The Roots Of Primal Therapy:
A New Abreactive Treatment For Neurosis
Various aspects of this revolutionary abreactive concept include its interesting origins and early development, its methodology, its physiological basis, and its emphasis on traumatic birth.
I. Primal Therapy is a natural phenomenon with many roots in the past.
A. Early origins of abreactive psychotherapies
1. Primitive societies and evil spirits
2. Mesmer and animal magnetism
3. Braid and hypnotism
4. Charcot and three progressive stages of hypnotism
5. Liebeault and Bernheim and suggestion
6. Janet and two stages of consciousness
B. Recent developments beginning with Breuer
1. Breuer and "Anna O"
2. Freud and psychoanalysis
3. Ferenczi and affection
4. Rank and birth trauma
5. Reich and character armor
6. Lowen and bio-energetics
7. Perls and gestalt therapy
8. Janov and the primal scream
II. A Primal is an experience that is facilitated and can be intensified by the therapist.
A. Description of a Primal
B. Techniques that facilitate
III. Janov's theory of the physiological basis for neurosis is the split-brain.
A. Right and left brain
B. Janov's gate theory
C. Psychosomatic illnesses
IV. The traumas of birth and early childhood are the roots of neurosis.
A. Birth traumas
1. Breech presentation
2. Caesarean delivery
3. Premature birth
B. Early childhood traumas
1. Lack of touching
2. Improper feeding
Primal Therapy is part of a new wave of humanistic psychology. It is an intense, short-cut trip toward self-actualization. Primaling helps build better people for a better world.
The breathing is deep and fast, the back tense and arched, the hands clench and strain, the jaws tight and rigid, the whole body fighting to contain "an eerie scream welling up from the depths."1 With this Primal scream, the nature of psychotherapy as it is now known may change. Arthur Janov has developed a new organized approach known as Primal Therapy to effect a relief or "cure" of neurosis. It is based on a natural phenomenon that has been recognized and used sporadically in the past. Briefly, it is an hysterical "letting go" of conscious controls of the body and emotions which opens up the unconscious to awareness. This allows insights to emerge which have a healing value. Various aspects of this revolutionary abreactive concept include its interesting origins and early development, its methodology, its physiological basis, and its emphasis on traumatic birth.
In primitive societies, in order to cure a disturbed individual, the witch doctor exorcised the evil spirits by casting a spell or coercing the ailing one into an hysterical crisis. A strong belief in the magical powers of the medicine man and the faith necessary to put themselves under his control encouraged a primal-type reaction and often effected a cure. Up until the 18th century, these cures were thought to be the results of the very special and mystical powers of certain men of medicine.
In 1779, Franz Anton Mesmer began attracting considerable attention with his theory of animal magnetism. He believed there was a fluid force emanating between himself and iron filings. This force he claimed to transmit to the patients, who were mostly women suffering from hysteria - a disease attributed to a wandering womb but today would be considered a functional nervous disorder bordering on the psychotic.
He would attempt to excite the patient by any means that worked, including touching and body contact. His aim was to bring about a convulsive state called a "crisis." The convulsions and violent behavior often resulted in a cure of their symptoms.
Also, Mesmer magnetized groups of up to thirty people at a time. They would sit in a circle around a large baquet; a table with a trough around the outside in which iron filings were placed. The people held hands and were also connected with a cord around their waists. Then in silence and darkness with their expectations high, Mesmer would direct their attention and awareness to their pains or specific traumas. These conditions are most inducive to hysterical attacks in susceptible people. The pressure of the group encourages participation and there is also a contagious effect. The same factors are present in Primal Therapy groups today.
