Psychoanalysis, Birth and Before

Stephen Khamsi, Ph.D.

Originally published in 1985, in The PPPANA Journal, 1(1), pp. 6-10. 

Thanks to Dr. Thomas Verny for asking me to develop this from another of my articles, “Birth Revisited.” 

Traces of the birth experience occur in dreams, myths, and fantasies, and sometimes seem to be acted out or re-experienced in various ways (Laing, 1976, p. 58). In recent years, many people have reported having had experiences, as adults, that they believe are directly related to their actual biological births. These people tell of their births and even of their prenatal lives either as memories never forgotten, or as memories recalled as a result of psychoanalysis, hypnotherapy, LSD-assisted psychotherapy, primal therapy, or rebirthing. Many of these people believe that what happened from their conception to and through their birth may exert an influence that persists into adulthood, and that “reexperiencing birth” may have beneficial effects.

Since the earliest days of psychoanalysis, there has been a suspicion that the birth experience may play a role in psychological development (Chamberlain, 1983, p. 26). Psychoanalytic investigation has produced a rather rich--if little-known--body of literature regarding the psychological impact of birth. Does the birth process have general and lasting effects on human personality development? Does a traumatic birth result in greater chronic stress that a “normal” delivery? Is birth universally traumatic? Are the salient factors ontogenetic or phylogenetic in origin? These are among the questions that have been examined in the psychoanalytic study of birth and before.

Psychoanalytic theory is universally recognized as having been the incentive to numerous researchers and to findings in the fields of normal and abnormal psychology (Ellenberger, 1970, p. 549). Freud, the originator of psychoanalysis, exerted a powerful influence not only on psychology and psychiatry, but on all fields of culture, and this has gone far to change our way of life and our conception of humankind (p. 546). His influence has been pervasive, and many of his views have persisted in a lasting legacy. As in so many other areas, Freud’s views of the importance of birth have been all but authoritative.

Freud never considered the birth process to be a major determinant of personality. He was affected by the neurological opinion of his day, which held that a child lacks the physiological maturity for meaningful experience until the age of two or three. Freud did concede that the act of birth represents an individual’s first experience of anxiety, and that there is some connection between the birth experience and the form of later anxiety; but aside from serving as the prototype of anxiety, birth was considered fairly unremarkable in its effect on psychological life. Freud always stopped short of believing that there was active mental life at this time, so he considered “birth material” from psychoanalysis to be fantasy rather than memory--a position held by the majority of psychotherapists to this day (Chamberlain, 1983, p. 26).

While most psychoanalysts have basically agree with Freud’s portrayal of the significance of birth, a few have voiced dissenting opinions. Most notable are Rank, Winnicott, and Fodor. Otto Rank is well-known for his thesis that the birth trauma is a universal phenomenon with lasting ill effects that are central to psychological life. The core of this trauma involves the shock to the psyche when it is thrust from the womb out into the world. D.W. Winnicott, the English pediatrician and psychoanalyst, denied that birth is always a traumatic affair. He insisted that a normal birth is non-traumatic and leads to increased ego strength and stability. Nevertheless, he noted also that traumatic births leave a permanent mark on the individual, and that birth material sometimes surfaces and must be worked with in psychoanalysis. Winnicott was open as well to the possibilities of intrauterine trauma and to its later abreaction. Nandor Fodor, the Hungarian analyst, believed that dreams often reflect natal and prenatal material. His attempts were directed toward releasing the birth trauma integrating prenatal material. The remainder of this paper will focus on these notable perspectives of psychoanalysis, birth and before.

Freud

Freud’s theoretical interest in the birth experience was tied to his great fascination with the experience of anxiety. The problem of anxiety “is a nodal point, linking up all kinds of most important questions; a riddle, of which the solution must cast a flood of light upon our whole mental life” (Freud, 1920/1935, p. 401). Freud’s views of anxiety changed in complex ways throughout the course of his life (May, 1977, p. 117), and although a complete account is beyond our purposes here, a brief summary is in order.

Freud recognized three types of anxiety (Hall & Lindzey, 1970, p. 440). The basic type is realistic anxiety, anxiety about a known danger in the external world. Derived from this are neurotic anxiety, the fear that the instincts will become uncontrollable and result in punishment; and moral anxiety, fear of the superego. Anxiety is a state of tension that functions as a signal to warn the person of some impending danger, and serves as a motivator to do something to escape such danger. Anxiety, for Freud, is both an expectation of a trauma, on the one hand, and a repetition of it in a mitigated form in the hope of mastering it physically, on the other (Freud, 1927/1959, pp. 92-3).

