Primal Therapy, Not Primal Scream:
A Profound Experience of Life

By Bonnie Randolph

Although Freudian analysis has held and probably still holds the most respected position in psychiatry, the advent of the psychiatric counter movement seems to be a reaction to some of the tradition qualities of the Freudians, such as: the aloof and uninvolved manner of the analyst, the restrictions of the patient's "role", the confinement to an office environment, and the absolute loyalty to such concepts as the Oedipal complex, castration anxiety, and penis envy, all of which have been challenged in recent years.

Out of the counter movement in psychiatry have arisen therapies such as gestalt, T.A., behavioral modification, bioenergetics, rolfing, psychodrama, feeling therapy (which is not primal), and of course primal; and the other growth-type experiences such as group marathons, nude encounter groups, and est. Professional and public opinions have varied. The new therapies or growth experiences are considered to be anything from innovative to faddish, and at times destructive. Primal is a therapy that has developed out of several of these therapies.

In his book, The Primal Scream, Janov's presentation of neurosis and its treatment was provocative, dramatic, and promising; unfortunately these same qualities so exciting to many people were the very qualities that made it difficult for others to accept. I believe it was a mistake for Janov to emphasize the "scream." The idea of simply screaming to cure something so tragic as a neurosis or a psychosis is ridiculous. It just is not that easy. Thus Primal Scream became for many in the public an absurd joke. For those of us who have experienced the therapy, the term "primal scream" is an insulting misnomer.

Janov was enlightening in that he avoided the numerous categorical diagnoses that other therapies often rely on to an excessive degree; instead he described a very basic theory that, with historic differences, could apply to many kinds of people with many different types of problems. Briefly, his theory was that we are all creatures of need -- the need to group and develop at our own pace, to be held and caressed, to be stimulated, to be kept comfortable, to be fed, and to be allowed to be oneself. Janov considers these needs the "central reality of the infant." An infant has no way of fulfilling these needs himself; when they are not met he is left feeling helpless, frightened, unprotected, and unloved. These feelings, too, become a basis for how the adult perceives himself and the world.

Janov uses need, pain, and tension interchangeably, since unmet needs results in pain and tension. An infant has only certain basic responses to this pain. When the pain becomes too great, one of these protective responses is what is referred to as a "splitting off." When this happens, however, it is not only the pain which is shut off, but other feelings as well; and, most importantly, the individual's total consciousness of himself. Additionally, this splitting off results in the individual harboring the pain throughout his life. The individual becomes unreal because he has had to shut off what is essential to him -- his own self.

One can never have now what one did not get then. But the neurotic struggle is to keep trying. And the result of the struggle is much unhappiness, anxiety, anger, and tension which we see far too often in our patients, ourselves, and in the people with whom we are close.

Physical expression of feelings is necessary because we won't believe that there is a true separation of the mind and body. Feelings are an actual happening in the body -- chemical and hormonal. If this were not so a lie detector test would be useless. When the body experiences any kind of central nervous system impulsive the natural and automatic response of the body is to express this through the neuromuscular system. This involves movement and sound. For example, we have several patients who are asthmatic. When they begin to talk in a session about a situation that is emotionally loaded their asthma often recurs. The patient is encouraged to allow the asthmatic symptoms to happen and to attend to it as much as he can tolerate. As he drops into this body experience, he feels the immense pain of having his supply of oxygen depleted. In time, these patients realize that during the asthmatic attack they are reliving an earlier event when their oxygen actually was momentarily shut off. This horrible physical insult and trauma originated when they were so small, helpless, and fragile that they could do nothing about it. In all cases their primal trauma occurred in the womb. The agony of this moment is expressed with desperate gasping sounds and physical struggle. This type of expression is as natural as when one's finger touches a hot stove. Upon burning a finger the normal reaction is to quickly withdraw the finger and make some kind of exclamation. Unless someone is totally shut down he does not stand still and say nothing when he is physically hurt.

Nevertheless, the physical primal pain that is laid down in the body is repressed and controlled. Children growing up in certain cultures are taught this from the very beginning. Unfortunately, such control induces the feelings to find other means of expression -- as in asthma or anxiety. When the body is allowed full expression of feelings it does not need to utilize neurotic or psychosomatic outlets for its pain.

Probably the most common denominator to all psychiatric problems is anxiety. Anxiety has been described as a feeling of dread or of impending danger; it is usually accompanied by many physical symptoms such as increase in heart rate, sweating, shaking, flushing, pallor, diarrhea, constipation, shortness of breath, confusion, difficulty in concentration, hyperventilation, and many, many others. Lately many psychiatric professionals do not differentiate between fear and anxiety. Freud considered anxiety to be inherent in human beings. He developed his theory of healthy and neurotic defenses assuming that defenses are needed to guard against anxiety and considered some more functional than others. Although he may have asked himself why he thought anxiety must be basic to the human condition, he did not seem to take this question very far.

