This is the introduction of my third book (first book published in Japan in Japanese) “Awakening Into Awareness: Affective Emotional Neuroscience & Attention Therapies” set for publication January 2021. I will share the entire book, chapter by chapter up until the date of publication. 

Factoids

Mentally Ill

National Institute of Mental Health (NIMH) divides mental illness into two main categories: Any Mental Illness (AMI) and Serious Mental Illness (SMI). According to their latest statistics, 46.6 million adults 18 or older had AMI. That is 18.9% of all U.S. adults.

Breaking that down into age groups, young adults 18-25 had the highest prevalence of AMI, 25.8 percent. Older adults, 50 or older had the lowest prevalence of AMI, 13.8 percent.

For SMI, 11.2 million adults 18 or older in the U.S. or 4.5% percent of all adults. Young adults 18-25 years had the highest percentage (7.5%).

Prisons

National Alliance on Mental Illness

In a mental health crisis, people are more likely to encounter police than get medical help. As a result, more than 2 million people with mental illness are booked into jails each year. Nearly 15% of men and 30% of women booked into jails have a serious mental health condition.

The vast majority of the individuals are not violent criminals—most people in jails are have not yet gone to trial, so they are not yet convicted of a crime. The rest are serving short sentences for minor crimes.

With less than 5% of the world’s population, but nearly 22% of its prison population, America has the highest incarceration rate in the world. We imprison almost 2.3 million people today, as opposed to around 300,000 during the 1970s. Of those 2.3 million, estimates indicate between 300,000 and 500,000 are non-violent drug offenders.

Once in jail, many individuals don’t receive the treatment they need and end up getting worse, not better. They stay longer than their counterparts without mental illness. They are at risk of victimization and often their mental health conditions get worse.

After leaving jail, many no longer have access to needed healthcare and benefits. A criminal record often makes it hard for individuals to get a job or housing. Many individuals, especially without access to mental health services and supports, wind up homeless, in emergency rooms, and often re-arrested. At least 83% of jail inmates with a mental illness did not have access to needed treatment.

Incarceration and Mental Health

The Center for Prisoner Health and Human Rights  https://www.prisonerhealth.org/educational-resources/factsheets-2/incarceration-and-mental-health/

The closing of state psychiatric facilities during the process of deinstitutionalization in the 1960s was intended to improve care for people suffering from mental illness and shift treatment to less restrictive settings. People with mental illness left state-funded institutions to return home, to nursing homes, and other community-based residences. However, nearly half of the proposed community-based health centers that were to replace state psychiatric facilities were never built, and those that were completed ran into financial distress when federal money ran out a few years later.

The lack of sufficient community-based treatment options has instead resulted in a drastic increase in the incarceration of people with mental illness. In fact, correctional facilities in New York, Los Angeles, and Chicago currently act as the three biggest psychiatric facilities in the country. The number of hospitalized persons with serious mental illness (SMI) decreased from 550,000 in the 1950s to 70,000 in 2012; concurrently, the prison population grew from 178,000 in the 1950s to 5.6 million today. The percentage of individuals with SMI in prisons increased from .7% in 1880 to 21% in 2005.

The statistics paint a stark picture, with mental illness affecting a greater percentage of jailed women than men:

• In state prisons, 73 percent of women and 55 of men have at least one mental health problem.

• In federal prisons, 61 percent of women and 44 percent of men have at least one mental health problem.

• In local jails, 75 percent of women and 63 percent of men have at least one mental health problem.

Homelessness

People with untreated serious mental illness comprise an estimated one-third of the total homeless population in the United States and an even higher percentage of women and individuals who are chronically homeless.

Their mortality rate is 4 to 9 times higher than the general population. Many are victimized regularly. They are highly likely to be arrested at some point and then cycle from the streets through the jails.

Introduction

I’m an old man and don’t think I have too much of an ego. I wrestle back and forth with how much to introduce my life. When I include my background here, it sickens me to read it back. But when I leave it out I leave out what motivated me to spend my life researching and writing about therapies. Please skip over autobiographical sections that bore or sicken you. I guarantee you will find one or both.

When I read novels, I identify with magnanimous, noble, altruistic, respectable, accepting and kind people. But when I set out my life here, it reads back miscreant and monstrous. This is not an exaggeration. This is what it is when the facts are laid out bare. And truth be told straight out, I am not a likable person.

