LAPP - Arthur Janov - "Book reviews"

The book is the story of Pam who was considered a hopeless case. It describes how dedicated professionals in the fields of psychotherapy and social work went beyond their ‘call of duty’ to make recovery possible. In particular, the first psychotherapist, took a risk in working with Pam who was acting out frequently.

Because it is written in the first person, it is very revealing of the thought processes behind the experiences and the behaviour. It details the process of psychotherapy, together with primal psychotherapy and E.M.D.R. and as such is a good story for trainee psychiatrists, psychotherapists, counsellors, persons in the caring professions, parents, and all who wish to create a better society.

The story also details how it was to be in care in a large institution in the UK from 1950 to1956. It takes the reader through the child’s horrific experience of abuse within the family, her experience of teachers and other professionals, who were blind to what was going on and of a society that really didn’t want to know.

The story details the acting out of a distressed and disturbed teenager and her unsuccessful journey through several psychiatric hospitals and the then famous Henderson hospital, which was to start the recovery process. It also shows how a caring ethos in society in the1970s and caring workers could not only assist in the recovery of Pam but also accept her into Social Work training and managerial positions. This all enabled Pam to break the cycle of abuse and not pass on the maladaptive behaviour to her children. Ultimately she went on to qualify as a psychotherapist

The book gives hope to those with similar stories who have throughout their lives have suffered, disassociated from their experiences and have been written off as beyond help. It reveals the dangers of labelling and the consequent thought-processes which professionals can engage in when disorders are thought to be untreatable. This in turn can prevent any further action other than repeated hospitalisation and drug therapy. The author was diagnosed and labelled with several different conditions over the years, none of which were useful or helpful to her. The current diagnosis would be that Pam was suffering from a dissociative disorder.

The writer is now partially disabled by a back injury the origin of which was the physical abuse that she suffered as a child. Whilst recovering from the second of two major spinal operations, she found herself immobile. She had always wanted to write this book and used this time to do so.

Arthur Janov's 'Biology of Love'
Published by Prometheus Books, 2000

Janov's latest book ,'Biology of Love', illustrates both his strengths and his weaknesses. Although he claims the book is not about academic neurobiology, it is overwhelmingly about this topic, which is his passionate interest. I was eager to read 'Biology of Love', following a lecture I had attended given by Dr. Allan Schore on the neurobiology of emotional development. Thanks to accelerated research into the brain's cognitive, and memorial processes, it is possible to measure certain aspects of the brain's activity and development. What has emerged from this new knowledge is of crucial importance. Emotional deprivation during the first two years of life will change the brain's structure and chemistry in ways that will affect the ability of the infant to cope with stresses and emotions in later life. The brain of a child that is deprived of love is measurably different from the brain of a child that has received loving care. Early trauma is registered neurologically. This has long been Janov's belief and it must be gratifying for him to see that so many of his hypotheses are now proven and gaining acceptance.

There is now no doubt that feelings and thoughts are registered in different areas of the brain. Therefore a therapy that deals solely with ideas will not be sufficient to resolve the underlying traumatic feelings. We cannot of course 'think' ourselves better and we all have experienced knowing that something is 'mad' but not being able to change the feeling. Janov has long argued that the earlier the trauma the more far-reaching the consequences and on-going research would seem to bear this out. His message is very important. Contrary to popular belief, we do 'remember' everything, chemically if not cognitively. This has implications not just for birth and the early years but also for the foetus in the mother's womb. Smoking, drinking, excessive stress have all been shown to be detrimental to the foetus's healthy development. Depression has been linked to lowered dopamine production in the brain and current research has shown that dopamine levels can be affected by stress whilst 'in utero.' It is now clear that looking after yourself emotionally and physically whilst pregnant is essential to the unborn child's future health, both mental and physical.

Janov always writes clearly and he is still the master of the pithy phrase. For example the sentence, 'we usually don't die of overweight……we die from the lack of love that makes us overeat.' There is so much in this book that is important, clearly expressed and now proven scientifically. Janov's major failing is that he overgeneralises from specific examples and thus weakens his argument. If there is one reason why he isn't taken seriously by the scientific or therapeutic community it is that he is so disrespectful of other professionals or those with a different viewpoint. Of homosexuality he writes, 'Homosexuality gets started so early, it seems (my italics) genetic.' Allan Schore, professor of neuro-psychology at UCLA, and frequently mentioned by Janov, believes that we are born with genetic tendencies that the environment will modify. It is possible for both fields of study to yield crucial understanding and knowledge about how and why we develop as we do and claiming an 'either or' situation is increasingly redundant. We know that what happens in the womb will have consequences for us in later life. But even given that our physical and emotional development are affected by these earliest experiences, it is still a huge jump to claim, as Janov does, that homosexuality, mental illness and cancer are a result of early womb life. It is partly because of his tendency to make wildly simplistic claims that he doesn't get the recognition he deserves for his prescient thinking in this area. Since 1970 he has been arguing the need for good ante-natal and birth practices.

