Peter Levine is a Post-traumatic Stress Disorder therapist whose book Waking The Tiger: Healing Trauma has been influential outside the narrow circle of those professionally concerned with the treatment of trauma.
I have no problem with Levine’s methods, which are probably helpful to some people. Nor do I object to his attempt to move psychotherapy on from the dogmas of the 1970s. The trouble is twofold: Levine thinks his ideas are much more important and generally applicable than they are, and in seeking to critique the excessive emphasis on emotional ‘catharsis’ that characterized some 1970s therapies, he produces a theory so far at odds with reality that it’s liable to make things worse not better.
Levine’s thinking is characterized by a firm rejection of the idea that the way to mental health is through the experience of unconscious feelings, an approach that emerged from the anti-intellectualism of the 1960s, and was embodied most influentially in Arthur Janov’s The Primal Scream (1970), which sold over a million copies, making it one of the best-selling psychology books of all time.
Levine doesn’t mention The Primal Scream, but Waking The Tiger stands in an interesting relation to its much greater predecessor. Both books have their origin in a remarkably similar incident.
It was the case of Nancy, which provided ‘quite unexpectedly’, it seems, Levine’s ‘first major breakthrough in understanding’. This patient was having a ‘nightmarish’ panic attack, and gripped by his fear but somehow remaining present, ‘swept along with the experience’ (into a state, we are encouraged to feel, of mighty shamanic power), the Therapist suddenly found himself exclaiming -
‘You are being attacked by a large tiger. See the tiger as it comes to you. Run toward that tree; climb it and escape!’
This suggestion worked in pretty much the same way as Janov’s methods did on ‘Danny Wilson’ about two years before Levine’s session, which took place in 1969. When that young man was asked to imitate a performer he was fascinated by and call out for his parents, he emitted the famous ‘piercing, deathlike scream’ that gave its name to Janov’s book. And so it was with Nancy:
She let out a blood-curdling scream….She began to tremble, shake, and sob in full-bodied convulsive waves.
This continued for about an hour, during which Nancy ‘recalled a terrifying memory from her childhood’ – a tonsillectomy in which the anesthetic had induced frightening hallucinations.
An unexpected event in a psychologist’s office, a dramatic scream (this time a passing policeman gets involved), followed by a re-experienced childhood event ….! But these similarities are not really so surprising: reliving and strong feeling were ‘in the air’ in the late 1960s, and other psychologists have claimed that they were working in pretty much the same way as Janov when the publication of his book led to the association of ‘regressive’ psychotherapies with his name alone.
But what happens next in Waking The Tiger is interesting. Let me remind the reader that the walls of Janov’s office were shaken in 1967, Levine’s blood was curdled in 1969, and the American edition of The Primal Scream was published in 1970. In this book Janov describes his eventual realization that Danny was freeing himself through the expression of blocked emotion and that it was the reliving of past emotional trauma that was the only way to cure ‘neurosis’
In the same way, the meaning of the spectacular therapeutic events didn’t come at once to Peter Levine. After ’several years’ spent taking ‘detours and wrong turns’ he came to the following conclusion:
I now know that it was not the dramatic emotional catharsis and reliving of her childhood tonsilelctomy that was catalytic in her recovery, but the discharge of energy she experienced when she flowed out of her passive, frozen immobility response into an active, successful escape.
It’s hard for me to understand how anyone could have watched something as powerful as Nancy’s experience and end up thinking that it was the bit of fantasy before the screaming and sobbing that was the curative force. But following Frederick Jameson’s rule ‘Always historicize’ helps me see what might have been going on.
Levine’s work is located in a ‘countercultural’ field that has little time for such mainstream orthodoxies of behaviorism or psychoanalysis (although Jung’s archetypes do have their supporters, and Levine rather archly offers his humble thanks to ‘Medusa (and) Perseus…for informing my archetypal field of being’). In the early 1970s, the most typical countercultural psychotherapies were converging on three ideas: the body, emotion, and reliving of past experience. Janov saw himself as a champion of all three.
