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

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



Following conception and prior to the process of implantation is the short preliminary stage of the "blastocyst." Lake affirmed that this period is often felt to be a good experience of non-attachment, even of unitive and quite 'transcendent bliss.'"109There may be a sense of continuity with the monistic sense of 'union with the Absolute' experienced by some in the first week after conception, a kind of Blastocystic Bliss."110 This stage is immediately succeeded by implantation in the lining of the maternal womb, gradually resulting in umbilical circulation through the umbilical cord and placenta.

109Lake, Tight Corners in Pastoral Counseling, 15.

110Lake, "Studies in Constricted Confusion," C41.


Lake writes:

As this begins to function, the foetus is evidently put into direct contact with all that is being transmitted round the mother's own body as an expression of her emotional ups and downs. The foetus feels acutely the feelings which are the product of the mother's life situation, for better or for worse, and her personal reactions to it.111

According to Lake, the establishment of umbilical circulation allows every woman to have a profound impact upon an emerging fetus within her. This occurs through the phenomenon that Lake called "umbilical affect". This term is defined as the "feeling state of the fetus as brought about by blood reaching him through the umbilical vein.112 This maternal-fetal "affect flow" transmits the emotional state of the mother to the fetus by way of the umbilical cord in a manner similar to the transmission of nutrients and various teratogen such as viruses and chemical agents. As Lake states:

Before birth, the foetus may be seriously damaged if the mother is dependent upon alcohol, nicotine or other drugs. It is also damaged by the less readily identifiable changes that transmit to the baby a mother's rejection of a particular pregnancy and of the life growing within her. Any severe maternal distress, whatever its cause, imprints itself on the foetus.113

The effects of this "affect flow" are conditioned by the interaction between the mother's emotional state and the fetal response to it. The maternal "affect flow" spans the full range of emotional possibilities. At one polarity, stands the ideal of total joy and acceptance resulting in an "emotive flow" that communicates recognition, affirmation, and acceptance to the fetus. The other extreme represents maternal rejection and distress that results in the "invasion of the fetus in the form of a bitter, black flood."114 Either way, this "invasion' is usually the result of often very complex and mixed emotions. Lake states:

She may have been full of anger internally, while fear, compliance or compassion prevented its ever being shown externally. she may have loved the man by whom she became pregnant, while hating the resultant fetus, or loved the prospect of having a baby, while hating, fearing or feeling deeply disappointed and neglected by its father. The fetus receives all such messages but has difficulty in distinguishing what relates specifically to it and what belongs to the mother's feelings about her own life in general.115

111Lake, Light Corners in Pastoral Counselling, 15.

112Moss, "Frank Lake's Maternal-Fetal Distress Syndrome and Primal Integration Workshops," 203.

113Lake, Tight Corners in Pastoral Counselling, 16.

114ibid., x.

115ibid., 21.


Similarly, the fetal response varies from "'taking it all to heart' as a judgement against itself, to be passively endured, or strongly to oppose it, or 'to get right out of it' by splitting off the ego, the experiencing 'I' taking leave of the too-badly hurt foetal body."116 whatever it is, the foetal response to the maternal "affect flow" is contingent upon its own constitutional factors as well as the intensity and duration of the emotive flow.117 "The tendency is to feel identified with all of these invading maternal emotions in turn and to react to each."118

It is this response, according to Lake, that is so determinative for subsequent functioning, especially when the fetus is responding to an emotive flow of severe distress. The result, depending upon the specific intrapsychic dynamics, is the appearance of a particular group of symptoms and signs that characterize a particular psychopathology. Thus, "this intra-uterine interaction is the source of images, perceptions, meanings, values and personality defenses to cope with them."119

Lake organized the occurrence of "umbilical affect" and it's effects on the fetus into three general standards of manifestation and four subsequent graded response patterns. The former is primarily based upon the quality and quantity of the "affect- flow" from mother to fetus, while the latter is based upon the response of the fetus to this "affect-flow". Both the response of a woman to her pregnancy and the reaction of the fetus within her to her response are events that actually exist along a continuum of possible responses ranging from absolute and joyous acceptance to horrendous and cataclysmic rejection. In the most general terms, the three main anchors along this


117ibid., 21-22.

