Frank Lake's Maternal-Fetal Distress Syndrome:
- An Analysis -

By Stephen M. Maret, Ph.D.
Professor of Psychology
Caldwell University



A. The Definition of the Paradigm

1. "The Womb of the Spirit"

Frank Lake asserted that the essence of the Maternal-Fetal Distress Syndrome could be found in the observation that "powerfully impressive experiences from the mother and her inner and outer world . . . reach the fetus, defining its relation to the intra-uterine reality in ways that persist into adult life."1 Defined in this manner, the MFDS is really a part of a larger model.2 It is essentially the description of a negative ("distress") reaction to certain prenatal experiences. But Lake's theory encompassed not only the negative responses but also the positive. Thus, the M-FDS as described by Lake goes beyond merely a description of the "distress" reaction to accommodate the complete mechanisms within which the negative reactions can be understood.

The final formulation of the M-FDS came relatively late in Lake's thinking and can only be found in his later works3 encompassing the final four years of his life. Writing during this period, Lake stated that most of his professional psychiatric career had been spent working "in a half-light, oblivious to the earliest and severest forms of human pain. "4 This "half-light" was caused by the assumption that "the nine months of foetal development in the womb were free of significant incident, a blank without

1Lake, 'Research into the Pre-natal Aetiology of Mental Illness, Personality, and Psychosomatic Disorders,' 5

2Roger Moss writes the following: 'The Maternal-Fetal Distress Syndrome elaborated by Frank Lake is a key component of the theory, and one of its most testable hypotheses. But it remains only a part of the paradigm." (Roger Moss, "Review of Research: Frank Lake's Primal Integration Workshops," [Oxford: Clinical Theology Association, St. Mary's House, March 25, 1984]).
The 'paradigm' referred to by Moss here is what he called "Primal Integration," which essentially takes the understandings of the M-FDS and then seeks to apply them in a therapeutic re-experiencing of the original fetal experience, positive or negative.

3"Studies in Constricted Confusion: Exploration of a Pre- and Peri-natal Paradigm" (1979-80); Tight Corners In Pastoral Counselling (1981); With Respect: A Doctor's Response to a Healing Pope (1982), along with other articles, papers, transcripts and speeches from this period.

4Lake, Tight Corners in Pastoral Counselling. vii.


possibility of psychodynamic content."5 Lake was to eventually conclude the opposite, that fetal life is "not drifting on a cloud, [but as] eventful as the nine months that come after birth. The foetus is not unaware of itself, or of the emotional response of the mother to its presence, but acutely conscious of both and their interaction."6 While Lake was not dismissive of the potential suffering of the post-natal experience, he affirmed that "the soul-destroying pain and heart-breaking suffering that comes from the distress of the foetus in the womb when the mother herself is distressed" is indeed at the root of the "severest forms of human pain."7 This pain occurs during the first trimester of intra-uterine life. Lake stated that "these first three months after conception hold more ups and downs, more ecstasies and devastations than we had ever imagined."8

B. The Development of the Paradigm

Lake's final conclusions with regard to the M-FDS resulted from a process of gradual development. The component, if incomplete, parts of the theory can be readily discerned early on. An evolution of sorts takes place, particularly with regard to the definition of the critical period of maternal-embryo/foetal/child interaction. What remained essentially static throughout this evolution was the central assertion stated above; namely that a mother's behavior and emotional state and the environment which this creates for the emerging child, are determinative of that child's later emotional and behavioral state. Given this constant, there are at least four "phases" or steps in the process that eventually gave birth to the final formulation of the M-FDS.9

5Lake, "Mutual Caring." 57-58.

6ibid., 58.

7Lake, Tight Corners in Pastoral Counselling, viii.


9Roger Moss delineates three main "phases of investigation":

1. birth and peri- natal experience;
2. middle and late pregnancy;
3. the first trimester.
(Roger Moss, 'C.T.A. Occasional Paper #2: Frank Lake's Maternal-Fetal
Distress Syndrome and Primal Integration Workshops," [Oxford: Clinical Theology Association, St. Mary's House, December, 1953] 7-8; and Roger Moss, "Frank Lake's Maternal-Fetal Distress Syndrorne: Clinical and Theoretical Considerations," 202-203). Thus, Moss does not delineate a separate "phase" relating to infancy or early childhood. Even though Clinical Theology discusses BOTH birth and the first nine months of life (ie. "the Womb of the Spirit") as crucial, I believe that Lake at that early stage was primarily focused upon early childhood, with birth as its beginning point, as the crucial period. I believe that he gradually changed this early position and settled on a second distinct position of birth itself as the crucial experience. As evidence I cite 2 passages in which Lake makes a distinction between the two:

Until recent years we attributed this affliction mainly to the anguish of the baby who is not bonded to the mother after birth, but is kept waiting in a loneliness which becomes a panic, then a horror, and then, beyond a certain limit, a dreadful splitting, falling-apart and fragmentation of the whole person, body, soul, and spirit. We early recognized that there were also limits to the amount of pain that could be borne in the actual process of birth." (Lake, "Report from the Research Department #2," 3). We find that it is not sufficient to look back, to find the origins of significant trauma, of consequent fixated pain, and therefore of the personality reactions that represent flight from that pain, only so far as the first year of life, or even to the traumas of birth. Things go 'wrong -or go well- much earlier than that." (ibid., 1).