Primal has advanced the question, Janov's concept of need and pain has evolved and been taken back further to prenatal existence. What we have always considered to be a fairly uneventful state in terms of the effect on one's later life -- the first nine months -- is actually the most significant time in a human being's development, forming the rudimentary structure of his later existence. The womb is thought to be a pleasant and secure place where all of one's needs are taken care of; for many of us this is a myth. Our fetal existence in the womb was barely an existence at all; instead, it was a continuous struggle to stay alive.

At this time in development, needs are exclusively physical -- the need for oxygen, nutrition, fluids, growth, proper temperature, balanced hormonal, endocrine, and enzyme supply, genetic strength, and many others. Without these essentials the fetus would die. However, the fetus can survive under very minimal conditions - those which are extremely depriving and yet not totally void: Hypothetically assume that an embryo needs an environmental temperature in the range of say, 96 degrees F to 102 degrees F and that going to as high as 104 degrees F would bring on his death. Then imagine the embryo's environmental temperature is 103.999999 degrees F. The embryo, because of its own inner strength and instinct for life, manages to hang on and survive - though at most times on the threshold of death and in excruciating pain. What would that embryo be like once grown?

Depending on his strengths and traumas, he would respond to this memory laid down in his nervous system in a way somehow representative of this early feeling. Perhaps he would become a war hero constantly confronting death or a physician attempting to save other lives when it is really his own near-death that terrifies and drives him. Perhaps he would become a reclusive fearful of leaving his home, imagining threats everywhere, or even catatonic, with his body posturing the death-like feelings inside him. Possibly he would struggle with suicide throughout his life like Ernest Hemingway -- a holding a gun in his mouth every morning for years before finally pulling the trigger.

The explanation we have for this is that in the embryo or fetus the lower brain functions and the spinal cord are more developed that the higher brain centers, i.e.., the cerebral cortex. This is adaptive in that the fetus can react to stress and trauma in order to survive. Yet he does not have a fully-developed cerebral cortex and thus cannot know in the adult sense what is happening to him. If the womb environment is extremely depriving and stressful, the fetus can only experience life as dangerous. He has limited reactions to danger -- neuromuscular, autonomic, chemical -- all of them physical and a function of the primitive and lower brain. As he learns to respond to stress in this way it forms the structure of his later life, so that any later stress will evoke these early feelings. In other words, he learns to respond to stress with severe autonomic reactions such as panic or shock. This can revert in an adult to what we call anxiety or depression. If these feelings are not felt, they are acted out. If felt but unconnected and unknown to the individual, they result in a great deal of suffering in life.

Extremely painful circumstances that are a part of prenatal existence and birth are not remembered consciously because, as the cerebral cortex is forming, this part of the brain is capable of repressing and symbolizing the pain recorded in the lower brain. If, in addition, life is painful in childhood, the entire central nervous system becomes overloaded. The cortex does what it can to shut off as much of the pain as possible while still enabling the person to function. People develop the best defenses they are capable of in order to live.

Unfortunately, when a great deal of brain activity is needed for repression or if the nervous system is extremely overloaded with pain, the individual's responses to life situations are both limited and stereotyped. In some, the repressive activity is successful in holding the pain below the level of awareness, but at the cost of deadening their lives. Others, unable to repress the agony within, act out in a more impulsive and bizarre fashion; these we more easily label crazy or psychotic.

Because the nine months prior to birth have always been a mystery to human beings, no one has ever been able to help children or adults with this early derived pain. When a person's birth feelings are triggered as a child, parents do not know what is going on. Our culture is so anti-feeling that children are expected or forced to shut off their feelings; they lose the opportunity to let their feelings out, to connect them, to place them in some kind of perspective within their lives -- and, to add further injury, the child, in feeling the disapproval of his parents begins to feel the same negative reactions to his own pain. This is in effect labeling the very thing that is real and true about the person and his life "bad." Hence we see the adult not only suffering with anxiety, depression, or inappropriate behavior he cannot seem to control, but hating himself because of it. There is then further shutting down of his real self and stronger reinforcement of crazy and defensive behavior.

The motivations people have for going into primal are varied. For some it's a sense of emptiness in their lives; their craziness and the way their pain is expressed is subtle, yet they know there is something wrong. For others, primal offers the first real hope of alleviating their personal agonies. Their pain is close to the surface and life is not merely empty, but unbearable. They are vaguely aware of an inner need to release their pain in a total physical way; yet have not known how. They often state that upon hearing about primal they immediately sensed they had no other choice for their life but to go through the therapy. Whatever the motivation, primal touches something in them which they feel to be true.

Often as therapists we are confronted with patients wanting what primal cannot give, i.e., patients report that what they really want is escape from their pain. After being led on by The Primal Scream they indulge in fantasies that they will end up looking like Elizabeth Taylor, thinking like Einstein, or charming like Robert Redford. These are the same unreal hopes that have kept these people sick and unreal all their lives. All that primal can give anyone is himself and that involves pain. Unfortunately, the last thing many people want is to be themselves; many of our beginning patients, upon realizing this, experience disappointment. Yet for just as many patients their integrity is great, they have held on to the desire of having the self back they lost long ago. The promise of getting that self back is more than they ever could have hoped and is the most important thing they have ever confronted. Some want only a little more from the therapy and leave after a short time. Others want as much of themselves as they can get and stay for years. Most patients, regardless of how much they get out of the therapy, or at what point they leave, find that once they have felt the deep pain of their life, they continue to do so on their own.