118ibid., 21.

119Frank Lake, "Theology and Personality," 65.


continuum include joyful acceptance of the fetus by his mother, conscious or unconscious ignorance and/or disregard of the fetus by the mother, and finally, conscious or unconscious rejection of the fetus by the mother. The four "graded responses to increasing degrees of pain due to un-met intra-uterine and pen-natal needs"120 are also somewhat continuous.

Changes in the mother's environment may occur in the course of the pregnancy that drastically alter the fetal environment. The beginning of the pregnancy may be perceived by the fetus as positive and "ideal", while later changing to a negative perception due to some stressor in the maternal environment. An opposite experience is just as likely, with an initial negative environment, due perhaps to a crisis pregnancy, with a later adjustment and acceptance resulting in a much more positive environment.

1. The Manifestations of "Umbilical Affect"
a. Positive

One possible manifestation of maternal affect is what Lake termed "positive". This pattern is characterized by joy and acceptance. The mother, upon discovery of her pregnancy, exults with joy and happiness, giving rise to a "flow of the mother's positive, aware, attention-giving emotional regard to the developing foetus within her. The development of a positive Foetal Skin Feeling, as the ground of 'the excellent self' may be perceptible."121 Elsewhere Lake writes that the mother's joy and "recognition of her changed state leads to foetal joy in being recognized, accepted, and indeed, welcomed."122

b. Negative

The second general pattern resulting from the maternal-fetal affect flow is what Lake termed "negative". while this manifestation is disconcerting and distressing to the fetus, it is not so because of any perceived attack. Rather, the fetus "wants to feel its presence recognized" and "this is often denied. There is a puzzled, then distressed
120Lake, "Studies in Constricted Confusion," C68.

121ibid., C41.

122Lake. Tight Corners in Pastoral Counselling, x.


sense of being disregarded, unnoticed, of no interest or account in the cosmos."123 The fetus is frustrated by his mother's "non-recognition of her own body as she works on furiously before and after she knows she is pregnant. It is deeply disturbed by her lack of recognition of herself as pregnant and the fetus as a growing human being inside her when she does know."124 As such, the fetus cannot thrive because its yearning is fixated. There is often fetal distress in the awareness of the mother's emotional need and at times a response of "trying to help", of attempting to somehow palliate, ease or prevent the mother's distress. This gives rise to what Lake called the "Fetal Therapist."

c. Strongly Negative

The third and final consequential pattern of manifestation and response from the maternal-fetal affect flow is what Lake called "strongly negative". This pattern is what gives this entire paradigm its designation as the "maternal-fetal distress syndrome". As such, and because of it's dire and myriad consequences, it's discussion comprises by far the most material in Lake's thought and works.

When the "umbilical affect" is strongly negative, the fetal distress that results comes directly as a result of an "influx of maternal distress,"125 to her distress in relation to the world:

It may be due to her marriage, to her husband's withdrawal rather than more intimate supporting when he is asked urgently for more than his personality can easily give. It may be due to the family's economic or social distress in a distressed neighborhood . . . If she is grieving the loss of, or nursing a still dying parent, the sorrow overwhelms her and overwhelms her fetus.126

Whatever the cause, "the pain of the world, picked up by the family, is funnelled by the mother into the fetus."127 Included in this dynamic then, is "both the registering
123Lake, "Studies in Constricted Confusion," 041.

124Lake, "Theology and Personality," 66.

125Lake, "Studies in Constricted Confusion," C41.

125Lake, "Theology and Personality," 66.



of the intrusion of the mother's condition, of yearning, anxiety, fear, anger, disgust, bitterness, jealousy, etc. into the fetus, and its own emotional response to this distressed and distressing invasion."128 Particularly distressing, because they give rise to the "fear of being killed by maternal hatred,"129 are failed abortions and near miscarriages. when the fetus is invaded by a "black, bitter flood" of "incompatible . . . and alien emotions,"130 this transfusion leads to an assortment of possible reactions. The fetus may attempt to utilize various coping mechanisms or may seek to actively oppose this "invasion". The mode of contravention varies with Constitutional factors, intensities and duration of stress, as well as previous experiences severe enough to cause conditioned responses."131 Thus, the "strongly negative" pattern of manifestation and response, of the "foetus being 'marinated' in his mother's miseries"132 and reacting in a variety of ways, results in a variety of serious disorders.