The developments in neuro-psychotholgy do require a rethinking of clinical practice and for the psychotherapist these are exciting and interesting times. Janov enters the debate claiming that he is the sole repository of 'cure'. The real weakness of the book is not Janov the neurobiologist but Janov the psychotherapist He cannot resist overinflated claims. He knows that he has had little success in changing a person's sexual orientation and that sadly he also has lost therapists and patients to cancer. Yet he can still write, 'Yes, we can treat cancer successfully.'

The accounts written by patients are interesting but they become repetitive, written in a similar style. With few exceptions they describe 'primals' during one or two sessions. What is missing is any idea of how traumatic experiences are worked through. Much deprivation is cumulative, not overtly dramatic, but dreadfully subtle and painful. The research done in the area of attachment has revealed the importance of the quality of the parent's relationship with their baby. A parent needs to be able to respond with empathy to their baby's distress and joy and an inability to do this is known as 'lack of attunement.' To quote Allan Schore, 'the experiences that fine-tune brain circuitries in critical periods of infancy are embedded in the socioemotional interchanges between the adult brain and a developing brain.' The baby's brain needs a safe, loving and secure environment in order to reach its full potential. Our ability to cope with stress and difficult emotions are laid down very early in life. Children who are able to evoke the desired response from their parents develop a sense of 'effectiveness' and they will approach difficulties later in life with a greater sense of confidence and optimism.

Everybody's story has taken place within the context of a relationship and the resulting unconscious model of relationships will only become apparent when the patient is well known to the therapist. Nowhere does Janov mention the importance of continuity of care or even uses the term 'therapeutic relationship.' If, as he acknowledges, it can take months even years to work through certain issues, surely there is a need to have one therapist to witness and follow the process. In one example he writes that it took a patient nearly a year before the details of her incest became apparent. In such a situation it is crucial that the same therapist follows the patients through the experience. In this book he is dismisses kindness and warmth from therapists as being essentially 'palliative'. Of course, kindness and concern isn't sufficient by itself but I do not know of any therapeutic school of thought that claims that it is. Alan Schore argues that therapy does not succeed without a sense of the empathy and attunement missing in early life and these are crucial in creating the safety needed to experience past sufferings. Janov is so acute in his perception of what safety means to an infant that it is all the more striking that the concept of safety is so missing from his therapeutic model. Regularity of contact, stability, respect are all important features that need to be emphasised. He trivialises the contributions and work of other psychotherapists but in doing so he reveals his ignorance. In one passage he mocks therapists who talk about 'narcissistic' patients. His response is that a patient will become 'narcissistic' if you focus on them during a session. I'm not sure what he does during a session but he is completely trivialising a term that is used clinically to describe a person whose ability to have good relationships is deeply disturbed.

To read the book, one would believe that Janov has all the answers and that all of his patients get well. This simply isn't the case and any therapist that claims this is not telling the truth. One constantly has to think about what each individual requires from you as a therapist. Each person has a unique history and what might useful for one patient will not be suitable for another. An example of this would be 'touch'. Touch could be perceived by one person as an empathic response, and by another as an intrusion. Everyone's story is uncovered individually and to approach the situation as a technician misses the point. In one transcript written by 'Suzanne', Janov writes that most of the 'techniques' of the therapist have been left out although he doesn't explain why. In fact this leaves the account rather flat. Even to use the word 'techniques' implies a scientific objectivity which is bogus. The therapist uses his/her knowledge, experience, understanding and attunement to help a patient. There is so much that Janov could contribute if he would stop being a salesman.

In the final chapter he attacks 'conventional' psychotherapy as addictive and palliative. Yet conventional therapy covers a wide range of different therapies, so what sort of 'conventional' therapy is he talking about? I wrote earlier that these are exciting times for psychotherapists who believe in the importance of early trauma and the powerful role of attachments. The current research is confirming the relevance of their thinking. Pioneers like John Bowlby and Alice Miller are starting to get the recognition they deserve. Janov's work should also be recognised but his refusal to acknowledge the contributions of other psychotherapists or to engage in a genuine dialogue with colleagues has seriously damaged his reputation and limited his contribution. This book, very forcefully, brings that reality home.