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

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


B. The Development of the Paradigm

2. Birth

Lake early on parts ways with classic Freudian and KIenian interpretive schemes relating to the non-importance of birth. But there is no clear delineation between Lake's emphasis upon the first months of post-natal life vs. birth as the crucial period for subsequent functioning. In fact, in Clinical Theology, Lake emphasizes the importance of both infancy and birth. However, in the extensive chapters and the summary charts of the various disorders in Clinical Theology he treats birth trauma as a part of the process of infancy. In the aetiology of the various neuroses and psychoses, it becomes one factor of many in the possible cause of later psychological maladjustment.

Sometime after the publication of Clinical Theology, Lake's thinking subtly changes. He begins to place a much greater emphasis upon perinatal events than before, and speaks much less of the cruciality of the events of early infancy. While Lake never denies that post-natal experiences are not eventful or even momentous, they tend to be less so than earlier events, often being a recapitulation of the previous experience.28

For much of Lake's professional psychiatric career, birth and birth trauma were held to be THE pivotal and crucial events for later "being" and "well-being." In 1977, referring to the previous 20 years of his professional life, Lake wrote: "l had happily taught and theorized on the basis of birth as the first significant psychodynamic event for twenty years [from the age of 43 to 63]."29 This emphasis upon the cruciality of perinatal experiences, which includes 'events round about the birth; before, during and after birth,"30 was not widely accepted at the time. There were, however, those who concurred with Lake on the importance of the perinatal.

Primary among them was Otto Rank. His book, The Trauma of Birth, published in 1924, clearly described Rank's contention that not only was birth the first experienced anxiety, but that it was the prime source material for all the neuroses and character disorders. It was the "original emotional shock underlying all personality dysfunction." Rank wrote that "we believe that we have discovered in the trauma of birth the primal trauma."31 He continued, "we have recognized the neuroses in all their manifold forms as reproductions of, and reactions to, the birth trauma."32 Even at

28Lake makes an interesting comparison between two choices. This illustrates his de-emphasis of the relative importance of the "womb of the spirit" period of infancy. He writes: "If I were presented wlth a hard alternative, that in the case of a woman about to become pregnant, she had to undergo nine months distress during the next year and a half, but could choose whether the bad half came first, to be inextricably shared wlth the unborn baby, or came second, when her baby was already born, I would unhesitatingly urge her to choose to keep the months of pregnancy undisturbed, and face the task of coping wlth big trouble after the foetus had left her womb. Then she could cry or rage, grieve or despalr, while the baby was sleeping, apart from her tumultuous reactions, protected to a significant extent from them." (Frank Lake, Clinical Theology Newsletter #38 [Nottingham: Clinical Theology Association, Lingdale, July, 1981], 3).

29Frank Lake, "The Internal Consistency of the Maternal-Fetal Distress Syndrome," (Nottingham: Clinical Theology Association, Lingdale, 1977), 5.

30Frank Lake, "Perinatal Events and Origins of Religious Symbols, of Symptoms and Character Problems: The Possibility of Reliving Birth and its Eflects," (Nottingham: Clinical Theology Association, Lingdale, 1976), 1.

31Otto Rank in The Trauma of Birth, quoted by Frank Lake, "Primal Integration Work," Self & Society 15 (1987): 168: Lingdale Archive #118.

32ibid., 229.


this early stage, Lake quotes Rank as hinting at the importance of the prenatal: "'all symptoms ultimately relate to this primal fixation' and the place of fixation is 'in the maternal body' and in peri-natal experiences."33

Donald W. Winnicott34 also exerted an influence on Lake as it relates to this period of emphasis upon perinatal events. Winnicott spoke of an event "etched on the memory" that later manifested itself in the stresses of later life. Lake quotes Winnicott approvingly:

There is evidence that personal birth experience is significant and is held as memory material. When birth trauma is significant, every detail of impingement and reaction is, as it were, etched on the patients memory, in the way to which we have been accustomed when patients relive traumatic experiences of later life.35

