Life Before Birth: The Hidden Script That Rules Our Lives, Arthur Janov, PhD (2011).
NTI Upstream, 293 pages, $24.99

"A paradigm shift is happening" in the way that we understand the importance of our life in the womb, in the words of Dr. Marti Glenn at the 2010 APPPAH Congress. She pointed out that, "researchers are beginning to discover...that the events and environment surrounding pre-conception, pregnancy, birth, and early infancy set the template out of which we live our lives."

While this paradigm shift is new to most people, it is a view that was put forth decades ago by Dr. Arthur Janov, whose new book, Life Before Birth, explains just how fragile we are while in our first home - the womb. He believes that many – perhaps most – children have been damaged at a much earlier age than has been traditionally acknowledged. Janov stresses that we are especially fragile at birth and early infancy.

The main focus of the book is threefold: early development, especially in the womb; adult mental illness and disease; and the nature of a feeling therapy.

There is an important concept that is fundamental to all but the simplest forms of life: the experience of pleasure and pain, which tells an organism how to react to a particular situation. Pain is a signal that there is danger and by providing a strong incentive to act, it is critical for survival. Pain tells us that something is wrong that we need to pay attention to it. Failure to heed the signal can be fatal, which is exactly why it is painful. Those animals which ignored their pain were less likely to survive. We are the descendents of those whose sensitivity and respon- siveness to pain meant that they did heed the warnings of danger.

So, for better or worse, the ability to experience pain is a necessary part of being alive. More generally, the ability to feel, to sense your own physical and emotional condition – and to sense other people's feelings - is central to life and survival.

Just as our species has adapted to its environments over the ages, we as individuals adapt to our natural and social environments. Ontogeny recapitulates phylogeny.

One of the central themes of the book is that our experiences in utero and infancy literally sculpt our brains and central nervous system. Janov explains that "imprinting" may take place when the fetus reacts "to the womb environment by readjusting its vital signs, hormones, and neurotransmitters to adapt to a new reality; he is getting ready for life in the outer world." Or as Janov says, "What is outside becomes inside."

In other words, a baby learns what to expect from its experiences, and the child's brain and body then make adjustments to be ready for the world. If its experiences are healthy, it will grow in a normal manner. But if the child experiences the environment as threatening (due to, say, a stressed mother, an abusive father, or environmental toxins, for example), then the child's body takes defensive measures at the expense of healthy growth and development. Survival comes first.

As Marcy Axeness notes in Parenting for Peace, "At every level and every stage of life, an organism is either in growth mode or in protection mode."

These changes can reach so deeply down into a child's cells that they may switch genes on or off. This new science, epigenetics, explores how a person can be deeply affected by, for instance, a traumatic birth or emotional abuse, and how such damage may be passed on to their own children.

Stress ages our cells and is associated with increased risk for a host of diseases of aging, including cancer, heart disease, and stroke. Elissa Epel, an associate professor in the UCSF Department of Psychiatry, has shown that the way people respond to a stressful event "impacts their neurobiology and cellular health." Epel adds that damage to a cell's telomeres can occur in "the prenatal environment" due perhaps to "poor maternal nutrition" and that it correlates with low birth-weight.

That's why Janov writes that loving a child is not just a feeling that the parent has, but that it also "means fulfilling the needs of the baby," such as a providing a healthy environment in the womb, a gentle, natural birth, and lots of cuddles for children. The nature of one's birth can be crucial. He cites a study in the British Medical Journal which found that, "individuals who committed suicide violently were more often exposed to complica- tions during birth."

Janov's clinical focus is healing past trauma through his Primal Therapy (which, contrary to a common misperception, has nothing to do with screaming). Rather, the focus is on re-connecting one's consciousness with trauma buried in the lower parts of the brain. Again, early pain was repressed in order for the child to survive, but at the cost of healthy development.

This response is known as dissociation, "the universal human reaction to extreme fear or pain", in the words of Martha Stout, a clinical psychologist at the Harvard Medical School. "In traumatic situations, dissoci- ation mercifully allows us to disconnect emotional content – the feeling part of our "selves" - from our conscious awareness. Disconnected from our feelings in this way, we stand a better chance of surviving the ordeal, of doing what we have to do."

For Janov, it is the re-connection of one's consciousness to the repressed pain that is truly healing, and that is the goal of Primal Therapy. He contends that relatively superficial approaches, such as cognitive behavioural therapy (CBT) might address symptoms, but they ignore the source of one's pain - trauma.

Janov also writes that our bodies create very powerful and subtle defenses (ideas, emotions, attitudes, almost anything) to keep the buried pain away from consciousness. Therapy must carefully allow patients to unravel their defenses and feel as adults what was overwhelming as children.

Janov stresses that the most important task is to prevent children from being hurt in the first place. While he places a great responsibility on parents to be loving towards their children, he does not engage in parent- bashing. For one thing, parents themselves are the product of THEIR upbringing.

For another, it is clear that, for most children, the primary factors that affect their emotional and physical development are the social determinants of health, such as pollution, inequality, and poverty. One U.S. study found that children from "low socioeconomic environments showed a lower response to the unexpected novel stimuli in the prefrontal cortex that was the response of people who have had a portion of their frontal lobe destroyed by a stroke."

Co-author W. Thomas Boyce (now at the University of British Columbia), emphasizes that, "We are certainly not blaming lower socioeconomic families" for problems that they did not create.

Life Before Birth raises issues of the utmost importance for all of us, children and former children alike. It could have used an editor, especially to make sure that some complex ideas were expressed more clearly.

Nevertheless, Janov has again taken a leading role in illuminating what science is showing discovering about raising healthy children. His book explores some of the most cutting edge research in child development and neuroscience, and it deserves a wide readership.