Feeling in primal terms involves something much different from what is normally meant in the medical profession by this term. It is a total body release of inner pain. The facilities at the primal center allow for this. All rooms at the center are thickly carpeted and padded. The rooms are empty except for pillows, blankets, and kleenex boxes. The patient lies on the floor, and the therapist sits on the floor behind or beside him. Total physical expression is permitted except for self-inflicted injury or injury to the therapist.

Through primal therapy emphasizes feeling it is not a therapeutic process until what one is feeling is owned and is placed in perspective with one's life. It has to have some meaning to the way one's behavior is manifested and this is done in conjunction with what one is feeling. During a session a patient usually starts out by talking about something that is happening to him. As he talks the therapist waits for an opening, i.e., a time when the patient is close to a feeling and the therapist can intervene to allow him to experience that feeling. Once the patient begins to feel, the therapist sits back and watches. This is important because after the patient comes out of the feeling it is the therapist's task to begin to help him integrate what has happened during the session. She points out various movements his body made, she may ask him why he said or did certain things. Did he know what was going on in his body, etc. She tries to help him tie up what was said in the beginning of the session to what he was into. She also helps him to connect what he has been feeling to his life in the here and now. This takes a great deal of skill and sensitivity and is extremely important in helping the patient to integrate his pain with himself and his life.

We have a number of patients with severe disabilities. We believe they enter primal because they have such an overload of early pain. They are unable to contain much of this pain and therefore in other treatment setting are heavily sedated. The pain also interferes with their ability to interpret reality, and often they are unable to function. Primal offers them a physical release of that pain which they cannot get in other therapies, and for the first time in their lives they are able to give up or reduce the drugs they have been on. Patients who may be seen in other settings as "going crazy", i.e., banging into walls, screaming and throwing things, are allowed to act on those impulses so that they can experience the feelings behind the impulse. This behavior actually doesn't result in more craziness but less.

When we talk about the incredible early pain that patients have had in the womb and at birth, we are talking about the fetus who survived. It seems that when conditions are unbearable for this sensitive organism, and he is on the brink of death, there may be a choice for him: life with pain, or death. Those who died may not have had a choice; we have no way of knowing about them. Those who chose to live despite the pain surely must be recognized for their bravery and courage rather than humiliated as so many are who are labeled with psychiatric diagnoses.

We think this explains why people with a great deal of pain, which expresses itself in bizarre, crazy, or unusual ways, also often have many admirable traits -- the creative artist like Van Gogh, the many sensitive, so-called schizophrenics, and the successful men and women who struggle against incredible odds to achieve, and yet are so full of tension that one wonders how they manage a day's work. They manage because they did so in the uterus under the most grueling conditions. They had the integrity, the will, and the strength to stay alive despite the cost -- a lifetime of suffering.

A lifetime of suffering usually means that the person has known nothing else. The agony of life on the brink during the intrauterine experience becomes imprinted and locked into their nervous system. They cannot see, hear, or perceive without doing so through pain. These people, after a session in which a great deal of pain is felt and connected, experience a greater clarity than before. It may retreat, but even a minute's glance of the world without pain is not only one minute of relief, it is one minute of a glimpse into what their life is really like. What they see is extremely sad, for often they had not had a life at all, they were merely existing day to day. Suddenly they realize this for the first time. Unless a person can experience something different from how he has always lived, he can never know that life does not have to be as he lives it. No amount of intellectual knowledge, no guru, no therapist, and no magic drug can substitute for his own experience.

The closer people come to their feelings and know what they are like, the better able they are to sense what other human beings are like inside. Seeing, hearing, and responding to what is inside other human beings is what we call sensitivity and caring. Being able to give this and accept this from other feeling human beings is for some their first real experience of loving and being loved.

No one has ever known what life in the womb was like, and who would suspect that it would form the basis of an unpleasant existence later? The person with severe psychiatric problems, we have found, has lived through the first nine months suffering a great deal of damage to his body, is born usually in our hospitals today in a violent manner, often has a traumatic childhood to add to his injury, and then the whole experience is denied by him out of his own blinding pain and by others out of theirs. Thus, his real self, damaged and in pain, though brave and trusting, is lost. This horrible loss was from the beginning, one he could do nothing about. It is totally unfair, but for him it is his reality. When someone faces that -- nothing can be more tragic.

Millions of people with severe primal pain act out in bizarre ways and suffer because of it; they have lived and died and never known why they were the way they were. Now, some of these people have chosen a therapy which helps them to return to that self again, this time with the truth. This is what we mean by connectedness. This is why having one piece of that lost self is so precious. And this is why truth for patients in primal therapy is synonymous with pain.

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