You will remember Freud's statement "All anxiety goes back originally to the anxiety at birth." In his The Trauma of Birth, Otto Rank took that Freudian text and far exceeded Freud's own formulation in giving priority to the birth experience among the determinants of mental life, its compulsions and its sicknesses. Rank saw birth as a psycho-physical experience with "prodigious Psychical consequences." He called it the "ultimate physical basis of the Psychical." It was the primal cause of selective memory, since it is the first experience in the life of a human being to require repression. This repression seals off the unpleasant or actually traumatic sensations of parturition, which consequently remain forever as a background to all subsequent sensations.
Together with the reverberating record of these physical happenings, the concomitant feelings, which are often of high and panic intensity, continue as undisposed-of affect, and as such seek re-expression. Rank claimed that "every opportunity which somehow 'reminds' the child - mostly in a symbolic way - of the birth trauma is used again and again for the abreaction of the undisposed-of affect."
Rank regarded the baby's experience of parturition as one of the fundamental sources of birth in that constellation of symptoms he and others have associated with birth. He claimed that the adult's "choice" of the form of neurosis is determined quite decisively by the process of birth, and of the special point of attack of the trauma, and the individual reaction to it.
Ferenczi observed a close association between claustrophobia and the idea of being inside the mother. On the other hand, W. P. Laughlin, in The Neuroses, rejects birth trauma as not very important. He believes that some kind of protective unconsciousness is provided by nature to the infant at birth. This insensitivity to stimuli can, he claims, be "readily seen in the delivery room."
But then he seems to give his case away by describing this protective process as "dissociation."
Wilhelm Reich studied the body armouring and concluded that it was the contracted pelvis in particular which could make birth a traumatic experience, instead of a climactic release of energy. It is likely, and the author of this paper thinks similarly, that the experience of a bad birth becomes particularly crippling if it is locked-in and reinforced by a constrictive upbringing. But where an upbringing can provide warmth and security, all but the severest shocks to the energy-system at birth can be largely compensated for.
The crux seems to be, what are the sensations of the foetus under the impact of a birth with the left occiput pressed up against the pubic arch? Is this a pain in the neck until the pubic arch is passed? Does he at times feel 'driven round the bend'? When the right occiput comes to lie posteriorly, birth involves a long internal rotation, the head is severely flexed with the occiput in the sacral hollow, and the face, brow, eyes, nose and jaw are rammed up against the pubic bones.
Does the foetus feel anything or nothing? Does a transverse lie or an impacted persistent mento-posterior presentation, in which the chin has to rotate through nearly half a circle, produce at least as much panic in the foetus as it does in the young obstetrician who also comes upon the experience for the first time?
When the pelvis is contracted until getting through is like getting through a cleft in the rocks, is this experienced as such by the foetus? If so, is it, though dissociated, and immediately or rapidly repressed, none the less retained as a painful experience in the unconscious? If so, can it influence behaviour in analogous 'tight spots' and 'narrow squeezes' in adult life?
"There is thus a considerable degree of dissociation from the infant's potential conscious awareness, of the potentially traumatic process. Accordingly, one may doubt that the so-called trauma of birth could often play a significant role in emotional health, or in the concept of antecedent conflict."
A main cause for concern during delivery is the foetal circulation. Hypoxia in some degree is inevitable. Severe anoxia is common enough from cranial, pulmonary, umbilical or maternal difficulties. Some babies are born in a state of surgical shock with white asphyxia, grey, limp, cold and flaccid. Blue asphyxia in the warm, less shocked baby would none the less be a most unpleasant experience - if it is experienced, and could be an important element in conditioning were it also memorable.
The common finding, that LSD-25, given as an adjunct to psychotherapy in an acceptable setting, permits the release from repression of memories from earliest infancy, and the re-living or repetition of what appear to be first-year incidents, raises at least the possibility that by the use of LSD we could begin to answer this kind of question.
BEHAVIOUR THERAPY AND THE PHOBIAS
In his recent paper on "Behaviour Therapy for Anxiety States" (BMJ 1969 1 693/694), Professor Michael Gelder follows Wolpe in separating out the themes within the phobias into hierarchies, each of which is made the basis of a list of similar phobias which can be ranked in order of their power to disturb the patient. A primary hierarchy is that of claustrophobia, the fear of enclosed spaces.
The Latin root claustrum is a bar, or bolt, or lock. In this sense claustrophobia is not simply fear of the reduced space, but of the bolts and locks that bar the way out. It is characteristically not a fear of people. The phobias whose themes have to do with the distancing of people, who are felt to be too far away, or too close, are in quite different hierarchies.