I pretty much accept anyone who can accept me, but since there are so few people who can, I like less than a handful of human beings. I love animals because they all seem to accept me. But even this started out very bad. I worry about sharing this, but I feel guilty for not sharing it. So I have written this introduction over and over with and without it.

In my defense, I did not start out that way, but actually I did, at least early on, even though it was not my doing. That needs unpacking. I was on my own from day one. My mother was devoid of maternal instinct or any feelings for me. My father was abusive from very early on, abusive with me and my mother and viciously mentally and physically abusive with my sister. I never formed any kind of a bond with either of them, though that would be phrasing it overly positive, since there were times from very early on I planned out killing them.

During the first years of my life, I passionately loved my mother. She would come in to read me a story and I would hold her hand close to me, but it would fall away instantly when I released it. One day, maybe when I was five, I asked her if she loved me. “Yes,” she dispassionately responded, So I prayed for an angel to come down and love me. I can’t recall when my passion became numbness, but numbness morphed into hate, and then violence to all women I got too close to.

Why can’t I fall in love

Like any other man (Anthony Newley Lyrics)

In my teens, I became aware that I could not love. I had “normal” sexual feelings, without the slightest affectionate warmth that might be mistaken for love. Over the years there were countless short-term “intimate” relationships, that if lasted beyond lust became violently abusive. But the first of this violence happened in an intimate relationship on the island of Kauai, Hawaii when I was 27 years old.

In high school, perplexed by my inability “to fall in love” I entered a disastrous four-year encounter with a psychoanalyst. He wanted me to tell him everything but just sat taking notes. I became obsessed with literally telling him everything. A fellow student at Rutgers remarked how I took down every word of the lectures. When I told him my notes had nothing to do with the class, he stood there dumbfounded.

I filled large dresser drawers full of these notebooks. My psychiatrist would comment “You are a sick, sick lad,” and finally he resorted to prescribing a frightening series of electroconvulsive shock therapy (ECT) treatments.

Finding Meaning

I could speak of all this to no one. In high school, I began writing popular songs and one of the songs that got recorded was “Talk to Audrey.”

https://www.youtube.com/watch?v=cGLXE0Wk-Xk

This was in the late 1950s. Psychotherapy back then was predominately Freudian. I was in psychoanalysis and it was destroying me. I was fortunate to have had this creative outlet. I wrote hundreds of songs. They kept me in flow. 

Though I had no idea at the time, this was my PLAY therapy. It was what I lived for and eventually became my bibliotherapy. It still is what keeps me going. I engage in bibliotherapy researching and writing my blog and books in  hope of helping others who are suffering to find meaning in the belief that finding meaning is the answer to our suffering.

But nowhere in the public schools was there a mention of our suffering and how to deal with it. It was taboo. And that is pretty much the way it is today; that emotional insight must be either unnecessary or beyond reason and unteachable. So even though a fairly large number of the population suffer some form of mental illness at some time in their lives, they are left on their own to figure it all out. Albeit, it seems this is starting to change.

It was many years after all of my schooling when I read about vets suffering from PTSD that I first realized that I was in no way alone. But my initial psychoanalyst labeled me as “obsessive-compulsive neurosis.” That was way before it became a more palatable “OCD.” 

The first inkling I had PTSD was before PTSD entered the official lexicon of psychiatric diseases in the 1980 edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-III). I was in my twenties and was touring Okinawa sharing expenses with a guy about my age I had met on the navy base. Actually, the touring ended the first night. We were sharing a room at a local ryokan. In the morning he told me I had screamed at the top of my lungs and had woken everyone in the ryokan. I had no memory of this happening. Of course, he packed and departed.

Unbelieving as it seems, my wife of 45-years never departed – She did early on for a year or so – though I’d wake her screaming countless nights over the years of our marriage. It is truly unbelievable because I was abusive and in domestic violence counseling.

Much may be hard to take and so I want to have it out here upfront.

Monster Boy Becomes Monster Man

Perhaps I should start with an episode when I was between five and seven. I never could share this with my therapists or anyone else because it is too painful and guilt-ridden. But I need to strive for full disclosure here.

Irwin and I talked about tying up our mothers, tying them up with rope, and pulling down their underpants. This was fantasy and I stared with disbelief and admiration when Irwin went into his house and came out the back door pulling his mother into the yard. He told her to play our game and she could go back inside. He wrapped the rope round and round her pulling her snug against a tree. She strongly protested, too late. She screamed she would tell his father, sobbing uncontrollably as Irwin lifted her house dress and lowered her panties down around her ankles. Ignoring her sobbing pleas he examined and probed her vagina.