Lake also credits Winnicott as being clear that "intra-uterine experience pre-natally was of importance to later development."36

A third major influence at this point was Stanislaf Grof, who, with Lake, began utilizing LSD as a psycholeptic agent in 1953. Grof divided up the perinatal experience into four "basic perinatal matrices" and described the phenomenology of each as occurring in LSD sessions. The first, called "Life in the Womb", again prefigured Lake's later emphasis upon prenatal life. This matrix is composed of the recollections of fetal life and involves the summation of experiences with which the baby faces the impending experience of birth. This summation tends to be either the positive "experiences of an undisturbed intrauterine environment where the basic needs of the embryo/fetus/baby are met"37 or the negative recollections the 'bad womb' situation such as fetal crises, emotional upheavals in the mother and attempted abortions.38

33ibid., 168. Rank also writes: "We believe that we have succeeded in recognizing all forms and symptoms of neuroses as expressions of a regression from the stage of sexual adjustment to the pre-natal primal state, or to the birth situation, which must thereby by overcome."

34Winnicott, Collected Papers Through Pediatrics to Psycho-AnaIysis; Winnicott, The Maturational Processes and the Facilitating Environment.

35D.W. Winnicott, "Birth Memories, Birth Trauma and Anxiety", quoted by Lake, "Treating Psychosomatic Disorder Related to Birth Trauma," 233.

36Lake, "Primal Integration Work," 169. Lake quotes Winnicott: "There is certainly before birth the beginning of an emotional development, and it is likely that there is before birth a capacity for false and unhealthy forward movement in emotional development."

37Lake, "Studies in Constricted Confusion," C-56.

38Lake, "Perinatal Events and Origins of Religious Symbols, of Symptoms and Character Problems: The Possibility of Reliving Birth and Its Effects," 7-8. Lake described this phase of Grof's Basic Perinatal Matrices this way: "They [the participants in the primaling seminars] would begin to have very, very clear ideas of what an undisturbed intra-uterine life was like . . . [several months before birth the baby's] . . . swinging around with plenty of amniotic fluid round so you don't occasionally bump agalnst the edges. You are on swings and the roundabouts and it's all very pleasant and easy, oceanic, you're in the water but all your needs are met, hopefully. We're talking about a good womb now where there is constant nutrients, where the chemical come down, the endocrine come [sic.] down in the placental blood stream to you and not loaded with alcohol and loaded with nicotine or loaded with all kinds adrenal toxins . . . so it's a good place and here you are really one with the sources. You get this experience. The all is in the one and the one is in the all, and for all I know, since I'm not aware of dependency, I am God, I am the very centre of things. There's no problem at all other than staylng in this place of ecstasy where from time to time why whole body shimmers with ecstatic feeling and life is very, very good. Cosmic unity, a sort of paradise. But equally well some people would go into disturbances of this intra-uterine life. A realistic recollection of a bad womb experience of foetal crisis, diseases, and emotional upheavals in the mother, twin situation, attempted abortion.


The second matrix is called "No Exit" and occurs at the beginning of labor but before the cervix opens. The "good womb" experience, where it has occurred, is inexplicably terminated and the supporter of the fetus for the last 9 months becomes the aggressor. There is relentless force to "push out" the constricted fetus which can seem destructive or even murderous. Those that have suffered a "bad womb' experience are having their earlier traumas recapitulated and confirmed. Regardless of the experience of the first matrix, coupled with the contractions of the uterus which serve to expel the child, is, temporarily, the closed cervix, creating a trapped, controlled, unescapable, hopeless feeling of "no exit".

The third phase involves the actual process of birth. The cervix opens and the fetus and womb begin to elongate. The fetus' head is pushed and molded to fit into the inlet to the pelvis. The reaction to this third matrix is variable. Some are active and some passive; some sense a maternal synergy and others maternal opposition; some are excited about the possibility of a new environment and others want to remain in the womb.