Claustrophobia is a fear of walls and things, not people. It also has to do with travel in closed compartments, whether in trains or buses, the greatest fear being expressed as the mid-point approaches. The fear is that you are not in control, and you can't get out, so the expense of a taxi may become a necessity. The fear of tunnels, narrow underground passages and clefts in the earth or the rocks come under this theme. The fear is one of crushing, of the mountains falling on your head and suffocating you.
The now famous Jesuit anthropologist, Teilhard de Chardin, in The Phenomenon of Man writes that the whole psychology of modern disquiet is linked with the anguish of space-time, of being crushed by the enormities of the cosmos.
Here all the classical varieties of the claustrophobia theme are projected ontologically. The question is, is this a projection of the microcosms of birth on to the macrocosm?
Returning to the medical concept of claustrophobia, Legin, B.D. (Claustrophobia, Psychoanalytic Quarterly, 4: 227-233, 1935) observe that skin and chest sensations are particularly common in claustrophic anxiety.
Martin Roth in his recent BMJ paper on Anxiety Neurosis and Phobic States (BMJ 1969 1: 489-492) speaks of the tachycardia, pre-cordial discomfort or pain, shortness of breath and intermittent choking sensations. Tremulousness and lack of co-ordination make skilled manual activity difficult.
"The great secret pre-occupation of modern man is to find some means to escape from a shut-in world, from the futility of a 'dead-end', the fear of immobility, the anguish of being in a hermetically sealed world, unable to find a way out." The quest for an 'issue' (Fr.) is always with him, for an escape, opening, outlet, outcome, end or solution. "Human beings experience themselves" he says, "as miners trapped through an accident deep down in the earth. For these miners to summon up the courage needed for the difficult struggle to climb back up the shaft they have to pre-suppose two things: some opening exists at the other end, and when that opening is reached, there will be air to breathe again." Man may suspect that "the opening at the other end leads to what is inhuman or subhuman", "deformed and on a level lower than the noblest aspirations of man."
These descriptions unquestionably come under the theme of claustrophobia. It is characteristic, however, of these and other essentially behaviourist accounts of the claustrophobia theme, and indeed of the person-centered themes of separation anxiety or agoraphobia on the one hand, with the commitment anxiety to people who are too close and demanding on the other, that the accounts of the relevant psychogenesis are confined to recent precipitating events. No primary determinants are referred to. The possibility, for instance, that these variations on the claustrophobic theme might have a common origin in the birth trauma, tending to escape from repression and return to consciousness in symbolically similar situations, is not mentioned.
Usually, in medicine, we describe original causes if we can find them. Otto
Rank believed that the association could validly be made but found it hard to establish the hypothesis against what must be quite fundamental resistances.
My submission is that if the evidence of patients under LSD describing what they themselves are convinced is the birth process is admissible evidence, the association between the sensations experienced in claustrophobic sufferers, and the sensations experienced by the foetus during the second stage of labour is a direct one. Under certain conditions, adults can no longer maintain the repression upon the specific experience they each endured at the time of parturition.
"Dizziness, feelings of faintness, tight sensations round the head and aching in the neck and lower back are commonly complained of and are caused in part by muscular tension."
"Insomnia is common, and sleep itself is restless, unsatisfying and punctuated by frightening nightmares. The patient finds herself helplessly engulfed in outbreaks of war or revolution, trapped in burning houses or under cross-fire in some desolate no-man's-land, or imprisoned in a lift from which there is no exit."
"The main complaints will be of constant sense of being wound-up and on edge and of responding in a startled and irritable marmer to all unexpected stimuli, no matter how trivial . . . Dangers or disasters are feared to be lurking behind every unexpected event."
In this series LSD-25 was given as an adjunct to psychotherapy on some, though not all occasions, to 68 patients over a period of 8 years. The average number of sessions per patient was 6.2. A total number of 386 sessions is reported on, ranging from 1 - 38 per patient. Since each session lasts from 4 to 6 hours, this represents an average of about 30 hours per patient under LSD. The working dose of LSD-25 was about 200 gamma. I myself, or someone acceptable both to the patient and myself, sat with the patient throughout the experience.
A recent follow-up questionnaire made out by Dr Donald Ball and Prof. K. Rawnsley brought 58 replies. The common finding that LSD releases 'memories' of earliest infancy was confirmed by the number of positive responses to the following questions:
SUMMARY OF THE FINDINGS OF A SERIES OF PATIENTS GIVEN LSD AS AN ADJUNCT TO PSYCHOTHERAPY
Did you ever feel at the time that you were again: *My own clinical records, largely verbatim, show that at the time of the relevant LSD session, not merely 38, but 45 of 58 patients now reporting had said that they felt they were re-experiencing some part of the birth process. However, of the 7 who had apparently 'forgotten' this, 5 place on record that they felt they were again in the womb. It is probable that the question was not expressed with sufficient discrimination.
|a child?||35||affirmative responses|
|a baby? (0 - 1 yr)||37||affirmative responses|
|being born||38||affirmative responses*|
|in the womb?||21||affirmative responses|
STATEMENTS MADE BY THE PATIENTS WHO BELIEVED THEMSELVES TO BE RE-EXPERIENCING THE PROCESS OF BIRTH IN THE SECOND STAGE OF LABOUR
I am confining this report to a summary of the statements made by these patients when they believed themselves to be re-experiencing their actual birth. The exact status of this experience as "reality" of "fantasy" is obviously an open question. Most of you here are familiar with the way in which under LSD patients will themselves distinguish between the facts and sensations of infancy, and the interpretations, often quite mistaken, which they put upon those events at the time. This distinction between sensation and interpretation is fairly clear in their accounts of birth abreaction.
