THE PRIMAL SCREAM

Introduction: The Discovery of Primal Pain

Some years ago, I heard something that was to change the course of my professional life and the lives of my patients. What I heard may change the nature of psychotherapy as it is now known—an eerie scream welling up from the depths of a young man lying on the floor during a therapy session. I can liken it only to what one might hear from a person about to be murdered. This book is about that scream and what it means in terms of unlocking the secrets of neurosis.

The young man who emitted it will be called Danny Wilson, a twenty-two-year-old college student. He was not psychotic, nor was he what is termed hysteric; he was a poor student, withdrawn, sensitive, and quiet. During a lull in our group therapy session, he told us a story about a man named Ortiz who was currently doing an act on the London stage in which he paraded around in diapers drinking bottles of milk. Throughout his number, Ortiz is shouting, "Mommy! Daddy! Mommy! Daddy!" at the top of his lungs. At the end of his act he vomits. Plastic bags are passed out, and the audience is requested to follow suit.

Danny's fascination with the act impelled me to try something elementary, but which previously had escaped my notice. I asked him to call out, "Mommy! Daddy!" Danny refused, saying that he couldn't see the sense in such a childish act, and frankly, neither could I. But I persisted, and finally, he gave in. As he began, he became noticeably upset. Suddenly he was writhing on the floor in agony. His breathing was rapid, spasmodic; "Mommy! Daddy!" came out of his mouth almost involuntarily in loud screeches. He appeared to be in a coma or hypnotic state. The writhing gave way to small convulsions, and finally, he released a piercing, deathlike scream that rattled the walls of my office. The entire episode lasted only a few minutes, and neither Danny nor I had any idea what had happened. All he could say afterward was: "I made it! I don't know what, but I can feel!"

What happened to Danny baffled me for months. I had done standard insight therapy for seventeen years, both as a psychiatric social worker and as a psychologist I was trained in a Freudian psychiatric clinic, as well as in a not-so-Freudian Veterans Administration department. For several years I had been on the staff of the psychiatric department of the Los Angeles Children's Hospital. At no time during that period had I witnessed anything comparable. Since I had taped the group session that night, I listened to the recording frequently over the next several months in an effort to understand what had happened. But to no avail.

Before long I had a chance to learn more about it.

A thirty-year-old man, whom I shall call Gary Hillard, was relating with great feeling how his parents had always criticized him, had never loved him, and had generally messed up his life. I urged him to call out for them; he demurred. He "knew" that they didn't love him, so what was the point? I asked him to indulge my whim. Halfheartedly, he started calling for Mommy and Daddy. Soon I noticed he was breathing faster and deeper. His calling turned into an involuntary act that led to writhing, near-convulsions, and finally to a scream.

Both of us were shocked. What I had believed was an accident, an idiosyncratic reaction of one patient, had just been repeated in almost identical fashion.

Afterward, when he quieted down, Gary was flooded with insights. He told me that his whole life seemed to have suddenly fallen into place. This ordinarily unsophisticated man began transforming himself in front of my eyes into what was virtually another human being. He became alert; his sensorium opened up; he seemed to understand himself.

Because of the similarities of the two reactions, I began listening even more carefully to the tapes I had made of Danny's and Gary's sessions. I tried to analyze what common factors or techniques produced the reactions. Slowly some meaning began to emerge. Over the next months I tried various modifications and approaches in asking the patient to call for his parents. Each time there occurred the same dramatic results.

I have come to regard that scream as the product of central and universal pains which reside in all neurotics. I call them Primal Pains because they are the original, early hurts upon which all later neurosis is built. It is my contention that these pains exist in every neurotic each minute of his later life, irrespective of the form of his neurosis. These pains often are not consciously felt because they are diffused throughout the entire system where they affect body organs, muscles, the blood and lymph system and, finally, the distorted way we behave.

Primal Therapy is aimed at eradicating these pains. It is revolutionary because it involves overthrowing the neurotic system by a forceful upheaval. Nothing short of that will eliminate neurosis, in my opinion.

Primal Theory is an outgrowth of my observations about why specific changes take place. Theory, I must emphasize, did not precede clinical experience. When I watched Danny and Gary writhing on the floor in the throes of Primal Pain, I had no idea what to call it The theory has been expanded and deepened by the continuing reports of one patient after another who has been cured of neurosis.