I wonder if Levine read The Primal Scream during the years he spent trying to understand Nancy’s experience? As this sold over a million copies, making it one of the best-selling psychology books of all time, and as Levine was working in an apparently related area, it might seem probable that he would have. However, Alice Miller, a much more serious and important figure than Levine, didn’t read Janov’s book until she had found her own way out of the Freudian tradition, and, sadly, when she did discover Primal Therapy things went badly wrong, leading to the tragicomedy of her later career. Of course, if Levine did read the book, it would hardly have seemed an attractive option to identify himself as the man who discovered primals two years after Janov!
Instead, Levine developed a system that kept the emphasis on the body (through the ‘felt sense’ and the idea of unfreezing the energy locked in the nervous system), while promoting a carefully controlled form of reliving that sought to avoid the dangers that were coming to be seen as inherent in allowing the full experience, with its devastatingly powerful emotional component, to emerge into consciousness.
The dangers of cathartic approaches are real, and there was an urgent need to develop body-orientated approaches that avoid the full experience while giving some access to the trauma and some hope of ameliorating its debilitating effects on later living. The problem with Levine’s system (as described in this book) is that his method seems far-fetched and rather weak, he makes unsupported and almost certainly unjustified claims for it, and he places it in a theoretical context that militates against a proper understanding of psychological suffering.
Janov was rightly criticized for the audacity of his claim to have found the ‘cure’ for neurosis:
(M)ost of the professionals who are using primal techniques are embarrassed by Janov’s grossly exaggerated claims, especially the subtitle of The Primal Scream, the Cure for Neurosis.
No method, many people pointed out, was going to abolish all the complicated and interwoven agonies and inauthenticities of human pain. It risked misleading and exploiting desperate people to claim otherwise. Such critics were right, as Janov’s failure ever to publish a comprehensive and properly conducted ‘outcome of therapy’ study in the more than forty years he’s been practicing all too clearly indicates.
But Peter Levine makes Arthur Janov look modest, measured and pessimistic.
Contrary to popular belief, trauma can be healed. Not only can it be healed, but in many cases it can be healed without long hours of therapy; without the painful reliving of memories.
At least Janov acknowledged that Primal Therapy was always difficult and at times excruciating. At least he made clear that to get free of your pain you had to do something pretty tremendous. Levine thinks all that stuff about encountering your past, feeling your feelings, plunging into your pain and so on is old hat:
I learned that it was unnecessary to dredge up old memories and relive their emotional pain to heal trauma.
That’s an interesting metaphor ‘dredge up’ – he uses it three times, and it’s essential to his case. It implies that emotions are not part of our ordinary consciousness but deeply buried, accessed with difficulty, and usually not worth excavating. In fact, he maintains, the ‘dredging up’ itself can worsen the problem, as it sucks the therapand into the ‘trauma vortex’, making them experience old pain anew with a consequent worsening of symptoms. 
There is a limited truth in this. Primal therapy – and all ‘deep feeling’ therapies – can be dangerous in the way Levine suggests, as it is easy to get into a situation in which more feelings are forcing their way into consciousness than can be resolved through primal experience. The trouble is that the idea of the ‘trauma vortex’ that sucks us helplessly in is far too simple. Firstly, people seek to bring their past traumas into the present because this gives boring lives excitement and meaning, and secondly total repression of the emotional ‘traces’ of past trauma is not an option. The ordinary processes of existence reactivate our traumas all the time - how could they not do, as most of them are about actions and relationships, the stuff of life? There is absolutely no need to ‘dredge up old memories’.
We are tormented both by our feelings and by our repression of our feelings; if the feelings aren’t addressed, then the torment continues, although in some cases it can be ameliorated by approaches like Levine’s. I suspect that behind Levine’s theory is something like the following (not necessarily consciously articulated) chain of argument:
Re-experiencing repressed emotion is difficult and potentially dangerous;
It’s not a form of psychotherapy that is suitable for most people;
It’s possible to make significant progress without ‘feeling your feelings’
We need to find safer and more accessible psychotherapeutic paths using other methods than the cathartic.