I confess that from 1955 to 1958 under the sway of neurological opinion about the a priori impossibility of sensation and memory being served by an as yet undeveloped nervous system with unmyelinated tracts, I resisted my patients' attempts to tell me that they were re-experiencing birth, almost as if they were trying to bring my scientific work into disrepute. In any case, we were keenly following up under LSD the roots of separation anxieties, dread and the schizoid position, going for confirmation and elucidation to Bowlby, Winnicott and Fairbairn.
These statements made by patients who believed themselves to be re-experiencing their actual birth, cannot convey the sense of immediacy and actual re-enactment which are so vivid and realistic as to be compelling, particularly to some of my obstetrical colleagues who have sat with me. A phenomenological analysis of these experiences falls under certain main heads. You will see how closely they correspond to the medical descriptions of claustrophobia.
(1) The sense of being in, or traveling along a tunnel, with small rotating movements, and in some cases of getting stuck or wedged. (2) The sense of hypoxia or anoxia, felt as respiratory distress, breathlessness, suffocation or choking, and cardiac distress. (3) The specific sensations to the head, vertex, occiput, sinciput, temporal bones, ears, eyes, nose, jaw, face, mouth, throat, neck, chest, abdomen, navel, arms, hands, spine, groin. legs and feet. Many of these are recorded as unilateral events. (4) Sensations of heat and cold, of noise, of taste and of light. (5) Symbolic descriptions of the whole process of birth. (6) The reactions of what I can only call the foetal ego to these happenings, of confusion, anger, rage, panic, of fluctuations of courage and the will to struggle on, or to go back, or to survive on the spot if possible, or if possible, to die. (7) The sense of duration of time and the awfulness of waiting. (8) The records of final crowning and release as birth takes place.
"I've been drawn into a tunnel." (The walls of the passage are variously described like plates on the wall, or coins on the wall, or like passing hedges.)
"I'm going through this bloody tunnel backwards."
"I'm traveling down a tunnel with such a pain in my head."
"I'm sort of shut in, but not suffocated, not yet, that came later."
"I'm like a pea being pushed along a pea-shooter."
"It is a barrel, and I'm in it, gasping for dear life."
"I seem to be in a cavern."
"I had a sort of roof over me, like a piece of uncooked tripe, with holes in it, steamy and moving by."
"I'm feeling spirally." A university lecturer got the roots of his work-resistance problem here:
"I can see why people use terms like a 'vortex'." "It's like being sucked down towards a plug-hole in a bath, by spiralling water."
"In this vortex you are strained and twisted round like an old rag."
"I was spindled like a piece of laundry you are wringing the water out of. . .
"Always this tremendous twisting pain whenever I attempt to create anything out of my mind."
The feeling of being wedged, crushed and crunched:
"I got wedged round some god-awful corner." This man, the university lecturer, went on to say, "That's what they did to me, wasn't it? Poultry. Truss him like poultry and stick pins and needles into him, and see if the little bastard breathes. You important people squeezing and pummeling him." At this point his head was sharply and excessively extended. "There's no beauty, no intelligence in this, only brute strength. I've got that, too, I'd done everything I could. I gave them the last bit of my energy, but they didn't tell me about that crunch; some bastardy did that without warning and you cannot resist that - you break into pieces. All - that majesty destroyed - in a crunch. It is like peanut brittle. I can remember the feelings after it in all sorts of ways. But they all feel narrow - drawn and stringy. Oh, my neck! They'll never let you breathe. (He hits himself sharply on the back of the neck.)That's what they do . . .
