Diagnóstico y áreas de oportunidad de mejoras del REPDA

We have seen how the system will return again and again to the prototype, which most typically is one of either aggressive striving or easily giving up in the face of life’s challenges; how those who are detached emotionally from others begin with detachment from themselves; and how the imprint inscribed into the system early in life will drive act-outs such as repeated failed relationships, drug use, or fervent religious belief for a lifetime. The latter are not simple adult behaviors to be redirected in cognitive or behavior therapy; their roots are deep in the history.

The prototype, which is stamped in during preverbal life, cannot be reversed by verbal means. The prototype is engraved largely with the right brain; the left brain ideas will be of no help in making any change (except, of course, when the left brain participates in connection).

To feel defeated is real—a real reaction to a real event of being deprived any struggle at birth due to a heavy anesthetic administered to the mother, not some neurotic aberration.

When someone is detached and distant, we can sense this; we can’t really get through to him. His defenses cannot be penetrated. His seeming aloofness is part and parcel of the imprint, not something to be reconditioned or argued away in cognitive therapy. When someone goes lifeless—

shuts down—when sexually excited, it is not anything she or he can help. It may be an analogue of a birth where there was excitement and struggle followed immediately by anesthesia to the mother (therefore, to the fetus) and shut down. The birth sequence is a prototype that dogs us all of our lives. In therapy we see this in patients who try hard in the first minutes of a session and then give up and feel hopeless. Similarly, to feel defeated is real—a real reaction to a real event of being deprived any struggle at birth due to a heavy anesthetic administered to the mother, not some neurotic aberration! If we try to remove that attitude (“What’s the use of trying?”) without the imprinted memory, we are only cutting off the top of the weeds, and depriving someone of key aspects of the memory of survival.

Some cesarean birth patients we have seen have this struggle-fail syndrome, never having been allowed to finish the birth process. One patient always felt “unfinished,” as if there were something she had to do but she never knew what until she had the prototypic experience. The prototype is dictatorial. It allows no current mercy because it already was merciful at the start by allowing unconsciousness of key pains. We can’t have it all.

In terms of the prototypic frame of reference, the

parasympath’s shyness, timidity, and passivity are defenses, not bits of caprice. They were designed originally to keep the pain away. We are neurotic (deviated) for a good reason: adaptation. For the parasympath, his whole system veers toward less—less dopamine, testosterone, noradrenaline, serotonin, thyroid hormone, and so on. The parasympathic reactions stem basically from the prototypic

“freeze” response; the inability to react fully. That is, freezing was one option for survival, an option directed by the parasympathetic nervous system. From the beginning, the whole system has tilted toward this “hypo” mode as a mechanism for survival. It makes us inward, introspective, diffident, hesitant and conservative. The other option is the impulse dominated person who plunges in and tends to be far more spontaneous.

Because the imprint orchestrates a cascade of alterations, we can attack the problem with thyroid or any number of other medications, and they will all help. For example, adding any one of these ingredients to the deprived system may help feelings of depression and defeat. This is why giving thyroid to a depressive, or a drug that enhances the work of serotonin, often helps. But they are not cures. Hypnosis works on smoking, but there is still the person there who needs to smoke (someone who needs), and there will be more adverse reactions in the person’s area of vulnerability. Hypnosis helps suppress wants but not need. Those wants are the act-out of needs. “I want a cigarette” can be the act-out of the need to suck from very early on. To say nothing of the need to suppress

pain.

We have a choice: alleviate symptoms or cure people.

Either reregulate each physical change (add a bit of thyroid here, a dose of Prozac there, a nicotine patch to help a smoker break the habit), or address the orchestrator and change all of the physical alterations together.

When someone is a chronic smoker or a depressive, or is sedentary and avoids people, his whole system informs his behavior, and his system is a function of history. Our therapeutic task must always be historical. History is one essential difference between cognitive and feeling therapies. If we treat a person as ahistorical, we can only change his current presenting symptom, not his personality.

Modern cognitive psychotherapy stops with the mental. It is confined to the left frontal brain. However, as we will see, the right/feeling brain is dominant in infancy, and it is early right-brain imprints that continually activate the brain. That is where we find “defeat.” We must go to combat with that important feeling that governs so much of later life. The only way to go there is with the right brain and the right limbic system, ending eventually at the apex of that system—the right orbital frontal cortex (the right forward part of the top brain).

The cognitivists have confounded brain hemispheres and attempt to get there with an appeal to the left side. We cannot get there from here. The left frontal area only comes on line after the key imprints are set down on the right side.

If anything should prove that ideas follow feelings, rather than vice versa, it is that the feeling/sensation areas of the

brain are in force long before ideas; moreover, the feelings militate upward and forward to create resonating ideas, thoughts that “rationalize” the feelings. That is why we can take an idea in a therapeutic session and help the patient follow it down to early feelings. For example, “They don’t like me” becomes the mother who detested the child (“Please don’t hate me, Momma. Want me!”). Cognitive therapy deals mainly with the results of feelings on the left brain, when feelings on the right are importuning at all times.

We have a choice: alleviate symptoms or cure people.

When someone’s entire being is permeated with the sense that “no one wants me,” to the degree that he needs drugs to kill the pain, this is not just an idea we have to change; it is an organic part of that person. Ideas are not something we produce willy-nilly. We don’t just have differences in opinion; we have differences in total personality, which gives rise to opinions. Likewise, when a person’s “default” mode is to give up in the face of obstacles, he is responding to the sensation deep in his brain of “What’s the use of trying?” Because it lies so deep, it has a profound impact. The words to describe his state are a late evolutionary development. They are not to be confused with the biologic state; the physiology of defeat.

In the hierarchy of valence or strength, words are the weakest when compared to the force of these first-line

nonverbal imprints. We must not believe that if we treat the patient with words, changing the labels, we can make a profound difference. We can plaster on new (false) ideas to old feelings, but the feeling does not change at all. All that happens in this case is that the further suppression of the real feeling creates more stress on the system. Imprints are not conquerable nor can they be convinced to change. We may be able to convince someone to change her ideas, but never out of her physiology. Our job is to align the ideas with the feeling. I should say it is the patient’s job, because her feelings, when felt, will do it all by themselves.

No patient sitting up in a chair in a comfortable office can feel the kind of terror he can only feel in a darkened, padded room. Yet this sitting-up framework prevents the cognitive therapists from taking patients back in history.

First, their theory does not account for it, and secondly, the very office setup prevents it. The organization of an office follows from the theory. It is all designed to keep the focus in the present—often on the words of the therapist. Sadly, one of the greatest dangers we face is from our past and ourselves, a memory informing us that we are not loved by our parents, that we never will be, and that all is hopeless.

This forces us into all sorts of behaviors to avoid feeling hopeless. The problems we have may be between people, but the solution is within. The closer one is to oneself, the closer one can be to others.