I don’t know if his mother disclosed this event to his father. He seemingly felt no shame or remorse. I thought he was amazing. I would have felt guilt and shame. I would never have done this. For me, it was fantasy talk. 

If you are prone to look away in violent movie scenes, skim over the next few paragraphs. Of course, it pains me now, especially since I am an animal advocate who has cared for colonies of feral cats with a two-story insulated home built for them. One of my greatest pleasures was sharing the twenty-year life of Momo, one of the sick feral cats we took in. Often we mistakenly called her Hiromi, our daughter who lives with her husband and son in Las Vegas.

We were in Irwin’s yard playing with a litter of recently born kittens. I remember picking up one of the kittens, crossed the street where cars headed north up the hill, and stood on the grass divide facing the other side of the street where cars come south down the hill. As the car approached, I grasped the kitten by the back of its neck, and as the car got almost directly in front, threw the kitten under the front wheel. 

The car came screeching to a halt. Guts and brains splattered the tires and the road. The driver screamed at me. He threatened to have me locked up in prison. And, thinking back, it might have been best for him to have called the police and have me placed in custody, but there were no cell phones, of course, so he took down my address and phone number and called and spoke to my father that evening.

Though my father was always at me to stop my constant whining and wimpy behavior, there was nothing wimpy about this. Though I confessed I had done it, that I threw the kitten under the tires of the car, my father said I couldn’t have done it. The kitten jumped out of my hands and under the tire.

If you stopped reading the paragraphs above, you can resume from here.

The kitten incident took place in 1947 when there was no hope for someone destroyed by early childhood trauma. It would be many years before SSRIs and Attention Therapies, so a lifetime of misery lay in store for me, and for many lives I touched with violence.

I went on to disrupt all of my grammar school classes and make life miserable for my teachers. Teachers shouted my name as though it were a pejorative. They embellished my report cards with bright red Fs down the right side of my report card for Cooperation and Dependability. It had no affect. I did not even know what I ever did wrong. I was not in control.

I had no idea what teachers lectured about or what was discussed with the class. But my best friend was brightest in the class and he showed me what to study for tests and I studied and memorized enough to end up with Cs on the content side of my report cards.

In 1966, with a master’s degree from Indiana University, I applied for and got a job as school psychologist serving all seven schools on the little island of Kauai, Hawaii. That was when I discovered I was out of control with violence. (Actually, years earlier I had punched my father, but concluded it was a result of a series of ECT shock treatments I was enduring.)

On Kauai, I was brutally violent with the lovely Hawaiian girl who I married in a shot-gun wedding before departing the island. It was horrible, I was so out of control. I was a monster. I had to leave immediately. After departing, in 1968, my first year in Japan I learned in a letter from her mother that she ended up in the island mental hospital.

Nineteen-eighty-two was five years before Prozac and about seven or eight years before it was prescribed for me. I was involved with the police and in ineffective domestic counseling and going down. 

Awareness of KI

Nineteen-eighty-two, five years before Prozac and ten years before it was prescribed for me, I was involved with the police and in ineffective domestic violence counseling.

Thankfully, I had begun practicing Aikido and Ki Meditation, and I consider Ki Meditation my go-to Attention Therapy, though I did not realize this then. To practice Aikido, you need to practice Ki Meditation. Ki Meditation is the force beneath Aikido. Before you meet with any success with Aikido, you must comprehend and practice the four major principles to unify mind and body.

1. Keep one point.
2. Relax completely.
3. Keep weight underside.
4. Extend Ki

But these four principles of Ki are difficult for a non-Japanese to put trust in and have faith in. We associate fighting with brute strength and it is difficult to relax and not try to win by physical strength over your opponent. It was at first a daunting challenge to believe that I can be strong by relaxing completely, even acting with love toward my opponent. So in the first few years, I went through the motions, techniques, throws, and falls. But even the basic throws are called kokyunage which can be perhaps best translated as breath throws. Breath throws? So hard to believe possible.

You can’t advance to Shodan without that faith, because without faith in Ki you are weak and powerless. It took five years of almost daily practice to advance to shodan or first-degree blackbelt. Both my wife (4’9” 80lbs) and me (5’9’’ 150lbs at the time) had to defeat three attackers coming at us from all directions. Needless to say, I was proud to wear the black skirt black belt uniform.