They've strained and stretched and twisted and beaten you, and you can't complain. Officially you don't know a damn thing about this. Afterwards they can enjoy themselves. At the moment you have only one thought - you have got to get through it. It's survival. And that's all there is - and the crunch, it's a tremendous pit going round and round and round. Aarrgh! No! There's nothing beautiful in this. Ughl Crunch! Oh my God! You see, it has twisted the other way now. I wouldn't let that happen again to anybody." (After a long, slow wrestling movement, he moves on to his back and breathes for the first time more relatedly - long slow inspirations and expirations.) "There was nothing after that - they snapped my little spine. There was nothing left then. Just keep alive, they said. You're splintered from top to bottom, and nothing left to do anything with. All strength and confidence has gone with that crunch. Nobody asked - they just did it. It was rather important tome. Though I did survive, I suppose. Whoever did this job, botched it. The doctor never saw Harvard - nor Ivy League. Why do you bastards have to turn things into a cylinder and then squash it? That's what I accuse him of, bones held together and you crush the life out of them. All I can think of is skeletons and broker backs and plague pits,stretched out and distorted - bastards - you go through it a thousand times, but you never get through it."
Another patient said: "The crushing is so bad, that what used to be the outside is now part of the self."
"I'm getting crushed in a closet or a shoe-box."
"You've got me in a fix."
"Oh, my God, the pain!"
"Don't crush me again or I will die on your bed."
"That crunch was terrible."
"Midwifery hasn't improved much - it must be like being run over."
"I don't want that crunch again - breaking my spine."
"Better take away a man's life than break his spine in giving it to him."
"I could take more, for I've been given more. But that crunch makes you think - is it worth it?"
"Backwards and sideways and twisted, not that ..... but writhing and grunting, the crunch, till there was nothing left."
The sense of hypoxia, breathlessness, suffocation, choking and cardiac distress:
"My heart is beating fast, I'm fighting desperately for breath." "I'm working hard to breathe now." "Please do anything, but let me breathe." "I can't understand why I am breathing so hard." "I'm being smothered. I'm just fighting for existence."
Some patients describe tachycardia and breathlessness while the pulse and respiration rate are actually not much elevated, if at all, while others enter fully into the experience and reproduce intense apnea until they are blue in the face. All kinds of frustrated attempts at inspiration are reproduced.
"It's so good when you stop choking me for a while."
"If it happens again, my heart will certainly give out."
The specific sensations from the head to the toe:
Head: The flexion, extension, and rotation of the head are all vividly reproduced, often with a desire to simulate the particular area ofchanging pressure with his own or the therapists hand or fist.
"I'm going head first with my head in a funny position. My head'splashed right over to the left." Several patients identified their migraine as essentially a repetition compulsion or re-enactment of the intra-cranial events of birth.
"Oh, my head, my neck; my head is down on my chest, everything is going into a left-hand twist."
"My head feels enormous and throbbing. The pressure comes on intensely, then it relaxes. Oh it hurts Oh God! That's my migraine.
"It is a headache that I've really got to put up with all my life." Some patients referred to their habit of stroking the back of the head when worried to a protective impulse related to the ongoing hurt of parturition, others explained that this same memory of injury prevented them from ever wearing a hat. Two said it drove them mad to be hit on the head, or to see anyone else so hit, because in fact they were guarding against a perpetual memory of a head injury. "It's like a vice - your brain's taken apart, like a vice you can't get out of."
"There's a tremendous tension in my head."
"It is important to keep my head covered."
"It was as though a sharp edge of bone had scored vertically down the middle of my forehead. It was not just pain, even severe pain, in the ordinary sense, it was pain on the brain itself, as if my brains were being unzipped down the middle." (Presumably stretching and tearing of the tectorius or the fall, is extremely painful.)
Occipital pain in the nape of the neck is very frequent indeed:
"There's pressure on the back of my neck, a crushing type of pressure, all very tight. It is a kind of stiffness and shuddering." He screws up his face with the pain, "There seems to be extreme provocation. I don't know what. It is damned hard work, whatever it is. . . In one patient, the pain in the area of the left ear was the worst feature. One clergyman had actually had an eye damaged at birth. The inflammation increased during his breakdown and analysis and the eye had to be removed. The abreaction of this birth injury required of him the maximum courage.
"It is bursting . . . must withdraw . . . must withdraw it."
"It is a great weight to carry round on your head."
"It is going to take my head and my ears and swallow them whole."
The jaw may be experienced as locked open, or dragged on:
"Oh, you broke my jaw." An Indian biologist re-lived a face presentation in which the lower jaw was felt to be crushed up into the fact. The re-living of this birth injury with very extreme extension of the head, put a dramatic end to years of compulsive work procrastination that had held up his presentation of his M.Sc. work and then his Ph.D. thesis.
"There's a sharp twinge of pain in my upper jaw on the left."
"My face is all going funny." It seems that a good deal of non-specific or atypical facial pain is probably referable to partially emerging memories of birth. This is a likely hypothesis if there are other features of this syndrome present and the life situation is symbolically of a claustrophobic kind. In several patients the marks of the pressure areas, especially of the forceps, have become visible again, as red or blue marks, during the abreaction. We have also noticed them during breakdown in claustrophobic persons. Trauma to the neck and throat:
"My cheeks are forced flat."