Authorities discredited Mesmer and his theory of animal magnetism and attributed his patients' cures to some unknown physiological cause. The scientists were forced to admit the "hysterical crises" were genuine and not a sham because of the high degree of organismic involvement. Mesmer retreated in the face of the bad publicity and though denounced as quackery, mesmerism continued to be practiced by a few who really did not understand it.2
Then in England in 1841, James Braid became interested in the phenomenon and named it "hypnotism." He cautiously explored it in a different direction from Mesmer and ingratiated himself with authorities by publicly attacking the mesmerists. He did not see it as a cure-all and believed that the power was in the patient. Also his practice was not limited as Mesmer's had been to mostly female hysterics. Braid discovered that hypnotism could be induced by focusing the eyes on an object. He believed a change took place in the nervous system as a result of psychological prodding.3 He did not aim for the "hysterical crisis" that Mesmer sought to achieve for his patients. So the beginnings of Primal Therapy were discarded for a time.
There is a reasonable explanation for this difference in their attitudes. Mesmer was working in France during a period of great unrest and violence and the violent behavior of patients was not frightening or unacceptable to him. However, Braid was in England at a rather more tranquil time and violent behavior was frowned upon, so patients inclined to "hysterical crises" would be calmed instead of encouraged to go with it.4
In 1875 in Paris, Jean Martin Charcot, accepting hypnosis as a genuine phenomenon, began an intense clinical study. He found a close connection between people diagnosed as hysterics and their ability to go into deep phases of hypnosis. Moreover, he saw their symptoms relieved in the process. He found three main progressive stages in hypnosis: lethargy (drowsiness), catalepsy (rigidity and possible amnesia), and somnambulism (able to obey instructions with no memory afterward).5 Despite his contributions, Charcot was somewhat limited in that he believed only a person with a hysterical make-up could be hypnotized.
Meanwhile in Nancy, France, Ambroise-Auguste Liebeault and Hyppolyte Bernheim founded a clinic and did more work in hypnosis. They believed hypnosis was a passive-receptive state and could be induced in its mild form in nearly everyone. While the patient was in this state, they used suggestion and instilled beliefs which were accepted uncritically. They challenged Charcot linking hypnosis with hysteria and said his stages were the result of suggestions. They have been proven right in that respect.6
Near the end of Charcot's reign in Paris, Pierre Janet came to work with him. He favored the Nancy school of thought pertaining to suggestion but his main concern was the splitting of the personality or lack of normal integration. He was the first to realize the effects of what Freud would later call "repression." He found that when a patient was hypnotized, he could recall forgotten traumas and with appropriate suggestion, the related symptoms would disappear. This work of Janet's was the beginning of the belief in two states of consciousness.7
In the 1880s, Josef Breuer, a Viennese medical practitioner, had a patient named "Anna O." who seemed to be suffering from a nervous disease or "hysteria." Breuer tried hypnotism with her since that was the popular treatment for hysteria at the time. He noticed that Anna's symptoms seemed to disappear if she could experience painful feelings under hypnosis that she could not allow herself to feel when awake. He enlisted Sigmund Freud's help in researching and trying to understand this phenomenon.8
This was the beginning of Freud's research into and development of his theory of psychoanalysis. Most of his insights came between 1885 and 1900 and are generally still accepted as basic and sound. He was the first psychologist to realize the importance of unconscious motivation and the role it plays in directing behavior. This belief in "psychic determinism" led to his work with dreams and free association techniques.9
Freud originally believed in the cathartic method of bringing up repressed feelings and experiencing them through hypnosis. He eventually abandoned that approach for several reasons. He found that some patients resisted hypnosis and others seemed successfully treated but their symptoms were only temporarily relieved. He decided that long-term results were more dependent on the personal relationship between therapist and patient. Perhaps the most important reason was that he found it impossible to accept the conclusion that the more frequently and intensely a person re-experiences early traumatic anxiety the closer he will approach mental health. Then, through his research Freud became intrigued with the processes of the unconscious and developed the use of free association and dream interpretation. He also became convinced there was a sexual basis to neurosis and risked his reputation in pursuit of this concept. Thus Freud veered away from the path toward Primal Therapy and concentrated more on cognitive techniques.
Most of Freud's colleagues followed his lead with some individual differences. Carl Gustav Jung rejected Freud's emphasis on sex and went off in the direction of mysticism and archetypal symbols. Alfred Adler worked on ego theories, inferiorities and compensations. However, there were several who pursued courses that helped build the foundation for the Primal concept.
