Checking The Science

 

It’s important to always check data and sources, it is amazing how we all assume somebody has checked, and nobody actually ends up checking! 

 

Efforts to track down scientific papers on primal therapy have been frustrating.  It is like running around in circles.  Years ago I was told I could find lots of experiments done by Janov in cooperation with UCLA, so I went to UCLA to try and find them, and even got a librarian to help me, and I didn’t find any data.  There was no scientific papers, no raw data and no exact method. All I am left with is Janov’s interpretation of some in-house studies in his books, where the participants and researchers usually turn out to be primal patients and/or primal trainees/therapists. What I did find is an article called “Toward a New Consciousness,” which is not the kind of thing I was looking for, and one old paper not related to primal therapy, co-wrote by Janov in the fifties (if I remember correctly) that the librarian couldn’t track down because it had been moved into a storage building (maybe that was a masters thesis). 

 

However, it has occurred to me that the ‘experiments’ that I as told about were actually nothing more than strapping a primal patient to vital sign apparatus and describing with primal theory why the vital signs go so high when the patient screams or holds there breath in a “birth” primal.  And saying things like “wow, that heart rate went really high, that proves that….and is the first in the annuls of medicine that…etc, etc.”

 

I have all the books that Janov has written, and am unsatisfied with the studies he describes in them, I thought I might find more scientific papers in The Journal of Primal Therapy (published in the 1970s, edited by Dr Janov).  But there again the so called scientific papers were often opinion pieces (with no good data in my opinion) sometimes written by scientists who were either temporarily or permanently swayed by the new way of discovering the truth through one’s intuition. 

 

In one article, in Volume II, number 2, fall 1974, called “Primal Therapy and Woman’s role” the anthropologist Bernard Campbell (perhaps a temporary convert of primal therapy, it seems he went on to do better work later) says:  ”If a woman finds herself pregnant without a helpmate or any means of support, she should surely get an abortion immediately.” 

 

This type of opinion piece is what you find very often when you try to track down the science behind primal, it seems to consist of ascertains of intuition from former scientists who abandoned science to join the group. 

 

Even when there is data in some studies, the way that it is done is so unscientific one really has to question whether these people remembered their first year introductory scientific methods course in college.  It is flawed in that it usually is measuring something unrelated to mental health (e.g. vital signs) and flawed also because whatever the outcome, it would be interpreted as success. 

 

For example, if the vital signs go down you could say “see - the therapy lowers vital signs and calms the system due to a reduced pain load”.  If vital signs stay the same you could say “see - the therapy does not depress the patient, or make them more anxious, unlike some other therapies.  the stability of the vital signs tells us we are doing something right, the pain is being removed and not merely released into the system where it would usually cause havoc with the vital signs”.  If the vital signs went up, you could say ” see - the therapy succeeds increasing the energy level of patients, which beforehand was being taken up in the suppression of pain.  the increase in vitals we have seen to correlate with the lifting of depression.  in fact, since our patients on average come into therapy more depressed than a non-psychiatric control group, the increase of vital signs can be considered a normalization of function following the extraction of pain.  Without the proper extraction of pain, you would predict the vital signs to stay low in depressed people”.   So my point is, any outcome can be explained, which shows a lack of falsifiability, but it also indicates poor science that searches for confirmation only.  

 

But let us turn our focus to a study that at first glance seems more valid, and actually has some data and some nice pictures of brain maps:

 

THE EEG brain map studies (1995)

 

This study was shown in the book “Why You Get Sick, and How You Get Well” by Dr A. Janov in 1999. 

 

In The Biology of Love by Dr Arthur Janov (2000) still is hailing this study, (as he does in almost every new book he writes or interview he gives, often misleadingly calling them brain scans rather than EEG maps) Janov writes on page 20:

 

“In our research with Drs. Erik Hoffman and Leonid Golgstein of Rutgers University, we found a normalization and a more even balance between the two hemispheres after one year of Primal Therapy.”