"My face is paralyzed. There's such a pain as if my face had been pushed in and squashed."
"My face is all screwed up."
"My nose is crushed flat - it is bunged up as if I had a cold."
"My neck is being pulled right round." Sometimes a patient will grip at a kind of invisible cord, or band round the neck, as if to tear it away. More commonly he will say that he wants to do something like this, but that the hands are pinioned. The globus hysterics has, in such cases, much earlier determinants than the symbolic conflicts cantering round eating.
"I am trying to get something off the back of my neck."
"My neck is going to break. It is squashed up and twisted."
"You have broken my neck and my ribs and my shoulders."
"I am sort of half strangled by something round my neck."
"Someone's pushing at my throat."
The chest and shoulder-blades are spoken of as being
crushed: "The weight is being taken on my shoulders." One clergyman whose brachial plexus must have been badly stretched at birth. re-lived under LSD the neural injury for which he was independently being treated by a neurologist. It had flared up during his breakdown. The arms: are described as being crushed into the body, or caught up alongside the head, or not "belonging to me," or paralyzed, or twisted up, or dead. The hands in several cases have moved into the position of tauten. A sense of sharp and severe tugging at the naval has been marked in several cases. In two, this was in conjunction with a sense of the cord being wound round the neck. The body generally: goes through movements of struggling, twisting,twitching, convulsive movements, tremors, and severe shaking.
"I feel like jelly reverberating." The base of the spine: comes in for a good deal of punishment in these patients, as is frequently reported on. Low back pain is not as common as pain in the neck during birth abreaction.
"My body takes up these positions without my doing anything about it."
The posture changes as the birth proceeds.
"Somebody has hold of me as if I were being bound with a rope." (The escapologist seems to have a compulsion repetition for his birth.)
"I'm just being shaken and shaken, that's what I need, a good shaking." Another makes violent rhythmic movements of the arms and legs, and says, "I feel this is good for me."
Genital tension: builds up during abreaction in some patients. "I am holding on for dear life, genitally."
"There's a panic excitement here, and a desire to masturbate."
A case has been described of a baby being born sucking its thumb. I have not seen a record of a baby born masturbating. One clergyman whose genital tension became unbearably painful during the birth said, "The genital area was once alive and was ME. Now it is not alive, and not me." The groin: is a site of griping pain for some.
"It is as if I were screwed up, stomach and loins, as though slogged in the stomach."
'It is very painful at the top of the thighs and the groin, the right side of the groin, the genitals, all knotted as though I've been booted; my back is very painful. I can't describe it."
"I'm going to get that pain again - I don't want it, it's terrible. it starts like being kicked in the balls or twisted there, somebody squeezing - goes right up the side. Felt as if I had been kicked in the guts, can't describe it, it hurts so much." The legs: experience of a variety of sensations, and go through a variety of movements; a cycling movement, a fast beating and tapping movement, and the crawl stroke movement. Pain and deadness are reported but also the pleasant sensation of a cord swishing between the legs. In a breech presentation, the pressure on the dilating buttocks and pelvis is clearly recorded. Also the sense of the body being freed while the head is still engaged. "You are pulling me to bits. A very characteristic remark is:
"Feel as if I had been broken on a wheel - in many places, not one."
"My pelvis is hurting, as though it has been wrenched apart."
"God, I'm so damned small, that's the trouble."
"What is so hard to do, I really am doing something." (He is struggling hard physically.)
"I believe this ..... Oh Christ, no not over again."
"Something has struck me with a force of revelation. I can't translate. Somebody has twisted me all out of shape."
"I am being pulled to bits, pulled apart, pulled in two, torn like a branch from a tree." The change of the body image so that it is experienced as small is almost always present, and also the sense of relative size, "I am trying to get into a smaller space to get through." The feeling of losing valuable parts of one's self on the way is expressed as "I feel like something is being taken away from me. I am losing a lot (of luggage) on this passage."
There is often a sense of being in water, or of the waters flowing past. The feeling of "mucus is all over me", is not uncommon.
Sensations of heat and cold:
Some complain of the heat and experience the birth as an unbearable stuffiness. "I am frightened of heat and of sex and of rage. They are all down here. I shall explode." On the other hand, after a severe labour in which shock has occurred, there is intense experience of cold. One said, "This is where you get the feeling of cold feet when you are up against impossible dangers." Though I cannot account for it, since the shivering reflex is said not to be present at this stage of development, the cold has led to shivering and chattering of the teeth in adults abreacting the experience. The complaint of a dry mouth and thirst is hot uncommon where foetal shock is present. Noise is sometimes perceived, generally as the rushing of a pulsating blood-stream, but from time to time the patient attempts to signify the long-drawn-outness of the experience by indulging in a strange high-pitched, long-drawn-out moan. It may vary in pitch in a rather uncanny fashion. In a recent TV play "Spoiled," the young victim of homosexual assault by a schoolmaster portrayed this symptom very vividly. When the end of the passage is reached, the sense of light coming on the scene for the first time is remarked upon. In one case, after a very severe birth with transmarginal stressing and a forceps delivery, the hatred of life and light was so great that the clergyman in question cursed and swore at life and light for about 3 to 4 hours before he became for the first time reconciled to them. For summer after summer he had suffered from intense photophobia and atopic dermatitis. Five years ago, after this intense abreaction of photophobia at the point of birth, he was able to go on holiday to the seaside for the first time, and actually to sunbathe. He has had no photophobia since then, and only short-lived mild attacks of atopic dermatitis in response to severe stress.