Freud first came upon the problem of anxiety in his investigation of the “actual neuroses.” Concluding that anxiety neurosis always involves a disturbance of the discharge of sexual tension, Freud surmised that undischarged libidinal energy was directly transformed--through a purely physical process--into anxiety. Psychoneuroses were also thought to result from the transformation of accumulated libidinal energy into anxiety, though due to the psychological process of repression. 

Later abandoning this notion of anxiety as transformed libido, Freud came to favor the idea that anxiety is a reaction, on a particular model, to the threat or actual occurrence of danger. Freud’s original model for the affect of anxiety was, curiously, the act of sexual intercourse: “the dyspnoea and palpitations that occur in the hysteria and anxiety neuroses are only detached fragments of the act of copulation” (Freud, in Starchy, 1959, p. 10). This early formulation was later replaced by the idea that birth, rather than copulation, provides the model for anxiety: “the act of birth is the first experience of anxiety, and thus the source and prototype of the affect of anxiety” (Freud, in Starchy, p. 10). Children actually begin their experience of anxiety in the act of birth itself. Anxiety, seen previously as an isolated and exaggerated outlet for accumulated libido through the act of copulation, came to be seen as a derivative of the birth experience.

While acknowledging the connection between the act of birth, as an individual’s first experience of anxiety, and the forms of subsequent anxiety, Freud warned that this should not receive “undue stress.” He painstakingly pointed out that an outbreak of anxiety is not a reproduction of the birth situation going on in the mind. To understand this, one must be informed as to Freud’s image of the birth experience, presented briefly in the following classic passage:
In the fact of birth there is a real danger to life. We know what this means objectively; but in a psychological sense it says nothing at all to us. The danger of birth has as yet no physical content. We cannot possibly suppose that the foetus has any sort of knowledge that there is a possibility of its life being destroyed. It can only be aware of some vast disturbance in the economy of its narcissistic libido. Large sums of excitation crowd in upon it, giving rise to new feelings of unpleasure, and some organs acquire an increased cathexis, thus foreshadowing the object-cathexis which will soon set in. (Freud, 1927/1959, p. 61)

The newborn is unable to make psychic meaning out of the birth experience. The experience is physical in nature, and quite disturbing. Birth is important first and foremost only as a symbol for the form of later anxiety reactions. For Freud, sexuality and aggression are the primary determiners of human experience and behavior, and are of infinitely greater consequence than the birth experience.

In addition to this plausible portrait of the significance of the birth experience, Freud held two rather peculiar notions. The first had to do with the issue of castration, which he considered one of the strongest influences on character development. Objectively, Freud considered the birth experience a separation from the mother; but because the fetus is a “completely narcissistic creature” totally unaware of the existence of the mother as an object, it is not experienced subjectively as a separation. What then is the subjective experience of birth, if not one of separation? Freud’s peculiar response is that “it could be compared to a castration from the mother (by equating the child with a penis)” (Freud, 1927/1959, p. 56, parentheses in the original). This is a frugal theoretical stance, self-serving and parsimonious: it simultaneously diminished any possibility that birth might be a foundational experience for later losses, and elevates the castration complex as the nuclear complex which accounts for the prior birth experience.

The second peculiar notion finds Freud reaching even beyond these rather implausible ontogenetic speculations. Let me explain. For Freud, affects were, at their core, repetitions of an “exceedingly early impression of a universal type, to be found in the previous history of the species rather than the individual” (Freud, 1920/1935, p. 403). This phylogenetically-inherited schemata--in this case the predisposition to anxiety--has become so deeply ingrained in the organism through countless generations that no one individual can possibly escape it. Not even those born by cesarean section can avoid this inheritance. The predisposition to anxiety has at once both ontogenetic and phylogenetic elements: the individual experience of birth and the phylogenetic heritage, respectively. The child fills in the gaps of individual truth with prehistoric truth.

In sum, Freud believed that the primary importance of the birth experience, as the first experience of anxiety, is in providing a form for subsequent anxiety. Far more crucial than birth to psychic development are the instincts of sexuality and aggression. The castration and Oedipal complexes are considered critical nuclear concepts that subsume the more peripheral experience of birth. Deriving quite reasonably from such beliefs, Freud insisted that “there is no place for the abreaction of the birth-trauma” (Freud, 1927/1959, p. 64).

