Arthur Janov's primal therapy became a cultural phenomenon in the 60s and 70s, but today most experts say that the technique is unhelpful and can even be harmful to some patients. So how has it endured?
A woman shouts, "Go away, leave me alone!" as she takes a swing at a punching bag. A couple yell at each other. A man rocks back and forth, holding a teddy bear, sobbing. Another man screams and weeps in a therapist's arms.
This is primal therapy, and it's quite something to behold. Founder Dr. Arthur Janov once described his psychotherapy method as "the most important discovery of the 20th century," but the vast majority of people in the mental health community see it as pseudoscience or even a kind of scam. That hasn't stopped Janov and his supporters from touting it as a mental health treatment that's simpler and more effective than everything else out there.
Primal therapy largely rejects the uncertainty of conventional psychotherapy. Say goodbye to years on a shrink's sofa, endless self-examination, or CBT's charts and homework. With Arthur Janov's tried and tested method, so its adherents say, you'll be free of your neuroses in no time.
At the Primal Center in Santa Monica, California, Art—as he's known by friends and family—runs a foundation with his second wife and one-time patient, France, who does most of the talking when I call the center (Janov is now 92 and suffers from a throat condition that makes it hard for him to speak). She explains that clients come from all kinds of backgrounds.
"It's people, quite often, who've done other therapies, and they didn't get anywhere, or they could feel there was more that they had to access," she says. "A lot of people who've done a lot of drugs, or drink too much, or have a sexual life that is overly active or not active enough. All the shit that neurosis makes, basically, it all comes from the pain that had to be repressed, and it all comes from the unfulfilled need to be loved, because being loved means having your needs fulfilled. It's pretty simple."
"We are all creatures of need," writes Janov, and when those needs are not met as children, we create neuroses, obsessions, anxieties, and depression.
Freudians traditionally prescribe intensive sessions of therapy—sessions that can go on for years, even decades. Janov has a different answer: The only way to rid yourself of depression and anxiety, he argues, is to return to the state we were in when we first felt rejection: screaming, shouting, rolling around on the floor. Whatever it takes, get it all out.
Janov's peers have never been entirely convinced that his method works. A 1996 poll of practicing psychologists asked therapists what they felt were the most effective treatments available and found that primal was the approach "most in question as to soundness."
"Primal therapy has been pretty much debunked by all of the legitimate psychological organizations," says Janja Lalich, author of Crazy Therapies. "Very few legitimate therapists still use the treatment at this point."
Lalich argues that primal therapy exhibits many of the characteristics of a cult, comparing its emphasis on controlled catharsis to what she describes as the "high arousal" techniques used by sects to brainwash and subdue believers.
"These kinds of techniques essentially make the person more vulnerable," she says. "So whatever the situation is, trying to convince people that they're getting better, or they're crazy—no matter what your problem is, they've got the same answer."
In response, Janov says, "We have 50 years of published material to the contrary. We have several scientific articles in the journal Activitas Nervosa Superior, plus other journals. We do serious science and leave the nonsense to others."
Primal may well be included in a number of a legitimate journals, and there's no doubt it has worked for patients in the past. However, it's also hard to deny that the treatment has a tendency to sell itself as the cure for every neurosis, and that its therapists often overstate its effects.
"In psychoanalysis, you have to be there for 30, 40 years, or until you die or whatever," says France Janov over the phone. "But in primal, once we have restored the capacity of feeling for the patients—once they have what we call 'access'—our patients don't need us."
Janov's message has always had something of a messianic tone to it, straying off the path of what's socially acceptable in psychiatric circles. Janov declared in a 1971 interview, for instance, that he could fix everything from alcoholism and menstrual cramps to "homosexuality."
It's a position he does not refute when I ask him about it in an email, claiming that "we have done it" in "restricted circumstances," before writing, oddly, that "I assume you are gay but do not pay attention to the hyperbole."
Primal therapy originated out of a conversation Janov had with a patient in 1967 in a group therapy session about a strange performance the man had seen. The performer spent much of the show shouting "Mama!" at the audience and encouraging others to join in. Before long, the crowd was screaming and crying.
"I encouraged this young man to do the same," Janov writes. "He refused, but I insisted. Finally, he began to scream 'Mama!,' fell off the chair, and was writhing in pain on the floor. It went on for a half hour, something I had never seen before. When he came out of it, he touched the carpet and said, 'I can feel!' He felt different."