 

and

 

“The brain is more harmonious. What seems to happen with imprinted pain is that an asymmetry between the halves occurs that may be due to differential pressure from lower levels.  The pressure seems to be higher on the right side.  Therapy helps restore symmetry.”

 

Commentary on this:

There are several problems with Janov using this study as confirmation of his therapy, not the least of which is Dr Erik Hoffman’s own words:  

 

 Dr Hoffman’s email received 9 June 2007:

 Hi [researchers name],

 Primal Therapy is not a miracle therapy. It has its merits but also its 

 shortcomings. When you start digging into the past you find that it is a 

 bottomless pit. Eckhardt Tolle says ‘You cannot find yourself by going into

 the past. You find yourself by coming into the present (Power of Now, p. 

 75).

 I am writing a book now in which I also discuss Primal Therapy. It will be

 announced on our website www.newbrainnewworld.com when it is

 published.

 Good luck with your article.

 Erik Hoffmann

 

 

Now I should make it clear that Dr Hoffman may or may not agree with everything in this section. The point is both myself and Dr Hoffman do not conclude from the study that primal therapy is necessarily the best treatment method. 

Similarly I have not researched the book he mentioned, and do not advocate for any clinical treatment except for to say I recommend a treatment with good clinical evidence for it’s effectiveness (Barlow’s Abnormal Psychology (2004 or later editions) is the most evidence based and reliable source I have come across so far, but also check out Science and Pseudoscience in Clinical Psychology by Lilienfeld, Lynn, Lohr) .

 

However, this is not the only problem with the EEG lateralization study. In John PJ Pinel’s college textbook Biopsychology, 5th edition (2002) ISBN 0205349846, Pinel writes on page 416:

 

“Before I introduce you to some of the differences between left and right hemispheres, I need to clear up a common misconception:  For many functions, there are no differences between the hemispheres; and when functional differences do exist, these tend to be slight biases in favor of one hemisphere or the other - not absolute differences (see Brown and Kosslyn, 1993).  Disregarding these facts, the popular media inevitably portray left-right cerebral differences as absolute.  As a result, it is widely believed that various abilities reside exclusively in one hemisphere or the other.  For example, it is widely believed that the left hemisphere has exclusive control over language and the right hemisphere has exclusive control over emotion and creativity.  The most disturbing thing about this misrepresentation is that educational programs are sometimes inspired by it.

Language is the most lateralized of all cognitive abilities.  Yet, even in this extreme case, lateralization is far from complete.” Biopsychology (p.416)

 

Pinel then gives three evidences, including a dichotic listening test that gives the language difference as 55% left brain (right ear), 45% right brain (left ear).  Michael Gazzaniga’s work in 1997 and 1998 is also discussed to illustrate this point.

 

But there are still more problems with Janov’s EEG study.  Firstly, I would like to see replication of a better designed study by people with no financial stake in the results.  Secondly,  primal therapy is more than a treatment, it is also a way of life and a cause, where patients are often persuaded or inspired to make enormous changes in their lives. If they are studying a complex subject, or doing a demanding job, they are often encouraged to give those up to do therapy, so as to “get out of your head.”  In the initial three weeks patients have to give up most activities to focus on feelings. If they do return to work, the social norm that they may hear in the primal community maybe be 30 hours per week or less. Under these conditions, you might expect for there to be a change in lateralization, but it doesn’t follow that feeling primals is the cause of that, or that feeling Pain is the active ingredient in curing neurosis or any other disease.  Simply using less words will probably change lateralization, but it hardly means it shows increased mental health. And that lateralization may not be permanent, when they eventually go back to a professional job, or go back to college, that lateralization may return to what it was before (which is neither good or bad).

 

The taking of EEG’s and interpreting with an unfalsifiable theory is not science, despite the scientific equipment.  Because it looks like there was no random assignment and therefore no experiment, it is considered case study type evidence, despite the scientific equipment.