Sandor Ferenczi believed that infantile trauma and parental unkindness produced neurosis. He felt the therapist should try to neutralize early unhappiness by becoming the loving parent and promoting a tender relationship with the patient. This was in direct contrast to most analysts who tried to be dispassionate, reflecting mirrors. He used an active technique with greater participation, physical closeness, and psychological interaction by the therapist. Ferenczi believed in granting more direct gratification to patients than most professionals thought advisable. He fell out of favor because Freud was afraid of the dangers of indiscreet behavior in his approach.10
Otto Rank put his emphasis on the birth trauma, believing it to be "the ultimate biological basis of the psychical."11 Birth is the rude interruption of intrauterine bliss, being ejected out into a hostile environment, leaving the security of the womb - the original "separation anxiety" situation. Later separations from loved ones can trigger the original trauma.12 Rank built his theory on the conflict starting at birth between fear of life (separation and individuation) and fear of death (union, fusion, dependency). He believed the individual spends the rest of his life trying to achieve a balance between the two fears.13
Wilhelm Reich believed in a common energetic factor behind mind and body, a total psycho-biological functioning. To protect against painful feelings, the body develops tension in the musculature forming "character armor." His therapy involved working on the armor to release neurotic tension and permit the emotional or life energy to flow through the organism. Through the manipulations, the patient would sometimes flash-back and re-experience the original trauma that caused the specific tension.
Reich's therapeutic goal was to soften the patient's body armor and free him to respond in a sexually orgasmic way. This happened when the therapist could liberate the blocked emotional energy. Reich recognized this as a distinct type of energy and named it "orgone energy." He developed a box for the patient to sit in which supposedly concentrated the energetic charge.14 The FDA subsequently condemned his orgone accumulator box as fraudulent. After this the bulk of Reich's work passed on to Alexander Lowen who took a portion and expanded it to become bio-energetics as it is known today.
Stanley Keleman, bio-energetics therapist, defines the characteristics of this therapy:
"Bio-energetics focuses on the movement and form of the human organism. It tries to understand the relationship between emotion and motion, structure and process. We say that a person is a life process, a moving structure, a body in motion. And all emotional or psychological conflicts involve a distortion of body movement. To free the self is to free the body. We do not have bodies, we are our bodies."15
Bio-energetics utilizes some passive stress positions to bring a patient in contact with his body, to increase sensation, and to produce a release of tension through tremor and involuntary movement. These positions deepen the breathing and stimulate the body. Active movements are also used to help a patient become aware of his feelings and express them more.16 These techniques can bring on an emotional release that may become a Primal experience.
Fritz Perls was the founder of Gestalt Therapy although he said he was the re-finder as he believed the forming of gestalts to be a law which is constant and as old as the world itself. Life is basically an infinite number of unfinished situations, incomplete gestalts. When one situation is finished, another comes up and it is the most urgent at the time. According to Perls, "The gestalt formation, the emergence of needs, is a primary biological phenomenon."17 He believed that awareness, by and of itself, can be curative because you become aware of the organismic self-regulation. By relying on the wisdom of the organism and letting it take over without interfering, you can learn to accept yourself as the organism. This acceptance of self provides a firm and necessary foundation for growth. Perls states emphatically:
"Many people dedicate their lives to actualize a concept of what they should be like, rather than to actualize themselves. This difference between self actualizing and self-image actualizing is very important."18
In Gestalt as in other therapies, each new awareness needs time to settle in before the body is ready to accept a new one. Then a need will emerge and demand to be dealt with. The closer the problem is to the surface, the more resistance until the moment when it is experienced fully and then integration is possible. In this process, you may go back in time like peeling the layers of an onion until the underlying trauma is revealed. An abreaction usually occurs and if it is intense, could be a Primal.