Janov's 1970 book The Primal Scream was a cultural phenomenon, and the treatment was soon all the rage: John Lennon tried it, channeling the suffering of his childhood into Plastic Ono Band; the future voice of Darth Vader, James Earl Jones, said it helped cure him of smoking and hemorrhoids; pianist Roger Williams described Janov as one of history's greatest men.
Einar Jenssen, a London-based psychotherapist, worked and trained with Janov at his Paris institute in the 1980s, before becoming disenchanted with what he portrays as a cult-like organization driven by financial, not medical, objectives. By the time Einar Jenssen joined the primal movement, the optimism of the late 60s and 70s had been replaced by realism, and Janov was one of many psychiatrists pushing the limits of the scientific method.
Jenssen says that money was "always" a prime motivation for Janov, often leading to patients being taken on, he says, who were in no condition to go through such an intense process. He was shocked, for instance, to be given a 19-year-old with paranoid schizophrenia to treat.
"There was no way she could function in Paris on her own," he says. "If it had been an inpatient clinic, she might have been able to function in some way, but she couldn't, and she just fell apart. I went to Janov and said, 'This is just a mistake from the intake interview, and you have to give her the money back,' and he refused."
In response to the accusation that money is a prime motivation, Art Janov says in an email, "We take no salaries and no profits and have not in years. We have paid several hundred thousand dollars for research to maintain our scientific integrity. We fund therapy for those who cannot afford it." Janov also says they have no record of the paranoid schizophrenic patient Jenssen talks about.
Jenssen now believes that instead of helping patients recover from traumatizing experiences, primal can in many ways exacerbate mental health problems. The treatment, he argues, has no way of treating "dissociation"—the out-of-body experiences suffered by those with severe trauma. If anything, he argues, primal "puts people back into these terrible feelings."
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It's hard to find anyone these days who'll treat you with primal therapy, and the treatment has largely fallen out of vogue due to its reputation as a pseudoscience.
But there are some practitioners out there. Franklin Wenham, based on the outskirts of Brighton, England, still offers the treatment to those who qualify. He received treatment at the Primal Institute in LA in 1977, and it changed his life dramatically.
"I started talking about painful events in my childhood, and I started crying about them, essentially," he says. "That was the process... about getting in touch with your feelings. It's a very down to earth, practical therapy when it's done right, within safe boundaries."
Wenham now offers primal as part of a range of treatments. But it's a strict process: Patients who want to undertake it have to undergo significant assessment to guarantee they are mentally fit to deal with the intensity of the treatment. Wenham insists that primal is only appropriate for those who have "enough feet in reality"—those who would instead be spending years on a psychoanalyst's couch, not those who need urgent psychological help.
"It works very well with 'functioning neurotics'—that's another Janov phrase, I think," he says. "People who are able to cope with what life throws at them, but are pretty unhappy and keep making the same old mistakes... and basically have a life script that is self-defeating. Those kinds of people often do very well in primal therapy."
This is the thing to understand about primal therapy. If you're plagued by depression and anxiety, a general displeasure with life, the treatment could possibly help you: Talking about your feelings and expressing emotions openly and honestly in a safe space is always a liberating experience. However, there is a single-mindedness to how the Janovs speak about their theory, brushing off any criticism.
Despite his insistence that he would not treat a patient with, say, paranoid schizophrenia (as Jenssen alleges Janov has attempted), Wenham is reluctant to criticize primal's great guru, the man whose theories he credits with pulling him from the brink of a nervous breakdown.
"It's not the done thing to criticize another practitioner, you know," he says. "Because nobody's practice is perfect, and we all make mistakes to some degree."
As for Janov, he's still more convinced than ever in the truth of his theory, constantly making references to scientific theories that he believes vindicate his method. On the verge of releasing a new paper, Janov now argues that epigenetics—the study of the impact that external and environmental factors can have on our genes—could prove primal therapy right.
"We're developing all sorts of neurological proofs, or confirmations of what we're doing," he says. "I think there are sure signs of something."
Regardless of the wider scientific community's rejection of Janov's hypothesis, it's hard to imagine rejection putting him off: After almost 50 years and countless patients, there's no turning back now. We live in times where old taboos about mental health and pursuing therapy are being lifted. So you can't help but think: Could there be a place, albeit a narrow one, for primal in this brave new world of socially-acceptable self-care?
Janov seems to think so, but I find it hard to share his optimism.
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