Addicted to Prescriptive Medicines

All that time I was addicted to sleeping pills and benzodiazepines. Maybe because I was a foreigner I could get doctors at Kitazawa Hospital to prescribe any medication I asked for. Kitazawa Hospital was a five-minute drive from Camp Zama Japan army headquarters where I taught High School Junior English. I would alternate between five of the most potent sleeping pills, one each night of the week from Monday through Friday. A few of the students nicknamed me “Sleepy Dames.” And most sadly, I was in counseling on the army post for spouse abuse. The military police were familiar with our residence.

When an Xray showed some dark spots in my abdomen I decided to go cold turkey on at least the benzodiazepines that turned out to be a poor decision. During class, I had an irresistible urge to violently attack a student who was talking and not paying attention in class. I mean irresistible. I prayed for the bell to ring before I lunged at him in a rage. The bell saved my life and I could never go back. I took all the sick leave I had and then we packed and headed for Seattle. We chose Seattle because it is halfway between my wife’s family in Japan and mine in New Jersey and New York.

It was too early for my retirement, so I took a year’s leave without pay. Near the end of the next school year, Department of Defense Overseas Dependent Schools (DoDDs ) offered me a position as a middle school teacher on Okinawa, a position they were banking on my turning down. They knew that I could not tolerate middle school kids – I had made that clear – and would not want to be away from Tokyo as well. But our savings were nearly drained so I accepted the position. Only then they called offering me a disability retirement. It was about half of what I would get if I stayed on two more years for full retirement, but I had little choice. 

Had I taken the job it was like Jason Voorhees (or Norman Bates in my time) assigned as a counselor in a female dorm. I wasn’t a sexual predator, but without benzodiazepines, I was explosively volatile, and should not have been assigned to be with antsy middle school kids. If they looked at my army post medical record, the domestic violence counselor had written Psycho boldly across most of a page. It was ironic that I was her trigger and she could not conduct our counseling sessions without a dose of Valium. I guess you could say that’s “one degree of separation.”

Though my wife and I never practiced Aikido again, I practice Ki Breathing Meditation every day, at least every day I think of it. Ki Breathing Meditation and Prozac kept the monster at bay and now I can do without the Prozac. I have not been violent in years and I had been on the verge of going to prison.

Awakening Into Awareness: Affective Neuroscience

The next push forward, an awakening, came with reading “Affective Neuroscience” by Jaak Panksepp and then his second book “The Archeology of Mind: Neuroevolutionary Origins of Human Emotions.” I not only read his second book, I dictated much of it into my Mac app Pages writing program. I found each paragraph, if not each sentence packed densely with Affective Neuroscience. Affective Neuroscience is the term he coined after years of lab work mostly with rats, but it all applies fairly directly to primates including us.

Even though cognitive issues are important to deal with, primary-process emotions need to be dealt with on their own terms. Thoughts are not as strong as affects, which is why cognitive therapy often does not work well with serious psychopathologies like mine.

So it is essential to be aware of the power of the emotions. Not many psychologists are familiar with Affective Neuroscience and I hope psychiatrists now have a working knowledge of the field. For clients, an awareness of the basics of Affective Neuroscience should be a part of any therapy including Cognitive Therapy (CT).

Jaak Panksepp spent much of his life in his lab researching emotions. Affective Neuroscience is the result of a lifetime of research. None of Affective Neuroscience is speculative theory. It is based on his lab studies with rats. He mapped out the areas of the brain for seven primary affects: 

1. SEEKING
2. RAGE
3. FEAR
4. LUST
5. CARING
6. PANIC/GRIEF
7. PLAY

Affective Neuroscience developed by Jaak Panksepp in the 1990s deals with raw affective feelings and instinctual emotional responses deep inside our brains below the thinking-cap neocortex. Clinical psychologists rarely deal with affective feelings and psychiatrists attempt to counter them with drugs.

Panksepp divides emotional experiences into three basic categories: primary process, secondary process, and higher mental processes. Primary-process emotions are the evolutionary subcortical automatic processes. Secondary process emotions are built upon the primary processes and include conditioned responses like fear conditioning. Conscious emotions reside in the thin neocortex of the frontal brain.

The first two categories of processing are unconscious to us. We need to be made aware of them. As Panksepp puts it, many of our basic emotional feelings emanate from “the basement of the mind.” Though unconscious, these bottom-basement emotional feelings have powerful psychological and physiological effects.

