Potential Dangers of Using Primal Theory to make Decisions about Medication or Self Medication.

 

Note that the following is a discussion of potential and hypothetical problems, and it is not suggesting that these problems actually occur in any primal institution.

 

Is it possible that if primal theory is an inaccurate, untestable or untested model of the mind, it may be dangerous to base decisions on medications upon it?  Modern psychiatric medications come to market after they show safety and effectiveness to treat a specific disorder meeting criteria in DSM IV (Diagnostic and Statistical Manual of Mental Disorders).  The DSM IV is important because it makes sure all people are talking about the same thing when they say “depression” or “anxiety” or whatever.   This allows for better and more consistent drug development and better therapy treatments for sufferers.

 

The safety issue is balanced with the severity of the disorder, for example a drug to treat cancer will be allowed to have more side affects than a drug that treats acne.  Similarly, an antipsychotic medication’s side effects may be given more leeway than say a drug to treat mild anxiety.

 

If primal theory says that antipsychotics, selective serotonin reuptake inhibitors (SSRI’s), Lithium (, etc) all do the same thing: “kill pain” or “block first-line (birth) pain”, isn’t there the danger that people will think they can be used interchangeably with all mental disorders? 

 

According to primal theory, most disorders involve some degree of “birth pain”.  Psychosis is considered to be an overload of birth pain, and therefore antipsychotics are thought to “block first line pain” (first line means birth pain basically).  Can you already spot the danger in this?  So potentially, the primal theorists might think that antipsychotics may work on someone with mild anxiety, because anxiety also comes from birth pain.  Why not, they may say, block the birth pain so that the person can feel more recent pains?  Hypothetically, isn’t it possible that pressure may be put on the psychiatrist to prescribe a drug  to somebody just for the purposes of achieving access to feelings in therapy?  This actually may not be happening in practice, it’s worth asking the question, and it is worth looking at the statistical evidence of the crossover efficacy of drugs, rather than using a primal theoretical model.

 

Keep in mind that when scientists develop these drugs, they do not use the same model of mind as primal theory, it is more evidence based and statistical, atheoretical (which is a good thing in a way) or using the biopsychosocial model.  To these scientists, if an antipsychotic is to be prescribed to a non-psychotic, it would only be prudent to do so if that has been tested to be effective on that disorder too.  This argument applies to other classes of drugs too, I’m just using antipsychotics as an example.  However it should be pointed out that some medications are effective for more than one disorder, but this evaluation must be done on the statistical evidence, and by a psychiatrist (who is not pressured or advised by any theorist).  Decisions like this should not come out of any untestable or untested theory, and medications should not be prescribed to enhance a feeling experience, that is getting close to recreational use.  I’m not saying that happens, I just worry about it happening in the future, hypothetically. Medications are for the treatment of diseases that meet the criteria for psychological problems laid out in the DSM IV.  If criteria is not met, in my own opinion, it doesn’t make sense to risk the side effects.  These medications were developed to show efficacy in those who met the criteria in DSM IV.  The reason they pass testing, despite the side effects, is because those real disorders are so distressing to the individuals who have them.

 

 

The approach Janov has toward medication is touched upon at in this excerpt from his book, Primal Healing (2007), page 171: “Medication is used to permit access [to feelings], not to prevent it…We use tranquilizers such as Prozac and Zoloft (the serotonin elevators) to soften the pain so that some of it can be felt.”

 

 

Potential Dangers of Self Medication of the Amateur Primal Theorist.

 

Again, this is hypothetical, and I realize some primal theorists would not make these potential mistakes, but in my experience some did not know these things. 

Basic primal theory is a very simple and intuitive model of mind (although it can get very complicated in order to plug some holes in it). Pain explains everything in the realm of mental illness. It is seductive in its basic simplicity, some people believe it is all they need to know, and the rest they can just go with their gut or intuition.  I believe it is an inaccurate model and that poses dangers.

 

According to primal theory prescription medications, tobacco, alcohol, heroin, ecstasy, morphine, anesthetic, chocolate, coffee (etc) are all thought to kill pain in one way or another.  So a beginner may think a little alcohol may do the same thing as Prozac right?  DEAD WRONG. All these things do very different things, and it is dangerous to explain it with a model of pain and pain suppression, because I think it fits the evidence so badly.  Pain is not the best way to understand these things, and all these substances do specific and different things, and some are toxic and carcinogenic.  There are great potential dangers in mixing drugs too, adding one “pain killing” drug to another does may not produce more pain killing ability, it can be disastrous.  (to be fair the better primal therapists are likely to agree with the last point, but maybe beginners don’t always realize this).

 

Theoretically, amateur primal theorists may avoid the scientific literature and the help of conventional psychologists and psychiatrists and self medicate.   Primal therapists do not recommend this, but does Dr Janov’s writing inadvertently contribute to this? I don’t know to be fair, but in my opinion his book “Grand Delusions” in an authoritarian way criticizes, ridicules and labels some quite effective treatments.  (see section on Authoritarianism and how amazingly effective ridicule and distain are as social forces, they can override the statistical data).

 

Also consider, is it possible that in some rare cases maybe they need no medication, but primal theory leads them to believe they have overwhelming pain, or is iatrogenic? I don’t know, its worth asking the question. 

I am just a student, but I do want to ask the questions and try to warn about using an untestable or untested theory in general.  I also want to try to reduce some of the paranoia that I think may be created by Janov’s books towards psychological science literature.  I would trust university psychological scientists more than primal therapists, especially if they are evidence based.  Most these days seem not to be Freudian, old style behavioral, Jungian, primal, or anything. 

 

If you have a psychiatrist that is assigned to you by a primal therapy institution, it may be worth asking an independent psychiatrist (non-primal) about whether you really meet criteria for any disorder in the DSM IV. Or are your problems relatively normal (or caused by the primal belief system) and you can save money on psychologists and psychiatrists? 

 

Be aware too of the “medical student disease”, the common tendency of people to incorrectly self diagnose themselves with a disorder after reading about the criteria in a textbook or manual.  Psychological traits and mood are a continuum, everybody feels sad, desperate, anxious, mistrusting or grandiose to certain degrees at different times.  It is only when it is the extreme, where it causes severe distress and severe disruption to life that it is called a disorder. 

 

Medications are tested to work on those disorders, they should not be used for cosmetic reasons (cosmetic here means enhancement physically or mentally) due to the side effects and unknown variables.

 

Please be aware that I think learning primal theory and then believing you know all you need to know may lead to problems.  Don’t let primal’s attack on the “intellectual” or “cognitive” put you in danger.  Feelings are great, but not taking your own learning to the next level on this subject may leave you vulnerable.