Symbolic descriptions of the whole process of
"Birth is one big horror." This girl, a schizoid and autistic personality, began to make real progress in her therapy after the re-living of the birth experience. she is now most adequately caring for autistic children.
"Births - sheer graveyard."
"Isn't it ghastly to have to scratch your way down your mother's back passage before you find any access to life at all?"
"The terror of these past weeks has been of being stuck in this passage - alone - for ever."
''Being born seemed degrading - as if one was being pushed out as shit."
''I have been born - there wasn't anything nice about it."
''The last stages of my birth were bloody hard work."
''I was just screaming my head off when I came into the world."
"My God, my gosh, no wonder one is marked for life."
"When I got born it was like taking sides against someone else. There was no one glad when I was born, but they expected me to be glad."
"The very experience of being born was enough to scare the life out of me." I would agree with Otto Rank that we must look to the birth experience in which well-being is attenuated under most humiliating circumstances, in contrast with the glorious majesty and bliss of life in the womb as the two poles of the paranoid process in its humiliation and exaltation. There is also the awareness of the fact that interpersonal relationship were not yet a possibility. This is a later agenda.
"I am in revulsion at being carried along in an almost intestinal situation."
"I almost went mad that time - the things they subject a baby to.
"I haven't left the womb yet, how can I relate other things with myself." One patient, in astonishment at what had just been experienced, said, "Apart from birth, is there anything at all with this kind of pain connected to it, that could have happened to me?"
Homosexuality in Men: In a series of 37 clergymen with homosexual problems, 13 consented to treatment using LSD-25. 2 could not use it at all, 2 experienced severe claustrophobia and panic during the course of the LSD abreaction, but could not identify the happenings. In 9 cases out of the 11 who could use the LSD, the man without any question dated this experience as the origin of his distrust of women, his paranoid attitude towards them, his determination never again to encounter them genitally. Most of what Otto Rank said about this seems to me to be confirmed under LSD.
I don't think there can be any progress in the fundamental therapy of homosexual states in the male, or indeed those gross hysterical cases where women have an equivalent distrust of the mother and maternal identifications, unless the fear of birth injury within the woman can be borne in the course of abreactive therapy.
The reactions of the foetal ego to these birth happenings:
Confusion: "I wish I knew what it was. It is just caves in water, and then it lets me go for a bit. Alright, then oh God, it is back. What a fury!"
"Confusion, confusion! If only I could think. What is all this that is happening to me? What is it all for? If only I knew what it was all about. What have I done to deserve this?"
"They won't let you have a moment's peace; they keep pushing you around."
"I can't do anything about it. If only I could understand."
At the climax he covers his face and pulls up his legs. At this point fear overwhelms the anger.
Anger and Rage: "I'm mad at something. There's pain and anger here." "Rage rises to a climax of terror."
"Anger and hatred, but I'm quite helpless to express it." It would seem that the characteristic inability of schizoid persons to express the rage they feel, or to take arms against themselves in suicide, derives from the helplessness with which rage is experienced in the birth passages. There is simply nothing you can do about it, it is also inexpressible. To try to express it by screaming could only make matters worse, by inspiration with the threat of atalectasis or pulmonary drowning.
"I want to scream - my nerves were screaming but I couldn't."
The fluctuations of courage:
"I don't think I can go through with this. Doc, give me the antidote. But I must go through it."
Otto Rank insisted that the infant had a unitary will to live and to get on with the business of being born. I believe this is confirmed in these abreactions. There is no doubt in my mind, however, that the will to be born as the vortex is entered, can be transformed, as the black rocks ahead are encountered, into a fervent desire to return into the womb. Dr. Bierer's Centripetal Womb Reaction (CPWR) is certainly confirmed in this work.
A third stage is often reached in which going back and going forward seem equally impossible, and there is only a struggle to survive. Beyond that I have noted on many occasions particularly in those who turn out to be schizoid or male homosexual personalities, what I would describe as a Pavlovian transmarginal stress. The struggle to live changes in one dreadful moment into an equivalent struggle to die.
