In short, Why You Get Sick. . . is a slick makeover of Janov's (1991) last book, The New Primal Scream. Beyond its lovely cover art (The Dance by Henri Matisse), two of the three main sections ("How We Get Sick" and "How We Get Well" -- sound familiar?) were simply rewritten, and twelve of the twenty-six client-testimonials were merely recycled. Janov's thesis? Pain and repression cause disease, and primal therapy restarts natural healing mechanisms.
So why this new edition? Brain maps.
"Brain maps," trumpets Janov (1996), "are one of the most important tools for understanding personality and psychopathology and for measuring progress in psychotherapy" (p. 255). And with this announcement we begin the three appendices which contain virtually everything new and of interest in this volume.
Four brainwave (EEG) studies--conducted at UCLA, Copenhagen University, Rutgers, and the Primal Institute--contributed to the creation of brain maps. With brain maps, Janov claims that he and his associates are able to objectively detect prepsychosis and ascertain suicide potential; diagnose a patient's level of consciousness; proffer a prognosis; and establish whether and which prescription medications are indicated.
So what exactly are brain maps? Brain maps are color print-outs of brainwave activity, with three color scales graphically displaying amplitudes and frequencies. Each brain map contains seven ovals, each of which represents the shape of the human head as you look down on it; a protuberance at the top of a brain map indicates the nose position. Also included is the absolute distribution of power ("the sum of the square of the voltage in each frequency band") within five major frequency bands (delta, theta, alpha, beta-1, and beta-2).
Beyond this, however, the descriptions offered are none too clear. "Appendix A: Mapping the Brain -- Diagnosing and Predicting the Course of Therapy" offers dogma and speculation; research findings are presented illogically and in pieces; and the actual scientific procedures are never presented at all. "Appendix B: The Limbic System" (which begins the glossy portion of the book) presents eight cross-sections (Figures 3-10) of the brain that are more colorful but still reminiscent of those in The Anatomy of Mental Illness (Janov, 1971, Figures 1-7, pp. 85-91). Appendix C presents figures and legends of six types of brain maps (normal, low-frequency alpha; repressed, "flat" EEG; borderline, "split-frequency" pattern; first-line, slow-wave intrusion; overload; and "open access" hypersynchrony), legends and figures of brain map changes in EEG following primal therapy, and a graph of frequency changes after primal therapy. No explanation is offered on how or why these six brain maps were selected as representatives of this new typology, nor is there any discussion of how Janov's EEG-brain maps relate to modern brain imaging technologies such as computerized tomography, positron emission tomography, magnetic resonance imaging, single-photon emission computerized tomography, or the superconducting quantum interference device.
Electroencephalography, or EEG analysis, was developed by Hans Berger in the 1930's and is one of several techniques available for recording the brain's electrical activity. It consists of sampling the electrical activity of the cortex through electrodes attached to the surface of the scalp, and allows investigators to make gross determinations of brain activity without actually cutting into the skull (Kalat, 1988, p. 110). The electrical fluctuations are recorded by the electrodes and amplified, and drive electromagnetic pens to produce a written record of neural activity.
EEGs can reflect alertness, hemispheric asymmetry, and levels of arousal or sleep (Buchsbaum & Gershon, 1980, p. 147). They are a valuable tool for monitoring the depth of anesthesia and for diagnosing epilepsy and brain damage. Differential recordings and sophisticated averaging procedures can be used to localize areas that generate abnormal EEG activity (Kolb & Whishaw, 1990, p. 56). Attempts have even been made by cognitive neuroscientists to draw inferences between EEGs and various psychological processes, as when readers encounter sentences with an unexpected word or unusual grammatical construction (Zimbardo & Gerrig, 1996, p. 47; p. 393).
But interpreting the brain's electrical activity is problematic. Decisions about whether an electrical event is normal or abnormal are fairly easy to make, but interpreting the significance of normal electrical activity is difficult. Just how difficult? It is almost imposible to tell species apart by examing EEG activity (Kolb & Whishaw, 1990, p. 82). While it can be used as a crude index of the brain's level of excitation (p. 52), EEG analysis is only a very crude measure of the underlying brain activity (p. 119).
Given all this, how can Janov make such pointed assertions about the po er of EEG-brain maps?
THE CREDIBILITY PROBLEM(S)
It is during his discussion of "real-time" brain mapping that Janov (1996) makes a serious disclosure. He notes that "computer software is just now being perfected in Denmark to allow us to measure the brain during a session," that he had been recording "false information," and that "now we are just beginning to . . . obtain accurate readings" (p. 265). So what are we to make of Janov's confession that he is just now beginning to obtain accurate findings? He explains that muscle movement ("artifact") has previously interfered with the brainwave readings and given false information and, moreover, seems to be hinting ipso facto that the findings from all previous brainwave studies during primals sessions are inaccurate. If so, this would seem to invalidate many of the previous EEG research findings on primal therapy--including not only "real-time" brain mapping but also basic research on the physiology of primals (Holden, 1976) and the quantitative pain resolution index (Holden, 1977).
