical community does not see anything in what we're doing, enough to be able to even ask. That's a chip on my shoulder. I felt really angry about that.

DPJ: In a lot of ways you are ostracized, aren't you?

Warren: Pretty much. I thought I couldn't go to psychiatric meetings because it would be difficult to say I was doing Primal therapy. Then I'd have to deal with their lack of respect for Primal as a valid approach to psychotherapy.

DPJ: It seems so unfortunate. What are they basing their judgment on?

Warren: They're basing their judgment largely on incomplete information about Primal therapy. It's similar to what Freud when through. He developed an approach which recognized the value of looking at sexuality. This is oversimplified obviously, in statement, but he aroused the antagonism of a great number of people just by the fact he was dealing with a subject that was considered taboo in those Victorian times.

I think the same thing is going on now. We're saying in essence, your intrauterine experience, your birth and early childhood are very, very crucial in what happens to you later, and can influence the development of your personality. People don't like to think about that. I think they are as threatened by that as the people in Freud's time were threatened by sexuality. Also, there's been a lot of quackery surrounding Primal therapy that has contributed to Primal's reputation.

Today the whole humanistic movement is in question by the medical profession. just recently I read an article by someone who was discussing the need to go back to the medical model. He was describing the humanistic approaches as, "a bad odor that psychiatry was trying to get over."

So it isn't just Primal therapy; it's anything that approaches it . . . Carl Rogers, Perls - they're looked upon with skepticism without any attempt to get to the fundamental understanding of what they were saying.

DPJ: Could you say why the medical profession takes this position?

Warren: We're in a very conservative time right now. Everybody is retreating. I think that the freedom of the 60's, the questioning everything held sacred, frightened a lot of people. And of course the medical profession has been attacked up one side and down the other - some of it legitimate and some of it crazy. I think their response has been to retreat and go back to a very conservative attitude.

DPJ: What do you think is the future of Primal therapy?

Warren: I keep hoping for better days for all kinds of innovative therapies if we can survive this conservative period we're going through.

DPJ: Have you seen any change in attitude toward accepting Primal theory as a legitimate contribution to the body of knowledge?

Warren: I think it's become worse. I think there's more intolerance of even looking at what Primal is about.

Psychiatry is looking askance at anything that appears more unusual than is practiced in more routine types of therapy. Some of that's good because they really are trying to get firmer scientific foundations for theories. The trouble is, when you're doing something scientific, you've got to have the imagination and the ideas to create a good kind of rigid experimental model. Primal could add a great deal to that. Many of the other innovative therapies could add a great deal to that.

DPJ: The only comment I can make about Primal therapy relative to your practice and ours is that we do good therapy. Slowly we'll gain respect. I'd like to think we have the respect of the people we've made contact with, already.

Warren: Unfortunately, it only takes one or two people who do something eccentric who say, "I've taken Primal therapy," to do a lot of hearsay damage. If you work with somebody for two years and they make an entirely different life - they go off somewhere and you don't hear any more about them.

Maybe the conservative period is necessary to kind of get our balance about things again. But it feels very frightening to me. I'd like to think we can keep Primal therapy as such going as a sort of island reserve of innovation, and save the world later!

Return to The Denver Primal Journal Index