2. The Graded Levels of Fetal Response

Corresponding somewhat to the three variations of maternal "umbilical affect" are the four variations of fetal response.

a. Ideal

The first such response is the "Ideal". This condition exists when, from implantation onwards, "the fetus in the womb is well-supplied in every way," it's physical, emotional, and spiritual "shopping list" being satisfied by the "hopes of a well-stocked maternal shop."133 There is a sense of "warm and contented happiness, even of a deeply embodied bliss. . . . The umbilical connection with the mother from

128Lake, "Studies in Constricted Confusion," C41.


130Lake, Tight Corners in PastoraI CounseIIing, x.

131 ibid.

132ibid., 141.

133Lake, "Studies in Constricted Confusion," C68.

the placenta is wholly satisfactory."134 There is the communication of peacefulness, tenderness, love; the mother is said to "keep a warm womb."135 Contingent upon her reaction to her life situation is her ability "to meet the emotional needs of the foetus, and fulfill the archetypal 'blessed mother' image."136 Ideally, "all the warmth and tenderness of the love she is receiving from her husband, family and neighbors, fortified, perhaps by a spiritual sense that God the Father's exchanges of love are just like this, and as she opens to him too, all her loves mix and are made available to the foetus within her, though she may as yet have only an inkling that she is pregnant."137

b. Coping

When the maternal affect flow is less than "ideal" but is still "good-enough" to prevent a loss of trust, the second response level is manifested by the fetus. The "Coping Response" results when there is a "discrepancy between need and proper fulfillment . . . but the main conditions of satisfactory interaction are being more or less met."133

There is either a maternal failure to meet perfectly the "essential need for recognition and caring attention" or an "influx of maternal distress,"134 or both. while the fetus has "lost hope of the 'ideal,"' it attempts to "cope with the deficit or the distress"140 by accepting the "ongoing exchange with the source person, out of sheer need."141 These interactive conditions, although not perfect, are "good enough" to permit the fetus to cope adequately with the disparity. It is only when the emotional supplies of the "maternal shop" are less than ideal and there is the recognition of this

134Lake, "Mutual Caring," 13.


136Lake, "Studies in Constricted Confusion," C68.

137Lake, "Mutual Caring," 14.

138Lake, "Studies in Constricted Confusion,"C68.

139Lake, "Mutual Caring," 21.




lack or "badness", that what has preceded. if "ideal" in some sense of the term, is now defined as having been "good". Thus "fetal coping is really saying 'However hard it is to hang on to the acceptance of the mixed good/bad, rough/smooth stuff that comes in the navel, the alternative, to refuse the good because the bad is so bad, is to cut oneself off from life itself."'142

The consequences of the "coping level" for later functioning are determined by the severity of the deficit and the consequent reaction. However, since the world is not an "ideal" place where one's needs are always met fully and immediately, the coping level is more predictive of future interaction and thus can serve as a kind of vaccination against future deficits and disappointments.

Lake states that "those who in the first trimester were well able to cope with a mixed bag of maternal emotional inputs are better placed for dealing with later troubles than those for whom it was so 'ideal' as to have escaped their notice."143 Indeed, this level can serve to "flex the muscles of faith" with the spirit expanding "to include the negative aspects of relationships with increasing and justifiable hope and trust."144

A second possible consequence, this time definitively negative and shared with the third and fourth "levels", results from the economy of the exchange between the fetus and his mother. The "good" and "bad" of the "affect-flow" are accepted "with the corollary that the 'badness' must not be fired back at the placenta/mother via the excretory umbilical arteries, but 'loaded up' in the foetus' own body structures. Thus the "badness" is displaced and contained within a body part and may include muscle groupings, or any one of the alimentary, respiratory, or uro-genital tracts. Thus the "ostensible ongoing acceptance of the way of exchange is riddled with ambivalence."146

142ibid., 22.