Rank

Otto Rank, one of Freud’s closest friends and colleagues, surprised psychoanalysts in 1924 with his new book, The Trauma of Birth. Ostensibly offered as a contribution to Freud, the book represented an attempt to reformulate psychoanalytic theory and practice (Ellenberger, 1970, p. 844). Rank greatly expanded the idea, originated by Freud, that the neonate’s anxiety during the birth process is the prototype of all later anxiety. Rank concluded that not only anxiety, but the whole of psychic life is related to the trauma of birth. Freud as at first favorably impressed by the book, but after several months rejected Rank and his theory (p. 845).

Rank believed that the fetus enjoys a completely protected and pleasurable existence, and that this blissful primal state is interrupted by the act of birth--wrenching, tumultuous, traumatic. The ego recoils from the primal anxiety of birth, and massive repression buries the memories of both the birth trauma and the blissful intrauterine state. We are then urged forward to seek Paradise in the world formed in the image of the mother; repression prevents us from pathological regression which would make us unfit to go forward in life. The remainder of life is marked by an unconscious drive to restore Paradise Lost.

For Rank, (1929/1952), “the nucleus of every neurotic disturbance . . . lies in the birth trauma” (p. 46). Neuroses are failed attempts to overcome the birth trauma and are, in all their forms, reproductions of, and reactions to, the birth trauma and/or the prenatal state (p. 212). Moreover, birth replaces castration as the nuclear psychogenic trauma and the Oedipus complex is dethroned because “the historical and genetic primacy of the birth fear as compared with castration fear . . . seems undeniable” (Rank, 1936, p. 119). According to Rank, the birth trauma and the weaning trauma are both painfully experienced actual traumata; they are massively repressed, and their effects are displaced onto the later castration fantasy. In exact contradistinction to Freud, Rank (1929/1952) insisted that the castration fear is based upon the “primal castration” at birth (p. 20). The birth trauma and the weaning trauma are of primary and secondary importance, respectively, while the castration fantasy is of only tertiary significance. 

Rank (1929/1952) believed that the patient’s unconscious uses the psychoanalytic process to repeat the trauma of birth, thereby partially abreacting it (p. 11). In analysis the patients repeat the period of pregnancy, and at the conclusion of treatment repeat their birth “for the most part quite faithfully in all its details” (p. 5). Successful analysis brings a belated mastery of the birth trauma and separation from the mother, who is symbolized by the analyst. There is always great resistance on the part of the patient to sever the transference relationship, because it represents in some ways the patient’s physiological connection to the mother’s womb.
Unfortunately, Rank was quite vague about what he actually did and did not do in therapy (Kirschenbaum, 1979, p. 91). It is clear, though, that he deplored lengthy analyses; his analyses were rather short in duration, lasting from four to eight months. Rank believed it best to begin with disclosure of the primal trauma, and to allow the patient to repeat and understand the birth trauma and its solution during the analysis and within the transference (Rank, 1929/1952, p. 213). The therapeutic advantage here is that the “Gordian knot of the primal repression” is severed with one powerful cut; the compulsion to reproduce the primal trauma is removed, so that the end of analysis brings the sexual conflicts and guilt feelings in pure form undisturbed by the regression mechanism.

The idea of abreacting the birth trauma was never comprehensible to Freud. While admitting that Rank’s birth trauma theory was a legitimate endeavor to solve the problem of analysis, Freud (1927/1959) objected to its “far-fetched character” (p. 62). He criticized Rank for assuming that the neonate is capable of receiving visual impressions at the time of birth, and for the arbitrary nature of his interpretations, focusing variably on neonatal agony and on prenatal ecstasy. Freud’s main criticism, however, was that while Rank’s ideas about birth and psychopathology could be tested with empirical research, no such attempt had been made. In addition to these manifest criticisms, it is reasonable to assume that Freud perceived Rank’s birth ideas as a threat to the basic foundation of psychoanalysis, since Rank characterized birth as a universal phenomenon with a determining influence on personality development. In any event, Freud’s dismissal of Rank and his ideas has affected the development of psychoanalysis ever since.
Rank’s assertions in The Trauma of Birth were modified substantially during the remainder of his life. The birth trauma was later considered important as a symbol of the original suffering nature of humanity (Rank, 1936, p. 122), as well as a pathogenic biological emergency. His later methods of therapy were of great influence to the young Carl Rogers (Kirschenbaum, 1979), and his wide-ranging thought has been hailed by the late Ernest Becker (1973) and many others (cf. Khamsi 1997). 