Arthur Janov drew from all of these theories and organized a therapeutic approach designed specifically to achieve a healing for neurosis through primaling. "A Primal experience is the reliving of those early life events during which the child turned off his primal needs and pains and developed a personality split and unreal self."19
Primals occur in varying intensities and types. A full Primal is a complete feeling-thought-body experience accompanied by basic feelings such as need, anger, helplessness. The therapeutic value is in the completion of childhood scenes and making connections between these traumas and present-day neurotic symptoms or compulsive behaviors. Experiencing a partial Primal is having pure feelings without accompanying memories, or the reverse, reliving or acting out memories devoid of intense feeling. These are also beneficial as they help to strengthen understanding of behavior. Sometimes the Primal is incomplete because of the strength of the fear involved in feeling it fully. A residual tension and confusion might be left instead of relief. Because of the drive within the organism to complete the gestalt, patients find themselves compelled into working on that particular trauma until it is resolved, and that can take several months if it is powerful enough. There are Primals related to the present where the person allows himself to lose control and be overwhelmed with emotion related to a current situation. Sometimes these will trigger similar feelings from the past and can be connected in a full Primal way. It is important to feel Primal joy as well as Primal pain to help re-own the good parts of one's history and real self and occasionally this will happen in a positive Primal. It might be a rather quiet, happy experience like a reverie, feeling Mommy's love, Daddy's strength, or re-living happy times from childhood. Or it can be an explosive breakthrough to an important realization with relief pouring out in tears and laughter at the same time.20
Primal Therapy is briefer but more intensive than other therapies. The patient begins by moving into a motel where he will remain alone for three weeks. He is not to distract himself with any tension-reducing devices such as television, radio, books, cigarettes, or the telephone. Instead, he will try to stay awake, restrict his food intake, and write in his journal. There will be daily sessions with his therapist usually lasting about two or three hours and a close relationship develops between them encouraging mutual trust. The therapist is emotionally supportive, non-judgmental, non-directive, and non-interpretive. He allows the patient to feel his own needs as they emerge and also to experience his own insights. He discourages any defensive behavior or avoidances.21
[Note from the author in 2003: The intensive is no longer a requirement to be involved in Primal work. Sometimes, a person will come in for a short intensive of two to seven days. This can happen in the beginning of therapy or at any time when there is a need for a more intense focus. Periodic extended groups (20 + hours) are also useful for being able to go deeply into the work.]
There are many methods that lead to a Primal and a good therapist is aware of them and tuned in to his patient so he can facilitate in an appropriate way. The basic posture is lying on one's back in a spread-eagled, wide open, vulnerable position. Breathing deeply and heavily and then allowing sounds to come out and become louder often produces a spontaneous regression into early traumas (Lowen). Rolling one's body back and forth and allowing it to flail about loosens up the body armor and can release feelings (Reich). Physical contact, either positive such as holding close and rocking, or negative such as holding down and wrestling, is very effective (Ferenczi). Massaging of muscular tensions or painful areas helps to focus awareness and may activate connected memories (Reich). Free association verbalizing can bring up painful memories to work with (Freud). Fantasy plays a large part in dream work where the patient roleplays each part of his dream and guided fantasies are also utilized (Perls). The therapist encourages the patient to "sink into the feeling - keep going - let it flow" (Janov). Once the patient has learned to accept and allow his own feelings to surface, the therapist need only be there in a supportive role.
As in most therapies, success is related to the motivation and emotional involvement in the process and also faith in the therapist and the method.22 A supportive group is also helpful. However, Primal Therapy goes beyond those considerations and does in fact have a sound physiological basis.
Research has been done in the last several years on the functions of the two hemispheres of the brain and the connection between them, the corpus callosum. It has been found that in right-handed persons, the left side of the brain is the dominant side and is involved with analytic thinking, especially language and logic. The right hemisphere appears responsible for spatial orientation, artistic talents, body awareness. If a person's brain is surgically split (commissurotomy) through the corpus callosum, he can function fairly normally but body feelings and logical thinking are split in a strange way. Most people can write or draw to some extent with either hand. After this operation, a right-handed person could write (left hemisphere) but not draw well (right hemisphere). With his left hand, he could draw well but write hardly at all.