These propositions are all, in my opinion, true, and I applaud everyone, including Levine, who’s acting to help others in the spirit of these truths. The trouble is, Levine doesn’t stop there, but adds what seems like a logical development of such ideas but is in fact a further and unwarranted assumption:
So repressed emotion has no role in creating human suffering, which can be resolved without experiencing it.
Levine tries to write emotion out of the picture completely, and refuses to accept that if you don’t address unfelt feelings then there will be limits to the relief from suffering you can expect. There’s a Zen saying: ‘If you become a vegetarian, you get the benefit of not eating meat’. No more and no less! Instead of realistically assessing the limitations of his own methods – something that Janov too is not exactly good at – Levine drops into New Age fantasizing:
We must realize that it is neither necessary nor possible to change past events…The past doesn’t matter when we learn how to be present; every moment becomes new and creative.
No-one has ever claimed that it’s possible to change past events; the real claim, that Levine is misrepresenting because at some level he’s aware of how weakly-supported his own ideas are, is that you can change some of the ‘traces’ past events have left in you, and that, if you don’t the past, through these ‘traces’, or as Janov might call them ‘imprints’, will continue to dominate and degrade your responses in the present. (In a future post I’ll discuss the way in which another ‘be here now’ merchant Eckhart Tolle tries to write emotional pain out of the authentic experience of the present.)
What does Levine substitute for emotional catharsis? As we have seen, he regards it as crucial to return to the trauma – without reliving the emotions – and to fantasize an outcome happier than the one that occurred in real life. He believes that this movement from the passive to the active mode of experience will enable healing to take place, but only if another crucial matter is attended to:
(I)t is of the utmost importance to understand that, even though this experience was imagined, because of the presence of the felt sense, the experience was in every way as real for (the patient) as the original one, that is, mentally, physiologically, and spiritually.
The ‘felt sense’ here is a term from focusing, a practice with its origins in the work of Eugene Gendlin, that encourages people to get in touch with their bodily sensations:
Felt sense is the name Gendlin gave to the unclear, pre-verbal sense of ‘something’, as that something is experienced in the body. It is not the same as an emotion. This bodily felt ‘something’ may be an awareness of a situation or an old hurt, or of something that is ‘coming’ — perhaps an idea, or the next line of a poem, or the right line to draw next in completing a drawing. Crucial to the concept, as defined by Gendlin, is that it is unclear and vague; and it is always more than any attempt to express it verbally.
Classic focusing makes the amazing assumption that the only useful ‘felt sense’ occurs in the trunk, although this has been challenged by some practitioners – it seems obvious that the real point of this restriction is to rule out so much human experience that the practice is unlikely to get out of hand.
Using the ‘felt sense, Levine argues, we can reapproach the trauma and move out of the original ’freezing’ or ‘immobility’ response – a biological mechanism we share with all mammals – into the healing fantasy of an active engagement with the experience which will ‘discharge’ the energy that was frozen into the nervous system at the time of the terrible event and left behind to create the symptoms of PTSD. (A minor point is that Levine doesn’t seem to understand the theory of evolution, as he believes that ‘Nature’ has developed the ’freezing’ of the impala in the claws of a cheetah partly in order to spare it from suffering as it’s killed, which is, in fact, a matter of sublime indifference to natural selection.)
In any case, Levine gives the ‘felt sense’ almost magic potency because without some such reinforcement all he has to offer is the obviously trivial process of going back to the experience and fantasizing a different outcome, something that millions of people have tried for themselves without the help of a psychotherapist
Janov, for all his faults, at least had a realistic idea of the depth and horror of our suffering, and of the extreme measures needed to end it. Every time I watch someone primal I think the same thought: this isn’t enough, but I can see why some people think it’s enough. A full reconnection to a powerful childhood emotion is a violent experience, and there was once good reason to think it might be sufficient to heal minds and bodies shattered by mistreatment, deprivation and the absence of love. Getting away from your imaginary tiger by pretending to climb an imaginary tree doesn’t seem quite potent enough to do the trick.
Let me reiterate: I am not saying the procedures described in Waking The Tiger are useless. Going back to the traumatic experience and reimagining it while staying in touch with bodily sensation, is likely to be useful as far as it goes, but it’s not, by a long way, the whole story. Levine is praised by some for helping bring ‘the body’ back into psychotherapy, but it’s the body, with its massive store of repressed emotion, that he’s desperately afraid of.