Lastly, Grof described the immediate post-birth experience as variable. There is the ideal of close, physical, and prolonged contact with the mother to "soothe away all the foul tensions that have arisen to perplex them, which they cannot understand."39 Along with the sense of confusion and bewilderment, there is the possibility of the sense of abandonment, loneliness, separation anxiety, and in the extreme, a sense of nothingness and dread.

Grof's organization of the perinatal experience along these lines was important for several reasons in Lake's subsequent definition of the M-FDS. First, there is the affirmation, along with the perinatal, of the prenatal effect upon subsequent functioning. Second, early experiences become "patterns or principles of perceptual organization for later experiences" and serve as underlying prototypes for later complex reaction patterns.40 Third, biological stress experiences are at the root of later psychopathology.
39Frank Lake, "The Significance of Perinatal Experience," SeIf & Society, 6 (1978) 229; Lingdale Archive #044.

40Lake, "The Significance of Perinatal Experience," 230.

3. The Prenatal Period

While in 1976 Lake could say that "pre- natal events are quite important,"41 sometime in the period between 1977 and 1978, there was a gradual and discernable shift in Lake's emphasis towards the prenatal period as the MOST critical for subsequent functioning. Toward the beginning of 1978, Lake wrote that "even in the nine months' growing in the womb there may be unimaginable sufferings and catastrophes."42 In a Research Report from December 1978, Lake wrote:

Some of you have followed our research into what Iooked like the earliest recallable experiences of human beings, namely, the sensations and emotions accompanying one's birth. . . . Increasingly over recent years we have been invaded by evidence that the foetus in the mother's womb is picking up all sorts of messages about itself."43

Lake continues to describe the rudiments of a M-FDS:

The catecholamines which convey the 'messages' to do with emotions round the mother's circulation, gearing all her organs and cells to feeling joy or sorrow, love or loathing, vitality or exhaustion, pass through the placental barrier (which to these substances is no barrier) into the foetal blood stream via the umbilical vein. In this context the foetus does its own emotional homework and responds, either passively accepting the mother's bad feelings as its own, as if true for itself, or by being protestingly overwhelmed by them. It can aggressively fight them back, in resolute opposition to sharing the mother's sickness. Others become 'foetal therapists', trying to bolster up a debilitated and debilitating mother from their own feelings of relative strength. Sensitivity to 'poisonous' feelings coming from a rejecting mother is very great. . . . To be the focus of mother's love imprints a confidence that 'sets you up for Iife.'44

The evidence that Lake cited to give credence to this shift in thinking came form the ongoing workshops in which deep-breathing techniques were being used to abreact early perinatal and increasingly pre-natal "memories." Lake likewise found support for his findings in the orthodox psychoanalytic dream and association analysis work of Nandor Fodor, M.L. Peerbolte and Francis Mott, particularly Mott's utilization of a term first used centuries earlier - "umbilical affect".45

Both Mott and Lake used this term to describe the "feeling state of the fetus as brought about by blood reaching him through the umbilical vein.".46 As Mott envisaged it, the umbilical vein not only conveys nutritive resources and as such could be experienced as a "life-giving flow, bringing . . . renewal and restoration" but could also "be the bearer of an aggressive thrust of bad feelings into the foetus if the mother herself was distressed and 'feeling bad."' If the mother felt emotionally unsupported, then "this feeling of deficiency, lack of recognition and the failure of looked-for support, would be just a specifically felt by the fetus. It became distressed by the failure of its immediate environment to provide the expected acceptance and sustenance, not so much at the level of metabolic input but to nourish the earliest beginnings of the person in relationship."47

Thus, Lake's formulations are highly similar to Mott's. where Mott's research primarily focused on dream analysis, Lake's ideas took shape following the results occurring from over 1200 LSD and deep-breathing assisted re-experiences of peri­ and pre-natal events. That the two were so highly corroborated encouraged Lake that his findings were not unique. where Lake differs from Mott is in his final emphasis upon the first trimester as the MOST determinative phase of development.