It may be that transmarginal stress here provides the model for the transmarginal stress in relation to the personal agendas. There is a limit to the baby's ability to endure separation anxiety. At the end of that time there is a fall into the abyss of dread, non-being and de-personalization. After this, we frequently observe a transmarginal stress into autistic or schizoid withdrawal. But it is not my purpose to speak of that here. [*Dr Lake's views on this were developed in his earlier paper "The schizoid personality reaction" in Volume 3, No. 2 of The Journal of Energy and Character, May 1972. ]
"I nearly died, or I was nearly born - I haven't got the guts to face it."
"I can't make myself be born."
"You haven't got the fucking guts to get born."
The Death Wish in the birth passages is quite marked.
"I wanted to die several times then."
"I had an absolute desire to die. I still have."
"Just a tiny bit more and I'd have died. If I hadn't been able to get out of the birth passage I'd have been all right. I'd have died. They made me come out. I didn't want to come."
"What are we but people all struggling to be nowhere."
"I didn't snatch at the thread of life. I wanted it to snap. That stupid doctor saved me."
The crowning of the head is occasionally re-lived with an agonizing cry, and a final struggle. Suddenly all goes flaccid with a sense of relief.
The sense of duration of time and the wretchedness of waiting:
"I feel such relief. I've been squoze out at last."
"Press harder and harder, at last I'm through. I'm quite free. Free all round. Lovely."
"I was born.''
"I feel I've come out of the bowels of the earth. I don't want to sink back again."
As psychiatrists and case-workers
of long experience, you are familiar with this commonly occurring syndrome of claustrophobia, with its conglomeration of affects, compulsions, autonomic concomitants, and variable sensations in the head, face, neck, trunk and limbs. It tends to occur when environmental and relational pressures rise above a certain individual threshold, and then to be projected on to external situations to do with confined spaces and travel in compartments from which immediate escape is desired but not possible.
It is suggested that there is some significance in the fact that patients under LSD-25 in a secure setting who feel that they are re-expressing the feelings, sensations and reactions actually associated with their own births, give a virtually identical description. Moreover, they themselves often spontaneously identify aspects of the birth trauma as the determinative events from which their particular form of claustrophobia reaction arises, It appears to be a form of compulsive repetition touched off by analogous life situations of painful pressure and stress. The null hypothesis, that in spite of the close correspondence of two lists of quite diverse phenomena, there is no connection between them, would not be sustained, for instance, by the calculation of a correlation co-efficient.
Prof. Kenneth Rawnsley, commenting, not on this paper, but on the raw figures arising out of the questionnaire, writes, "The birth experiences I suspect, may be determined to some extent by the expectations of the investigators . . . I am just wondering how strongly this particular team were inclined to think that LSD would produce this type of reaction."
By the time that this series of 68 patients, seen by this investigator, began 8 years ago, he had, it is true, accepted the evidence of his own patients and of other psychiatrists using LSD that abreactions of birth experiences could occur. However, during the early years of a previous series of 43 cases similarly treated, he had strenuously refused to accept the testimony of patients that they seemed to be experiencing birth. He relayed to them the verdict of neurologists and paediatricians who had told him that memory could not possibly extend back to such events.
The fact that his incredulousness and resistance did not prevent patients in this earlier series from reporting exactly the same birth experiences, even though they jeopardised the relationship with a young psychiatrist sensitive to ridicule of his findings, must tend to allay the natural suspicion that the putative birth experiences are determined by the expectation of this investigator.
Moreover, although it is not unreasonable, in view of the well-recognised proneness of patients to fulfil the fantasies and expectations of their doctors, to suspect that those investigators who expect birth abreactions in a proportion of cases will be the gullible victims of responsive fantasies in their patients, this would tend either to repetitiveness in those cases where the patient managed to reproduce the doctors' expectation of what babies experienced during birth, or to wide diversity and scatter in cases where the patients' fantasies were their own individual productions.
In fact we find that whereas in respect of certain almost invariably occurring features of all births, such as a general sense of pressure on the head, there is a sameness of response in almost all patients, in those aspects of birth experience which differ widely from person to person, such as the successive points of maximal painful pressure on the head, face, neck, trunk and limbs, there is a wide disparity in their responses. This disparity extends particularly to specific sensations such as twisting or tugging of the neck and limbs. Moreover, these specific sensations, reported on as part of the birth experience, are often accurately correlated with long-standing clinical symptoms suffered by the patients such as neurological disorders, tics, localized headaches and attacks of unilateral migraine.
H. F. R. Prechtl of Groningen (BMJ 1967 4. 763-767) has shown that a full neurological assessment of neonates who have been subject during birth to adverse factors such as these reveals much hitherto unsuspected damage. Certain constellations of abnormal signs, the hyper-excitable syndrome, the apathetic syndrome and the hemisyndrome are still present in 60-70% of cases when followed up even at the age of 8.