Waking The Tiger provides no evidence for the efficacy of Levine’s methods – he implies he’s got files full of case histories of satisfied customers, but so does every psychotherapist who writes a book. The Primal Scream was equally unable to back up its claims, although Janov did make some effort in later books to provide statistical evidence.
Part of the trouble is that Levine tries to expand his ideas beyond the narrow field of PTSD. At first, he seems to be clear about what he means by ‘trauma’, citing ‘ automobile and other accidents, serious illness, surgery and other invasive medical and dental procedures, assault, and experiencing or witnessing violence, war, or a myriad of natural disasters’.
This is fair enough; but then Levine should make it clear he doesn’t have much to say to people like me – I’ve had one exploratory operation and lots of ‘invasive dental procedures’, but if this was the sum total of my pain how happy I’d be!
The stuff of human suffering isn’t in this list of the minor and the relatively rare. So when Levine goes on to say, ‘body sensation rather than intense emotion is the key to healing trauma,’ we need to bear in mind he should mean ‘trauma of the kind you suffered when that root canal got infected or you almost got whisked away by that hurricane’. I wouldn’t argue with (although wouldn’t necessarily accept) the claim that in dental trauma the emotion is secondary at best, and that in, say, the treatment of a Vietnam Vet, it’s too overwhelming to be safely worked with by a therapist. But a sleight of hand comes in a later list of traumas (or ‘traumatic antecedents’): this includes birth trauma, loss of a parent or close family member, sexual, physical, and emotional abuse, including severe abandonment, or beatings. The list even includes ‘fetal trauma’, something that has figured more and more prominently in Janov’s theories as time has gone on.
Now we are in the territory of most modern psychotherapies; the ordinary and intolerable pains inflicted on us as we grow up to be citizens of a particular society at a particular time. Can we resolve ‘emotional abuse’ through Levine’s methods? All of Levine’s generalizations beyond the rather narrow base of traumas that he usually discusses and his implied criticism of cathartic therapies, suggest he thinks the answer is yes. But he has avoided making this claim directly, and he gives us no extended examples of his work with such cases, nor, and more importantly, does he ever provide any kind of reasonably developed theory of human functioning that would explain why he thinks he can avoid the return of the repressed – the nearest we get is a few simple reflections on the nature of memory, which should certainly be read as a corrective to Arthur Janov’s failure to take on board the fact that memory, including memory of trauma, is a much more active and recreative process than he would like it to be.
Janov in his recent books has been trawling neurology and related disciplines for a mass of evidence that something is recorded in the brain and body during trauma that can’t be conjured away by methods such as those recommended in Waking The Tiger, and, in any case, if neuroscientist Antonio Damasio is correct, the whole enterprise of the quest for bodily sensation without emotion is a futile one:
The records we hold of the objects and events that we once perceived include the motor adjustments we made to obtain the perception in the first place and also include the emotional reactions we had then….You simply cannot escape the affectation of your organism, motor and emotional most of all, that is part and parcel of having a mind.
By ‘affectation’ Damasio means the full emotional response to a stimulus – he gives the example of a car heading quickly towards you, and points out that this ‘does cause an emotion called fear, whether you want it or not’ and that the changes in the gut, heart and so on that accompany (or in some theories are) this emotion are equally involuntary. All such emotional responses are permanently there in the ‘records’ we hold of an event, and are inescapable. Again, so much for having to ‘dredge up’ emotions – according to Damasio you simply can’t escape them! And, for what it’s worth, that’s my experience too.
Why then has Levine been so influential? Partly because there was always going to be a reaction against the 1970s emphasis on catharsis, especially when books like The Primal Scream made such huge and unsupported claims for its healing power.
But beyond that there’s been a huge change in the broader ‘alternative’ culture and, just as cultural developments in the ‘1960s’ helped produce The Primal Scream, ideological movement in the 80s and 90s laid the groundwork for the revisionism of Waking The Tiger.