Winnicott

Drawing on experiences both as a pediatrician and as a psychoanalyst, Winnicott (1949/1975) held that “the personal birth experience is significant, and is held as memory material” (p. 177). Due to the importance and pervasiveness of birth memories, Winnicott implored analysts to be prepared for such material. His stance was that “since the birth trauma is real it is a pity to be blind to it, and in certain cases and at certain points the analysis absolutely needs acceptance of birth material in among the other material” (p. 180).

In contrast to Rank, however, Winnicott held that birth is sometimes traumatic and sometimes normal. For Winnicott (1949/1975) the normal experiences are constructive, and promote ego strength and stability (p. 181). In a normal birth the reaction to the challenges of birth does not exceed that for which the fetus is already prepared; the normal birth experience is an exaggerated sample of something already known to the fetus. In the memory trace of normal birth there is no sense of helplessness. Instead, the birth can easily be felt by the neonate to be a successful outcome of personal effort (p. 186).
Normal birth aside, Winnicott postulated two grades of traumatic birth. One is common and largely nullified by “good management,” while the other is definitely traumatic, difficult to overcome even by the best of care, and leaving its permanent mark on the individual (p. 190). Presaging many later birth theorists, he insisted that “when birth trauma is significant every detail of impingement is, as it were, etched on the patient’s memory” (p. 183).

Winnicott believed that some individuals’ birth traumas presented such adversity that, apart from reexperiencing birth in the course of analysis, they had little or no chance of making normal progress in emotional development. While providing little information about technique, he did note that interpretation in terms of birth trauma was insufficient, that something more was needed. Winnicott implied that he worked directly along non-analytic lines with patients who were deeply regressed during sessions. He felt that talk about the birth trauma was superfluous with patients who were not regressed in their sessions, and who were not clinically ill between sessions.
Winnicott agreed with Freud regarding the existence of a clinical relationship between anxiety manifestations and the details of the birth experience. But whereas Freud felt that anxiety was rooted in phylogenesis, Winnicott disavowed any such explanation. Winnicott thought it logical to relate the universal phenomenon of anxiety with the universal ontogenetic phenomenon of birth, including the so-called normal birth. Nevertheless, he felt that too little was known about the psychology of the neonate to proceed with this theory relating anxiety and birth. Winnicott insisted that such information should come from psychoanalytic experience with regressed psychotics who tend to relive such early phenomena, bypassing fantasy which employs symbols. He felt that such study should take precedence over intuitive understanding and even over the objective study of infants.

Perhaps most interesting--and certainly most extreme--among Winnicott’s findings is the possibility of intrauterine experience being re-experienced in psychoanalysis. His brief reference to this is that “in the very close and detailed observation of one case I have been able to satisfy myself that the patient was able to bring to the analytic hour, under certain very specialized conditions, a regression of the self to an intrauterine state” (Winnicott 1949/1975, p. 191, italics in the original). He distinguished this experience from common fantasies with a similar theme. The psychosomatic continuum extends back to birth and before, says Winnicott, and should be properly investigated.

Fodor

In many ways, Fodor reiterates the earlier contributions of Rank. Each believed in the importance of the birth trauma, had concerns about its lasting ill effects on subsequent personality development, and designed therapies to abreact the birth trauma. The important distinguishing feature, however, is Fodor’s greater appreciation of the prenatal origins of consciousness and trauma.

Like Rank, Fodor (1949) believed that the child’s reactions to birth are always catastrophic (p. 383). After nine months of relatively peaceful development, the child is suddenly catapulted into a strange new world by cataclysmic convulsions. These unwelcome changes come about in three violent stages: the loss of the waters, the beginnings of labor, and the actual delivery (pp. 14-15). He believed that the change from prenatal to postnatal life involves an ordeal as severe as dying (p. 4). The agony of birth is repressed; our natal and prenatal beginnings are forever dissociated from consciousness (p. 190). The record of these experiences is preserved in the unconscious, however, and we have access to it in our dream life (1951 p. 17). 