Janov also claims he is starting to do a pilot study of "real-time brain mapping" in which selected patients are monitored by a video camera during therapy. Software is said to allow a split computer screen displaying eight channels of brainwave signals on one side and three colored brain maps on the other showing the distribution of alpha, beta and theta activ ity; four to sixteen brain maps per second are produced. Janov promises to analyze these materials, looking for correlations between EEG data and behavior during sessions (pp. 265-6). But when this pilot is completed, what will he have? Correlations between thousands of brain maps, on the one hand, and observations and reports of primal session-behaviors on the other. And how can this be scientifically interepreted? Inferences will have to be made from tangibles (brain maps and behaviors) to intangibles (such as feelings and pains). It will then be, as they say, a matter of interpretation. And as Janov's own assistant David Lassoff freely admits, "it is surely true that no one can really interpret a brain map" (Lassoff, October, 1994).
Janov has also reported--in a single paragraph!--that he has completed a two-year follow-up of fourteen patients (p. 267). But how can one complete a follow-up study even before completing the pilot on which it is based? Perhaps it is no wonder Vivian Janov (October, 1994), co-founder of primal therapy, has publicly announced that she is skeptical of some of her ex-husband's research. Even the journalist Carol Lynn Mithers (August, 1994) has rightly scolded Janov and his associates for their failings.
"Janov may well be onto something. The fact that some primal patients show changed EEG readings is very interesting, and I assume he plans to submit articles on these findings to peer-reviewed scientific journals. However, Janov and his followers do not simply say they've discovered eeg [sic] changes; they make a wholly unjustified leap of logic to claim those changes have specific meanings--for instance, that certain brain-wave pat terns indicate whether or not a subject is repressing pain. Lassoff's letter is a case in point: primal therapy changes electrical activity in the brain, he says, ergo it 'normalizes brain function.' This is exactly the kind of exaggeration that gives primal therapy its credibility problems" (Mithers, October, 1994).
Why You Get Sick. . . summarizes Janov's earlier work; presents many valuable ideas on the subject of depth psychotherapy; and offers a provocative vision of how the process and outcome research on psychotherapy might be improved. Primal theory has been influential as a philosophy and a world view, and primal therapy has succeeded in helping many people all around the world.
But Janov (1996) has attempted to establish a new science (p. 253). In the process, he has extrapolated far beyond the established facts and made numerous unsubstantiated claims. While speculation is acceptable in the early phase of research known as the context of discovery, it is quite unacceptable in the later phase known as the context of justification. Real scientists remain skeptical and disciplined, but Janov has conducted "scientific research" his own way. From a strictly scientific standpoint, then, we are prevented from embracing Janov's results as rigorous science. When it comes to real science, Janov's work has been decidedly unreal.
Holden, E. Michael. (1976). Primals versus non-primals. Journal of Primal Therapy, 3, 50-62.
Holden, E. Michael (1977). A quantitative index of pain resolution in primals with discussion of probable relevant biologic mechanisms. Journal of Primal Therapy, 4, 37-52.
Janov, Arthur. (1997a). Grand delusions: Psychotherapies without feelings. West Hollywood: Dove.
Janov, Arthur. (1997b). Prisoners of belief: Booga booga and the return of the mystics and magicians. West Hollywood: Dove.
Janov, Arthur. (1997c). Sex and suicide: We make love and die like we w ere born. West Hollywood: Dove.
Janov, Arthur. (1996). Why you get sick and how you get well: The healing power of feelings. West Hollywood: Dove.
Janov, Arthur. (1991). The new primal scream. Wilmington, DE: Enterprise Publishing.
Janov, Arthur. (1971). The anatomy of mental illness. New York: Putnam
Janov, Vivian. . Letter to the editor. Buzz Magazine.
Kalat, James W. (1988). Biological psychology (3rd ed.). Belmont, CA: Wadsworth.
Kolb, Bryan, & Whishaw, Ian Q. (1990). Fundamentals of human neuropsychology (3rd ed.). New York: Freeman and Company.
Lassoff, David. (October, 1994). Letter to the editor. Buzz Magazine.
Mithers, Carol Lynn. (October, 1994). Letter to the editor. Buzz Magazine.
Mithers, Carol Lynn. (August, 1994). Silent scream. Buzz Magazine. 70-73, 102-103.
Zimbardo, Philip G., & Garrig, Richard J. (1996). Psychology and life (14th ed.). New York: HarperCollins.