Thus, with emphasis upon the prenatal stage, the M-FDS is essentially the affirmation that a maternal-fetal "affect flow" exists and consequently the emotional state of the mother is transmitted by way of the umbilical cord to the fetus. This "affect flow" is determinative of subsequent psychological and emotional functioning and perception.48

40Lake, "The Significance of Perinatal Experience," 230.

41Lake, "Perinatal Events and Origins of Religious Symbols, of Symptoms and Character Problems: The Possibility of Reliving Birth and its Effects," 17.

42Frank Lake, "Theological Issues in Mental Health in India," (Nottingham: Clinical Theology Association, Lingdale, 1978), 1, quoted in In the Spirit of Truth, ed. Carol Christian (London: Darton, Longman & Todd, 1991), 46. This article was commissioned by the Institute for the Study of Religion and Society in Bangalore, but was apparently never published.

43Lake, "Report from the Research Department #1," 2.


45Moss, "Frank Lake's Maternal-Fetal Distress Syndrome: Clinical and Theoretical Considerations," 203.


47Lake, "Treating Psychosomatic Disorders Relating to Birth Trauma," 51.

48Lake, Tight Corners in PastoraI Counselling, viii-x.

4. The First Trimester

The fourth and final phase of Lake's thinking with regard to what constitutes the critical period of maternal-fetal affect flow is also the most controversial. That there was a distinction between his emphasis upon the prenatal period in general and the first semester in particular can be determined from a later paper he wrote:

We thought initially that the pervasive traumatic influence of maternal distress on the foetus would be spread (if it occurred at all) throughout the nine months of pregnancy. We have now modified our thinking in the wake of the evidence that the first trimester is the locus for most of the catastrophes, for most of the sufferers from the M-FDS.49

Referring back to the "womb of the spirit," Lake later wrote that from 1966 to 1977, he had applied the "womb" analogy as it related to the spirit to the first 9 months of past-natal life. And while the described dynamics are still true, the term "womb of the spirit" "could now more accurately be transferred to the earlier developmental stage, within the first half of the nine months of pregnancy - which are the crucial ones - though extending throughout until birth."50

In a second research Report written in 1980, Lake implied the evolution of his thinking:

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.51
Referring to these earlier sources of pain, Lake writes that it is the fetus who is vulnerable to "all that is going on in the mother, particularly in the first trimester, that is in the first three months after conception."52 Lake later reaffirms this in Tight Corners in Pastoral Counselling when he writes:

The focus for psychopathology is now, for us, the first trimester of intra­uterine life. These first three months after conception hold more ups and downs, more ecstasies and devastations than we had ever imagined.53

Thus, it is on the first trimester as the primary and cmcial period of life that Lake finally settles. Although Lake continued to affirm that later pre-natal, peri-natal, and post-natal experiences all powerfully affect the post-natal functioning of the child and later the adult, it is the first trimester of intra-uterine life that is most determinative for all subsequent psychological, cosmological and ontological functioning. Referring to the evolution of his thinking regarding the critical stage of maternal-embryo/fetus-baby interaction, Lake noted:

The old is as true a picture as ever, but the absolutely solid reality of the new, embodying the astonishingly rich vicissitudes, responses and interactions of foetal life, cannot fail to highlight the deficiencies in depth and shading, and in clarity about the inner structure and texture, of the post-natal picture as it has hung on the walls of our minds for so many years.54


49Lake, "The Internal Consistency of the Maternal-Fetal Distress Syndrome," 3.

50Lake, "Mutual Caring," 127.

51Lake, "Report from the Research Department #2," i.

52ibid., 3.

53Lake, Tight Corners in Pastoral Counselling, viii

54Lake, "Mutual Caring," 58-59.

Dr. Maret's e-mail address is

Next Section

Return to the Chapter II Menu of Frank Lake's Maternal-Fetal Distress Syndrome
Return to the Primal Psychotherapy Homepage