You cannot analyze feelings away. They mix with higher neocortical processes opening the flow of repetitive patterns of worry, rumination, and fixation on threat. In turn, these thought patterns act back on lower emotional feelings, feeding the monster and keeping the hellish home fires burning.

Panksepp wrote these subcortical primary emotions in caps to delineate them from the higher brain feelings and behaviors associated with each of these seven primary emotions. Primary affects are buried in the subcortical brain. Feelings associated with these emotions are primarily in the 2 to 3 mm six-layer cerebral cortex, the outer covering of gray matter covering both hemispheres of the brain that Panksepp refers to as the tertiary brain.

I attempted to stick with his system of caps for prime emotions, but I found there are times when I can’t be clear whether they are prime subcortical emotions or tertiary feelings.

Although a brilliant scientist, Panksepp was not a good communicator. Every sentence is so densely packed, I had to not only reread, but I dictated a good part of the book into my Mac Pages application. This is the only way I could focus deep enough to unpack some of his sentences. And when I did, sentences blossomed, revealing the amazing depth of his work. I get more each time I reread the book or my transcription. I feel the need to transcribe his book so others can benefit as much as I do from his research. There is hardly any other information available on prime emotions out there. Affective Neuroscience is still an incipient science. Universities are starting up programs, but professors are needed to set up Ph.D. programs.

If what has gone wrong in someone’s life is within recent and specific sets of life problems, then cognitive-behavioral counseling can be effective. But as Panksepp writes, most severe emotional problems do not simply arise from recent events. Their etiology can be traced to trauma often extending back early in life, so far back, that few explicit memory traces remain, just imbalanced emotional states and associated cognitive biases. These early imprints can be remarkably long-lasting. 

Emotionally Attuned Therapists

Many studies evaluating psychotherapy conclude that common factors such as empathy, warmth, and the therapeutic relationship correlate more highly with client outcomes than the specific therapeutic approach taken. Panksepp concludes that the critically important overall variable in therapy is emotionally attuned therapists.

Out of all my therapists, one was emotionally attuned. It was so much a part of her nature. She was a professor in the medical school at the University of Washington. I was blessed to have found her, but it lasted a very short time. She stopped doing therapy, but at least I experienced and now know what emotionally attuned is all about. In a sense, I was experiencing the mother I never had. Even though it was such a short encounter, I was enormously disappointed in losing her.

I am here to attest to what Panksepp said about emotionally attuned therapists is on the mark, but good luck in finding one. The ironic postscript here is my last psychiatrist, a totally “unattuned” schmuck, had been a medical student of hers.

In my eighties, I still occasionally – I am in hopes it has ended – awaken my wife screaming at the top of my lungs with no trace memory; my wife takes the entire brunt. I would not blame her for leaving me. Each time I apologize profusely. And each time she responds, “No, no, no . . . .” – meaning not to worry – I am a most fortunate man. She is a strong woman, my strength. Fortunately, as I write this, I have not woken her up screaming in several months.

Though I am much relieved of a lifetime of stress and anxiety, eighty years since the trauma, prime emotional juices can be deep-brain aroused for a lifetime by reactions and responses innocuous to others. 

The title of the book, “The Body Keeps the Score,” says it all. The body remembers in the deep inaccessible wordless recesses of the brain. Being shut off from the nightmare is part of the trauma process.   A spot in the left frontal lobe of the cortex called Broca’s area, the speech center of the brain goes offline when flashbacks occur. It is identical to having a stroke in that area. No speech is available to describe the trauma so thoughts and feelings cannot be put into words. The body reexperiences terror, rage, and helplessness along with the impulse to flee, fight, or freeze, but the experience is not there in thoughts and words. 

In contrast to the deactivation of Broca’s area, the visual cortex is alive with images. The visual cortex lights up as though the trauma were actually occurring, unmodified by the passage of time. Brain scans clearly show that images of past trauma activate the right hemisphere of the brain and deactivate the left.

I guess that is why I never brought the trauma up in all the years of therapy. It is not there to talk about. Specific events are there. But the actual horror of the experience is locked up deep in the brain. No talk therapy enables the left brain to rationalize the right brain out of its trauma.

Self-help books that help:

Total Self-Renewal through Attention Therapies and Open Focus

The Open-Focus Brain: Harnessing the Power of Attention to Heal Mind and Body