 

It is easy to lose track of what the EEG study is actually trying to show, a change in lateralization in the brain, it is NOT showing any positive therapeutic effects. EEG’s are a coarse measuring tool (they measure electrical signals on the scalp, the sensors do not measure the brain directly), and there were severe confounding variables in the studies, not least of which is confirmation bias and the cult-like suggestions on a change in lifestyle (dropping out often to some degree) that comes which entering primal therapy. No outside replication was done and it seems the study did not pass peer review standards (it did not appear in any peer reviewed journal as far as I can find) .

 

Psychotherapy and Imipramine Binding to Blood Platelets, Brain Research Group, Open University, Milton Keynes, England. Rose, Steven, Sean Murphy.

 

This study I could not find on the databases for peer reviewed journals, or any journal (I used college science databases and online searches). 

In checking sources for this study I emailed professor Steven Rose, and received a brief reply on July 10th 2007.  I have included the original email to place his reply in some context:

>:

Hello Professor Steven Rose
   ref: psychotherapy and imipramine binding to blood platelets, open university,
   as quoted in The New Primal Scream, p254
 
I am checking sources for an article I am writing about the scientific basis for Dr Janov’s primal therapy.
In particular, what is your reading of your results of your study with Dr Arthur Janov, do you agree with his presentation of the study.
he says “we found primal therapy brought about the changes we anticipated in imipramine binding. after six months of therapy, the primal patients, who had begun with much lower imipramine binding than the controls, moved up to parity with these controls” (p. 255) The New Primal Scream
 

And do you recommend primal therapy, if not why not?
 
Many thanks,
[researchers name]

 

                                           ———-

 

Professor Steven Rose’s reply, July 10 2007:

 

“No I do not recommend primal therapy, and would not necessarily endorse Janov’s interpretation of the results.”

 

——

 

I must add that one of the problems I have about this study is that I can’t find it anywhere!  So it makes it difficult to check how it was done, what controls were done, and comment on what would be happening with this study.

 

However I can say this about it.  The post primal patients had a measure of immune health LESS THAN the control group of university students at the end of the study. It seems that although the treatment group did move up closer to the control group, this is what you would expect simply due to regression-to-mean effects (that require no active ingredient or treatment, it just happens),  Yet in the primal books the suggestion is that post primal people may have health that is above average.  Other explanations could include spontaneous remission, social influence or placebo effects. This illustrates how important it is to have more comparison treatment groups and control groups.

——-

 

 

 

http://www.amazon.co.uk/dp/0140237003/

These are Steven Rose’s comments about Janov [page 55 in the UK
paperback edition]:

 

“A few years ago I was approached by Art Janov, the founder of a form of psychotherapy known as Primal Screaming. Janov was convinced of the validity of the theory on which his therapeutic method, a form of ‘rebirthing’, was based, and was further convinced that depressed clients who underwent his therapy should show biochemical and immunological changes which indicated that they were improving. Could I test this idea? I agreed to make measurements on blood samples taken from clients both before and up to a year after they went through their screaming therapy. One of the measures I chose was of the quantity of receptor molecules for the neurotransmitter serotonin present on the surface membranes of a particular class of blood cells (platelets). These are the receptors which are the target for the class of drugs known as selective serotonin re-uptake inhibitors (SSRIs); Prozac is one of the best known examples.

As Janov had hoped, it turned out that before therapy, the quantity of these particular receptors in his client’s platelets was considerably below normal. Within six months of therapy, clients’ depression had lifted, and the biochemical and immunological measures I was making approached the average for ‘normal’ non-depressed people of the same age and sex. Janov was (and I believe still is, for he has cited this finding in books he has subsequently written) convinced that this proved his therapeutic theory to be valid. But while there is a weak correlation between the biochemical measures I was making and standard psychiatric rating scales for depression, there is no way of knowing whether (a) his clients would have recovered even without therapy, or more importantly, (b) whether the therapy Janov offers works because his theory about it is correct, or because he is a charismatic figure whose clients recover because they believe that they will get better if they scream appropriately. Indeed, I obtained similar biochemical results when, a couple of years later, I did a similar study with depressed clients going through other, less dramatic forms of psychotherapy, so I suspect that in such cases the therapist matters more than the therapeutic theory.²⁴ The therapies thus meet the criterion that they ‘work’, inasmuch as clients going through them show behavioural and biochemical changes in accordance with prediction. However, these changes apparently occur irrespective of the therapeutic theories on which the treatments are based.”