There also was a phenomenon of a split-brain individual insisting "I am not angry", yet his tone of voice, facial expression and general body language indicate he is furious.23 This same "split" can be observed in a neurotic person whose brain is intact. As Janov states:
"In one sense neurosis can be considered a functional commissurotomy in which the integrating mechanisms of the corpus callosum are impaired. This leads to a key hypothesis: An overload of Primal Pain disrupts the smooth unifying functions within the brain and literally produces a split personality - someone with a non-integrated dual consciousness each part of which acts as an independent entity....The point about the split is that one side of our brain can be feeling something while the other side is thinking something very different. The split person can yell at you and not know why he is doing it, though he will manage to rationalize his acts and put the blame on others."24
Janov believes there is a vertical as well as a horizontal split and possibly a front-back split also in the brain. He says repression is a process of blocking or "gating" in the brain to protect the organism from psychic pain. The Primal method is simply stated as a system of learning to open the gate a little at a time to let out the stored pains and effect a connection between two parts of the brain.25 Feeling deep emotions in a Primal can bring on instant insights and long forgotten memories and connect the present to the past. Gradually as the patient progresses in his therapy, he increases his ability to not only open the gate but to keep it open more and more thereby expanding his consciousness. His mind and body begin to integrate and physical symptoms brought on by the blocking diminish or disappear altogether.
Freud said, "What is repressed exercises a continuous straining in the direction of consciousness, so that the balance has to be kept by means of a steady counterpressure."26 This counterpressure can cause a breakdown in the tissues and organs resulting in somatic illness. Physiological disturbances as a reaction to anxiety and stress include cardiovascular disorders, respiratory ailments, gastro-intestinal complaints, skin problems, sexual inadequacies or deviations, and many others. When the early pains are felt and integrated, the need for repression and subsequent stress on the body is eliminated.
Studies have shown the greater the birth trauma, the greater the amount of later trauma or anxiety.27 The significance of catastrophic early trauma such as a difficult birth is that it becomes a prototype of later behavior. The trauma produces a psychological set that is reinforced by each similar succeeding trauma. For example, a breech presentation can leave a person feeling "everything is all wrong, I am all wrong." If reinforced, this may become a pervasive negative force in his life. Or a caesarean delivery might instill a feeling of inability to initiate action. "People do things to me." A premature birth is an ejection before the baby is ready and may leave him feeling unprepared to face the world and always wanting to go back to a secure place.28
The original elemental state of the newborn is a generalized awareness. He is a receptive, perceptive being and his feeling experiences are registered and recorded in the brain. At birth, one of the most developed sensory areas is the skin. There is a great physiological need to be touched and the child who lacks enough of this stimulation will be a deprived child.29 His emotional responsiveness and ability to show affection will be limited. If this attitude of not touching extends to a prohibition against touching his own body, then he may turn off his body feelings completely. As Janov says:
"Inhibition of nonsexual pleasure at a very early age interferes with the experience of sexual pleasure at a later age so that sexual problems such as frigidity and impotence have their origins in nonsexual events and times."30
Babies need to be fed when they are hungry and not on an arbitrary schedule. Improper feeding can lead to a myriad of problems. The baby may not get enough sucking satisfaction and later becomes addicted to cigarettes or an alcoholic or foodaholic. The mother may not know how to show affection and resort to expressing her love by overfeeding. If this is the only way the child can receive love, then later on food will still be used as a substitute for love. Other traumatic situations during early childhood include illnesses, hospitalization, sexual abuse, loss of a parent, divorce, and rejection by one or both parents. Only by going back and feeling the pain of those early times can the shackles that bind body and mind be loosened and eventually thrown off completely.
Primal Therapy is part of a new wave of humanistic psychology. People gradually are giving up their inhibitions, accepting strong feelings in themselves and others, becoming more sophisticated about mental health, and learning to integrate their own insights and connections. Therapists, who are not bound to traditional standards, are losing their fears and are allowing their patients to let down their controls and go with the feelings. A Primal can happen in any type of therapy if it is allowed and encouraged. The Primal phenomenon is spreading and will continue to grow because it is "now." It is an intense, short-cut trip toward self-actualization. Primaling helps build better people for a better world.