He warns that there are other severe resulting problems in addition to the neurological findings, alarming data" which are not dramatic from the neurological point of view.
Thus far, attention has been drawn, not to individuals in whom a direct connection between their claustrophobia and their birth experiences can be demonstrated, for 'proof' in such purported connections is notoriously difficult to establish, but to the high degree of correlation of phenomena, amounting to a syndrome identity between the experiences of those in whom a diagnosis of claustrophobia is commonly made, and those who, deeply regressed under LSD, claim that, or feel that, they are experiencing the actual birth process to which they were subjected as a baby.
The degree of phenomenological correlation is certainly significant. In the face of this, is it reasonable to deny a significant correlation to the events themselves, namely birth experiences and claustrophobia? The null hypothesis, that the connection is nevertheless a chance one and the correlation irrelevant, would seem unlikely to stand. You must make of this what you will.
Though my paper is submitted in these general terms, a list for a list, you will naturally ask whether claustrophobic reactions had, in fact, been experienced by the 49 patients in this series who under LSD reported at the time what they took to be birth experiences. (The figure 49 here replaces the 45 earlier mentioned since of the 10 patients who could not be traced or who did not reply to the questionnaire, 4 had reported birth experiences and I hold the clinical records of the whole series.)
Confining claustrophobia to the classical symptoms on which the diagnosis is commonly made, 26 had projected their anxiety of being confined onto typical situations such as small rooms, and travel in the closed compartments of trains or buses. This half proportion may seem so small as to threaten the hypothesis until we remember the other 'irrational' situations upon which this same hierarchy of fears is commonly projected.
Discussion of individual correlations and birth-related syndromes:
In these 27 patients we do not need to ask why the fear of what happens in the dangerous vaginal birth passages does not express itself as a classical claustrophobic reaction. It has not even been displaced or projected from its original site of occurrence. The vagina remains too firmly associated with pain to be used for pleasure, too memorable as a prison of ultimately dentate danger (when oral fantasies have been added) to be a corridor of delight.
You may remember that Otto Rank extended the category of what he claimed were birth-related syndromes or symptoms to include migraine and migrainous headaches. 15 patients in this series reported migraine or headaches accompanied by feelings of sickness.
His list included tics. 7 of these patients had observable facial tics. Ferenczi (1926) comments on the association of the tiquer with impotence, and with the desire to free his body from the irksomeness of clothing. He quotes Meige and Feindal that the tic is 'mental infantilism.' 'His own body appears as something foreign to his ego and is perceived as part of the environment, whose fate leaves its owner absolutely cold.' By the time the birth injury has become severe enough to produce what later emerge as tics, the ego has split, and the mind is dissociated from the fate of the body in typical gnostic fashion.
Rank associated asthma with the respiratory distress first incurred during birth. 5 of these 49 were, or had been, asthma sufferers.
Rank does not, I think, mention eczema which particularly
when it is of early onset, I have come to regard as a syndrome in which a traumatic birth, in susceptible individuals, may be so important a factor that to re-live the birth trauma, as in one of the 5 atopic eczemas in this series, can produce immediate and dramatic disappearance of the dermatitis.
Examination fears, ceremonial and compulsive positions in bed and resistance to leaving it for the outside world, are among Rank's birth-related symptoms which were common in this series though not numerically recorded.
- 20 were clergymen, 4 of these unmarried men with overt homosexual problems, and 10 of them married men suffering from impotence or other sexual difficulties.
- 13 were single women unable to contemplate marriage or recoiling from it in view of its far-reaching genital implications.
44 patients reported on 'the results' of their treatment (which included but was not wholly dependent on the LSD sessions), as follows:
5 completely cured
20 much better
14 a little better
The somatic and psychic concomitants of phobic anxiety are exacerbated by the patients' inability to understand in adult terms what is happening to them. The interpretation of their claustrophobic distress as being related to the partial return to adult consciousness of distress presumed to have taken place during their birth, is found to be acceptable to many of these patients. It makes 'good sense,' drawing their strange feelings into the realm of the comprehensible and, by promoting confidence, reduces the intensity of the phobia, in some cases abolishing it even before the precipitating life situation has eased.
Fortified by this interpretation, certain patients have been able to tolerate and indeed invite a thorough catharsis of what they feel to be their birth experience, with prompt and striking benefit. This 're-living' has occurred under LSD-25 and without it, both within the therapeutic session and independently of it.
THE RELEVANCE OF THESE FINDINGS TO THERAPY (even
when the use of LSD is not contemplated)
Frank Lake, M.B., Ch.B., D.T.M., D.P.M.
Clinical Theology Association,
Nottingham NG7 4BA, England.
Thanks to John Rowan, former editor of the journal, The Undivided Self, for permission to reproduce this material on the internet. -- John A. Speyrer