Chapter note #24 is a reference to a student Thesis:
Willis, Sarah (1992) ‘The influence of psychotherapy and depression on platelet imipramine and paroxetine binding’, Thesis, Open University.

 

[The preceding quote was researched by D.  Many thanks for the time and work on that.  See also D's website here: http://pillsworld.blogspot.com  ]

 

So at the beginning of therapy the primal therapy participants had lowered imipramine binding - why?  

What about the possible iatrogenic effects of the primal therapy literature, including before or at the beginning of therapy of:

1 an induction of a feeling of social non-acceptance by the in-group (”unreal” outgroup vs a “real” in-group),

2 the isolation and deprivation of sleep or entertainment demanded in initial stages, 

3 and a persuasion that they are sick.

The subsequent therapy could have involved acceptance by the in group, a removal of isolation requirements, and a declaration that they are no longer sick and now cured.  These kinds of social influences could also account for an initial depression of imipramine binding followed by a recovery.

Dr Janov claimed to have done some scientific experiments.  However, I never observed, or heard of, a single scientific experiment in more than five years at the primal center. 

 

Measuring blood pressure and interpreting it with primal theory after the fact is not what constitutes science. The studies in his previous books are unsatisfactory scientifically, and enthusiasm for primal therapy seems to wane in some or all of those scientists who Dr Janov hired to do the studies. For example Dr Michael Holden who co-wrote one or two primal books with Janov, apparently went on to value Christianity more than primal therapy (see website: http://www.primal-page.com/holden.htm). Professor Steven Rose of the Open University (see above), who Janov hired to measure blood antibodies, seemed unhappy with Janov’s presentation of his results, Dr Erik Hoffman (see above), who worked on brain EEG maps, seems not to advocate for primal therapy.

 

There is no criticism of any of the names given here, only a critique on the scientific basis of the treatment primal therapy.

In addition, two of the researchers who wrote a research study  in Dr Janov’s 1971 book The Anatomy of Mental Illness, (pages 198 to 210) (which was portrayed as scientific experimentation which I think is misleading)  turned out to be primal patients themselves- a fact which was not revealed at the time. They went on to participate in the 1970s as senior therapists in the “Center for Feeling Therapy”, and lost their licenses as a result of abusive cult-like practices and law cases against them (see the books Insane Therapy Ayella, and Therapy Gone Mad, Mithers). 

---

 

 

David Goodman of the Newport Neuroscience Center’s endorsement of Primal Therapy

(as presented on www.primaltherapy.com home page)

 

An online search of the Newport Neuroscience Center, (that the endorser of primal therapy David Goodman is said to direct) does not yield any information on it.

However, we have found an article about David Goodman, check out the link:

http://www.nctimes.com/articles/2004/11/27/news/community/19_36_4111_26_04.txt

 

In this article it says that:

 

“Goodman has kept detailed records of his dreams for more than 25 years and has identified cycles in their themes. In the modest converted trailer he calls home, Goodman has stacks of hundreds of spiral-bound notebooks with records of his last 22,000 dreams. He’s trained himself to wake up three to five times per night and to record the exact time.”

 

And:

 

“To isolate himself from effects that would disturb his dream cycles, he resolved to live alone, without an alarm clock and without changing time zones.
‘I proceeded to live on a shoestring for the next 20 years,’ he said.”

 

North Country Times, Nov 26 2004, written by staff writer Quinn Eastman. <www.nctimes.com>