143Lake, "Studies in Constricted Confusion." C68.


145Lake, "Mutual Caring," 21.



The third possible result of the coping response may be that of the "fetal therapist". This result occurs when a constitutionally strong fetus receives an ambivalent or clearly negative affect flow from a weak, inadequate mother. The fetus accepts the burden, often life-long, of doing everything possible to prevent and palliate the mother's stress and resultant distress. This necessitates a denial of and refusal to meet one's own needs.

c. Opposition

When the "emotional store" of the mother is judged by the fetus to be "not good enough" for trustful coping, total opposition results. Between the previous level and this third one something shocking has happened; "distress has shattered the erstwhile trust between the ego and its world."147 Depending upon the constitutional style and strength of the fetus, the oppositional attitude will vary between being aggressive activity to passive non-cooperation. what is sought is the immediate termination of a "significant margin of pain."148

There is no longer an ability to cope, as was true with the previous level. "In the face of too severe, too prolonged, unremitting deficiency of maternal recognition of the fetal presence"149 "the organism stops being its trusting self, open at the interface"150 with the mother. Perhaps the fetus has a sense that the "negative umbilical affect" is like "a great nail of affliction or skewer transfixing the foetus at the navel, with an overwhelming invasion of bitter, black maternal emotions."151

The fetal reaction to this umbilical exchange varies. Sometimes the fetus can use the "down time" of the night, when the affect flows ceases or is reduced to a trickle, to "regather its incredibly renewable faith, hope, and love, to reaffirm what ought to be, and wait like Prometheus for the day when the carrion birds return to

147Lake, "Studies in Constricted Confusion," C68.


149Lake, "Mutual Caring," 22.

150Lake, "Studies in Constricted Confusion," C68.

151Lake, "Mutual Caring," 22.


attack."152 A concomitant reaction may be the willing of the death of the source person,153 which is often repressed because of its "unacceptability." The pain itself must be repressed and "split-off"; "the catastrophic sensations are dissociated from the memory of the hurtful environment. Stable 'character' is based on maintaining this."154 Life goes on, but with the unconscious scar remaining.

As with the earlier level of coping, these repressed memories are displaced symbolically, either onto some body system or part, or onto an representative "image." Thus, the "disposal of invasive maternal distress and deficiency . . ." is achieved by "displacement and containment within the foetal organism,"155 and serves to "contain the badness."156

In extreme cases of Level 3 opposition, and yet not extreme enough for the transmarginal stress of level 4, there is successive retreat from the umbilical badness to the point where the fetus is symbolically consigned to one small part of the body or compelled to "leave" totally. The remaining good of the fetus itself is "imaged as taking refuge in the head, or as retreating to just the centre of it."157 when this "good" is compelled to leave the body entirely, it is felt to exist "only outside the body, floating in the space above the head."158

152ibid., 23.

153Whether this is a symbolic "willing" or not, Lake does not make clear.

154Lake, "Studies in Constricted Confusion," C68.

155Frank Lake, "Supplement to Newsletter No.39," Clinical Theology Newsletter #39 (Nottingham: Clinical Theology Association, Lingdale, December 1981): wi 1.

156Lake, "Mutual Caring," 23.




d. Transmarginal Stress

When and if the "affect flow" from the mother to the fetus reaches the point where the fetus perceives a "sheer impossibility of keeping up the opposition to the invasive evil which seems interminable and relentless,"159 then the fourth level has been reached. when the absolute margin of tolerable pain has been reached and passed, paradoxical and supra-paradoxical response patterns result in which "the self turns against itself, willing its own destruction and death."160The stance of the fetus switches from being life-affirming to death-affirming. Beyond the margin of tolerable pain, of transmarginal pain, the "foetus longs, not for life, but for death. The plea is not for a relief of the weight, but that it may be crushed out of existence."161 "There is a loss of 'being' at the center, replaced by a paradoxical desire for 'nonbeing.'

159ibid., 30.

160Lake, "Studies in Constricted Confusion," C68.

161Lake, "Mutual Caring," 30.

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