This book is an invitation to explore the revolution they began.

Chapter 1: The Problem

A theory is the meaning we give a certain observed sequence of reality. The closer the theory meets this reality, the more vivid the theory. A valid theory is one that enables us to make predictions because it fits the nature of what is being observed.

Since the days of Freud, we have had to rely on post-dictive theories—that is, we have used our theoretical systems to explain or rationalize what has gone on before. As the observable data increased in complexity, our observations have led us into a maze of different theoretical systems or schools. In psychotherapy today, fragmentation, specialization abound; neurosis seems to have developed so many forms over the last half century that not only is the word "cure" no longer mentioned among psychologists, but the word "neurosis" itself has been broken down into a number of problem areas. Thus, there are books on sensation, perception, learning, cognition, etc., but none on what can be done to cure the neurotic. Neurosis seems to be whatever anyone with a theoretical propensity thinks it is—phobias, depressions, psychosomatic symptoms, inability to function, indecision. Since Freud, psychologists have been concerned with symptoms, not causes. What we have lacked is some kind of unified structure that should offer concrete guidelines on how to proceed with patients during each and every hour of therapy.

Before coming upon what was to grow into Primal Theory, I knew in a general way what I expected from my patients. Nevertheless, a lack of continuity from session to session bothered me, just as it bothers some of my colleagues. I seemed to be doing a patch-up job.

Wherever a leak appeared in a patient's defense system, I was there, like the legendary Little Dutch Boy. One day I might analyze a dream; another day, encourage free association; the next week focus on past events; and at other times, keep the patient in the "here and now."

Like many of my colleagues, I was staggered by the complexity of the problems presented by a suffering patient. Predictability, that cornerstone of a valid theoretical approach, often gave way to a kind of inspired faith. My unspoken credo: With enough insight, sooner or later, the patient will come to know himself well enough to control his neurotic behavior. I now believe, however, that neurosis has little to do with knowing, in and of itself.

Neurosis is a disease of feeling. At its core is the suppression of feeling and its transmutation into a wide range of neurotic behavior.

The dazzling variety of neurotic symptoms from insomnia to sexual perversion have caused us to think of neurosis in categories. But different symptoms are not distinct disease entities; all neuroses stem from the same specific cause and respond to the same specific treatment.

Genius that he was, Freud bequeathed us two most unfortunate notions which we have taken as gospel truth. One is that there is no beginning to neurosis—that, in other words, to be born a member of the human race is to be born neurotic. The other is that the person with the strongest defense system is necessarily the one who can best function in society.

Primal Therapy is based on the assumption that we are born nothing but ourselves. We are not born neurotic or psychotic. We're just born.

Primal Therapy involves the dismantling of the causes of tension, defense systems and neurosis. Thus, Primal Theory indicates that the healthiest people are those who are defense-free. Anything that builds a stronger defense system deepens the neurosis. It does so by encasing neurotic tension in layers of defense mechanisms that may enable the person to function better outwardly but cause him to be ravaged by inner tension.

I do not console myself with the rationalization that we live in an age of neurosis (or anxiety), so it is to be expected that people will be neurotic. I would like to suggest that there is something beyond improved functioning in socially acceptable ways, something beyond symptomatic relief and a more thorough understanding of one's motivations.

There is a state of being quite different from what we have contrived: a tensionless, defense-free life in which one is completely his own self and experiences deep feeling and internal unity. This is the state of being that can be achieved through Primal Therapy. People become themselves and stay themselves.

This does not mean that post-Primal patients will never again be upset or unhappy. What it does mean is that, despite what they may undergo, they will confront their problems realistically in the present They no longer cover reality with pretense; they do not suffer from chronic, inexplicable tension or fears.

Primal Therapy has been applied successfully to a wide range of neuroses, including heroin addiction. Primal sessions are interrelated, and for the most part, the Primal Therapist can predict the course of his patients' therapy. The implications of this statement will become increasingly important, for if we can cure neurosis in an ordered, systematic manner, we also may be able to isolate those factors that will prevent it.