"The Womb of the Spirit"

As a classically trained psychiatrist, Lake early on affirmed the importance of early infancy, the "first half of the first year of life."10 However, looking back on this early period, Lake later wrote that he stuck his "neck out 23 years ago in affirming birth and the early months as powerfully relevant occasions of stress."11 In distancing himself from the Freudian emphasis upon the cruciality of the Oedipal/phallic developmental stage, Lake wrote the following in the Introduction of Clinical Theology:

I have not done justice here to the extensive elaboration of sexual psychopathology which characterizes classical Freudian writing, not because I do not agree with these findings, for they are in accord with my own experience, but because I believe them to be secondary rather than primary. The neo-Freudian modifications of analytic theory have brought the era of significant trauma to within the first year of life, and it is these to which my attention has been drawn. Indeed, Otto Rank's postulation of birth trauma as the first significant source of personality deviation has been abundantly confirmed in many cases I have studied.12
During this first phase, Lake still held the assumption that "the nine months of fetal development in the womb were free of significant incident, a blank without possibility of psychodynamic content."13 But here we already observe the major

10Lake, With Respct, 42.

11Lake, Tight Corners in Pastoral Counselling, ix.

12Lake, Clinical Theology, xvi.

13Lake, "Mutual Caring" 57-58.


components of the later formulation of M-FDS: the primacy of the mother- embryo/fetus/child dyad, the existence of repressed memories from early life, the effect of these experiences on the adult personality and his/her present functioning, the ability to "relive" these experiences, and the existence of transmarginal states. Indeed, at this early point, the later definition of the M-FDS could be slightly modified and still hold true:

The behavioral reactions of a mother affect her child in ways that contribute to its perceptions of itself and of its environment and these perceptions persist into adult life.

In the Introduction of a pamphlet on personal identity written in the latter part of the 1960's, Lake wrote that "the very earliest experiences which can lead to disturbed feelings of identity . . . take their origins in the distresses of babyhood."14

This is illustrated clearly in a schematic representation found in Clinical Theology titled "The Womb of the Spirit" in which he writes that "the analogy of the growth of the baby in the womb is an apt one".15 This "chart" used Lake's Dynamic Cycle as the paradigmatic basis for making an "ontological analysis of the normal Mother-Child relationship."16 Lake describes the dynamics of each phase, two input and two output, in terms of the effect upon the emerging infant. Lake's analogy of fetal life, and indeed, his use of the term "womb of the spirit" prefigures his later theoretical emphases.

With regard to the first phase, the so-called genesis of "being", he writes that just as "physical being is the result of nine month's response by the fetus to the supplies of the Physical Being from the Mother" so "personal and spiritual Being is the result of nine months, (more or less) response of the baby to supplies of personal and spiritual being from the mother."17 Whereas the placenta and umbilical cord serve as the conduits for nourishment during the period of the "womb of the physical", so there

14Frank Lake, "The Origin and Development of Personal Identity," Foreword. Clinical Theology Association pamphlet #4; quoted in Carol Christian, ed., In the Spirit of Truth 43.

15Lake, "The Womb of the Spirit,' chart N.b., in Clinical Theology.




is the "umbilical cord of sight" by which spiritual being passes from the mother to the child during the period of the "womb of the spirit." If all goes well, this relational element allows the baby to "come into being as a person, gaining self-hood and the sense of identity by responding to the light of her [his mother] countenance,"18 just as consistent physical nourishment during the prenatal period will allow the fetus to be born physically healthy. There is a similar parallel with the constriction of supplies.

If the supplies of "physical being from the mother are constricted, the foetus will be distressed; if blocked, it dies."19 If "being" supplies are constricted, there is a diminishment of personal and spiritual "being" of the infant leading first to panic and then to dread; if all supplies of "being" are removed", "non-being" results.