Fodor denied that life for the unborn child is always an idyllic existence, peaceful and serene. Prenatal trauma was considered to be fairly common. Shocks to the fetus--caused, for example, by parental intercourse late in pregnancy, and by failed attempts at abortion--impress the unborn as murderous attacks. The cutting of the cord was also considered highly significant as a first postnatal trauma, and was thought to comprise the foundation for later castration anxiety in both males and females (1951, p. x). Fodor was fascinated by the effects of such events on the developing psyche, and believed that the last two months of prenatal development are particularly crucial to one’s later perspectives in life. He also believed that fetal consciousness might be affected through telepathic or clairvoyant communication with the mother (1949, p. 80).

For Fodor, analysis was complete only when it reached the fetal levels of the mind. His therapeutic approach (which he called “Birth Therapy”) was largely on dream interpretation along the lines of natal and especially prenatal trauma. Regarding birth trauma, he reported that some of his patients, though very few in number, appeared to actually relive their births on the analytic couch. His statements about these incidents are confusing: “it is impossible to abreact the drama of birth. No technique exists to meet the situation. Yet some patients can be led back to birth and do appear to re-live this remote event (1949, p. 193). In any case, he was more concerned with the therapeutic than the factual value of such experiences (p. 385).
Again, analysis for Fodor must reach the fetal mind. The release of the birth trauma, while of immense importance, was introductory to the more vital phase of prenatal integration. In order to release the shocks suffered prior to birth, the patient must gain an intellectual grasp of their existence and nature. By the power of understanding, these primitive fear reactions were thought to enter the conscious mind and gradually cease their pressure. Prenatal integration did not occur if one was unwilling or unable to accept such “facts” (1949, p. 353). Unfortunately, Fodor was rather nebulous as to how this process is either possible or therapeutic.

Also unfortunate was Fodor’s failure to provide clear statements about his methods in general. Although providing numerous examples of his “new approach to dream interpretation,” the actual techniques indigenous to Birth Therapy were, to my knowledge, never explicated. However, he clearly advocated the use of birth simulation techniques, stating that “we have to recreate the conditions of birth and permit the child to re-live it with conscious appreciation” (1949, p. 30). One specific recommendation was that nurseries provide tunnels through which children could crawl “safely but with difficulty,” perhaps encouraging with rewards those children who would otherwise shrink away from such simulations of birth. While believing that “an intelligent recreation of the conditions of birth and a re-living of the ordeal by simulation are techniques which the growing generation desperately needs” (p. 384), it remains unclear whether he actively explored such techniques.

Discussion

These are the major psychoanalytic formulations regarding the importance of birth and before. Bold attempts have been made to understand, describe, and explain the effects of such early events upon later personality development. Typical of psychoanalytic investigations, there is a lack of systematic control and little empirical evidence, but lots of speculation. Nevertheless, these provocative proposals represent highly creative first-attempts to seriously explore this psychosomatic terra incognita.

The persistent problems of psychology, like those of every other science, are initially the problems of philosophy (MacLeod, 1975, p. 31). In trying to solve such problems, the psychologist looks at the evidence in human experience and behavior, and becomes interested in the best ways of controlling and verifying observations. The problems here include: How are mental and physical processes related? What is the nature of the relationship between body and mind? What are the psychological, somatic, and psychosomatic human possibilities? More specifically, is the mind of a child tabula rasa at birth, as suggested by John Locke in his empirical theory of knowledge? Or could etchings on the blank slate of the mind occur during, or even before, birth? Might the so-called “innate ideas” of Cartesian philosophy actually be derivatives of intrauterine and/or perinatal experiences?

Several of the formulations under review suggest that traditional models of the human mind-body may be strengthened by incorporating birth and prebirth processes into our thinking. Natal and/or prenatal events may in some way affect the primary structures of consciousness, including the developmental course of perception, cognition, emotionality, and behavior. It may be that neonatal and/or prenatal elements, banished from consciousness, may be recapitulated in the areas of sexuality and aggression; these so-called “instinctual drives” may largely be non-instinctual reactions to actual prior events.

These psychoanalytic formulations represent some of the earliest considerations of the possible effects of birth and before upon later developments. By including these effects in our paradigm, we may eventually be able to better understand, describe, explain and predict human developmental processes. Now is the time for more systematic, controlled research of such phenomena. Important work remains to be done, and much can be learned from these early attempts to understand psychoanalysis, birth and before.

References

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