Janov’s book bears all the illusions of the age of Che Guevara. It’s heroic, violent, risky, gullible, misleading and still magnificent. Levine’s therapy is the product of the age of Bill Clinton and Tony Blair. Where Janov insists on head on violence against neurosis, seeking to smash it to bits as completely as the revolutionaries of ’68′ wanted to destroy capitalism, Levine hardly dares to ask it politely to move over a little on the couch, advocating methods so attentuated it seems generous to call them ‘reformist’.
We need to take what’s good from Levine’s work – the desire to find safe and more widely effective forms of psychotherapy that draw on the resources of the body in the quest for healing – and leave behind his clumsy attempts to aggrandize the status of his work by denying the role of emotions in suffering and its relief.
Otherwise we are left with an impoverished and distorted vision of human nature and forms of therapy that claim so much more than they can achieve. There are lots of mildly useful band-aids around at the moment, and only those who have never suffered themselves will despise them or fail to wish well to those using them: cognitive behavioural therapy, counselling, perhaps even approaches like the one under review– all are likely to help more people than a method as difficult and demanding as Primal Therapy. Besides, in any form with a claim to Janovian orthodoxy, the Primal base has shrunk to little more than a few dozen therapists working in two non-co-operating centres located in the western parts of one city. The other systems are useful because they are so mild, because they address the causes of human suffering so cautiously and so indirectly. For most people in most situations, such caution is appealing and appropriate.
In the current conjuncture I think we have two choices if we want to go beyond elastoplast: wait around for the neuroscientists to develop ‘prozac that works’, a dose of neurotransmitters that will act as effectively as Huxley’s soma to wipe out psychological misery, or to use all our resources to transcend the prejudices of the past and create a complex and multi-faceted set of psychotherapeutical methods that will relieve suffering without depriving us of our authentic minds. This will include the basic ideas and practices of Primal Therapy in a form made safer and more potent by an intellectual development that takes it out of of its context of ’sixties’ anti-intellectualism – ‘feelings’ are most dangerous when you’re told they’re all you need.
Or when they’re denied any role in healing. The creation of an adequate psychotherapy will require absolute intellectual clarity. Peter Levine’s book is the opposite of helpful in achieving this. He’s a thinker of very minor talents who tried to make a major contribution, with predictable results.
Meanwhile, the best of luck to anyone who has set out on any path in the hope of finding relief from emotional pain and greater fulness of life. Beyond all theoretical differences, we are all in this together.
 He has now developed this approach into something called Somatic Re-experiencing. Waking The Tiger is still cited on his website as a major resource for this approach, which, as far as I can make out, continues rather than breaks with its way of thinking.
 29. All references are to Waking The Tiger: Healing Trauma by Peter A. Levine and Ann Frederick (North Atlantic Books, Berkeley, 1997) unless otherwise indicated.
 R. D. Laing, with his willingness to draw on such ‘elitist’ figures as Sartre, was an important exception. Until he read The Primal Scream and….well, that’s another story.
 William Swartley, in Michael S. Broder, An Eclectic Approach to Primal Integration, 1976, v1.
 Levine, 1997, 38-39.
 See my obituary of J. G. Ballard for a few comments on this process.
 Levine, 1997, 118.
 http://en.wikipedia.org/wiki/Focusing#What_is_a_.22felt_sense.22.3F. Levine’s explanation is on page 67.
 Most notably Primal Man and Primal Healing.
 There is a similar ‘slippage’ from ‘rare’ trauma in Babette Rothschild’s The Body Remembers, 2000, 96, when she discusses a client whose ‘symptoms’ are due to ‘beatings he received as a child’. Although Rothschild is rather too attached to the idea that there is a special state called PTSD, she is generally more circumspect than Levine in her claims.
 Antonio Damasio, The Feeling Of What Happens: Body, Emotion and the Making of Consciousness, 2000, 147-8.
 For example:
STOP THE NIGHTMARES OF TRAUMA
Thought Field Therapy, the power therapy for the 21st century. Help trauma victims more quickly with less suffering (no painful emoting)
Advert Yoga Journal, (published from Berkely,CA, July/August 2000, 173)