The second input phase is what Lake refers to as "well-being", resulting from the ongoing sustenance of being. Here the communication of "well-being" is achieved simultaneously in both its physical and spiritual dimensions. Lake writes that "not only is there the obvious inflow of physical sustenance in the form of milk when the child is at the breast, there is an equally important flow of sustenance from the mother to the baby on every level of personality."20 Lake specifically mentions satisfaction, joy, fullness, and graciousness.21

The two output stages of status and achievement are directly dependent upon the events of the input stages. Lack of "being" and "well-being" ultimately results in adults who manifest these "lacks" in the form of various neurotic and psychotic maladaptive dysfunctions. The description, etiology, dynamics, care and cure of these various manifestations takes up the bulk of Clinical Theology. It is fair to say that this material retained its validity even after Lake's thinking about the M-FDS was formulated. The exception would be the timing of the etiological experiences. Speaking immediately prior to his death in 1982, and referring back to the nine month period of early infancy, namely the "womb of the spirit", Lake noted:




There is one statement . . . which obviously now demands correction [and it is this]: 'The roots of all the major neuroses -- hysterical, phobic, conversion, schizoid, anxiety-depressive and obsessional -- derive from separation anxiety in this phase.' Some cases of each do . . . but the evidence . . . indicates that, if we are talking about the main roots of personality disorders . . . , it is [to the first trimester that] we must look and not later.22

As stated earlier, Lake clearly owes a intellectual debt to both Freud and Melanie Klein.23 Both emphasized the primacy of the events of early childhood for later psychodynamic functioning. But when it came to an investigation beyond this period, Lake contends that the orthodoxy of both rendered the "investigation of life, distress and near-death in the womb . . . a 'no-go' area. The obvious distress of much intra-uterine existence has been assumed to have no emotional consequences. By definition, nothing could happen there to interest the analyst."24 However, Lake saw both Freudian and KIeinian theory pointing beyond itself to indicate the importance of prenatal life for later psychodynamics.

For instance, Lake noted that Freud's death instinct is present, by definition, at conception and thus must be functioning in opposition to the life-wish both pre- and post-natally. Freud himself "opened the door" to the thinking when he stated in Inhibitions, Symptoms and Anxiety that "there is much more continuity between intra-uterine life and the earliest infancy than the impressive caesura of the act of birth allows us to believe."25

22Lake, "Mutual Caring," 25, quoted by Carol Christian, ed., In The Spirit of Truth, 48.

23Melanie Klein, Envy and Other Works (New York: Delacourt Press, 1975); Melanie Klein, Love Guilt and Reparation and Other Works (New York: Delacourt Press, 1975).

24Frank Lake, "The Significance of Birth and Prenatal Events in Individual, Family and Social Life," (Nottingham: Clinical Theology Association, Lingdale, Lingdale Archive #057), S3.

25Sigmund Freud, Inhibitions Symptoms and Anxiety (London: Hogarth Press, 1936), 109.


Similar to Freud,26 Lake sees Klein's Object Relations as also "opening" the door" slightly. Klein's influence on Lake at this time is quite pronounced. Not only is he in full agreement with Klein of the cruciality of the mother-child/infant dyad, but Klein's contention that since the child experiences frustration and gratification from the same source, usually the mother, that this gives rise to a perception of objects as "part objects." This condition of "splitting" the good and bad "part-objects" results in Klein's "paranoid-schizoid position." It isn't until the latter part of the infant's first year of life that she begins to reconcile the two, and this realization results in the depressive position.

While Lake obviously was influenced by Klein, and would see KIeinian theory pointing beyond itself, he critiques Klein for failing to develop the logical implications of her conceptualizations. Lake cites the following KIeinian comment as emblematic: "I have suggested" she wrote, "that the struggle between life and death instincts enters into the painful experience of birth and adds to the persecutory anxiety aroused by it."27 That Klein didn't proceed then to examine in more depth birth trauma and pre-birth trauma, seems, to Lake, inconsistent.

26Lake makes much of Freud's initial embrace of Rank's book The Trauma of Birth: "It is the most important progress since the discovery of psychoanalysis." Lake further contends that Freud "yielded to the protests of Abraham, Jones and others of the core group, inflaming his fears 'lest the whole of his life work be dissolved by the importance attached to the trauma of birth"' and turned agalnst Rank. Later, Freud wrote to Abraham that he was "getting farther and farther away from birth trauma" and that he believed it would fall flat." (Sigmund Freud, quoted by Lake, Tight Corners in Pastoral Counselling," 3).
Elsewhere, Lake states that "Freud closed the door . . . on Otto Rank. Rank's Trauma of Birth had made the 'impressive caesura' of birth a much more comprehensible and less inhibiting 'full stop'. But a new theory of the primacy of birth would have displaced Freud's own theory, which gave primacy to the oedipal conflict. Freud and his followers refused to allow that to happen, for personal, not scientific reasons." (Lake, "The Significance of Birth and Prenanal Events in Individual, Family and Social Life." 95)

27Melanie Klein, quoted by Lake, "The Significance of Birth and Prenatal Events in Individual, Family and Social Life," 54.

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