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

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



2. Embryological and Fetological Thought of the 20th Century

With the biochemistry, biology, anatomy and neurology of embryology and fetology gradually becoming clearer and clearer though much of the early to middle part of this century, the groundwork is laid for a return to substantial speculation about the psychological sophistication of the fetus. Certainly crucial to this debate was the thought of Sigmund Freud. His impact upon the subsequent psychodynamic understanding of fetal life was profound and undeniable. Addressing Freud's influence, deMause writes, "virtually all contemporary psychoanalytic theory denies the possibility of mental life before or during birth. The newborn is believed to be without memory, ego, objects, or mental structure.64

But perhaps it could be stated that in some ways, whether he intended to or not, Freud "opened the door"65 to the psychodynamics of intrauterine life. For instance, even though Freud66 wrote in Inhibitions. Symptoms and Anxiety that "birth still has no psychic content"67 and that "birth is not experienced subjectively as a separation from the mother since the foetus, being a completely narcissistic creature, is totally unaware of her existence as an object,"68 in the same work he also referred to birth as the "earliest anxiety of all" and the "primal anxiety."69 Lake even quotes Freud as writing that "there is much more continuity between intra-uterine life and the earliest infancy the impressive caesura of the act of birth allows us to believe.70

64Lloyd deMause, Foundations of Psychohistory (New York: Creative Roots, Inc., 1982), 247.

65Lake, "The Significance of Birth and Prenatal Events in Individual, Family and Social Life," S5.

66Phyllis Greenacre, writing regarding Freud's position states that even though "he doubts the importance of the individual birth experience in influencing the quantum of the anxiety response, largely because the birth experience is without psychological meaning; at the same time, nevertheless, he emphasizes the continuity of the intrauterine and the postnatal life." (Phyllis Greenacre, Trauma Growth and Personality, New York: International Universities Press, 1952], 52).

67Freud, cited in deMause, Foundations of Psychohistory, 247.

68Freud, Inhibitions, Symptoms arid Anxiety, 130.

69ibid., 137.

70Lake, "The Significance of Birth and Prenatal Events in Individual, Family and Social Life," 5.


Freud's71 schizophrenic attitude toward birth is perhaps illustrated by his initial embrace of Otto Rank's book The Trauma of Birth as "the most important progress since the discovery of psychoanalysis."72 However, he apparently turned against Rank73 at the behest of Abraham, Jones and some of the others of his inner group who warned that Rank's book would eclipse Freud's work.74

Later, in writing to Abraham, Freud alluded that he was "getting further and further away from birth trauma. I believe it will 'fall flat' if one doesn't criticize it too sharply, and then Rank, who I valued for his gifts and the great services he has rendered, will have learned a useful lesson."75

71deMause cites D.W. Winnicott's Collected Papers: Through Pediatrics to Psycho-Anaiysis, 175 for the following exception: "The only time when he was said to have deviated from this view was once when he was heard to have wondered if an infant born by Caesarian section might have a different pattern of anxiety." (deMause, Foundations of Psychohistory, 246).

72Freud quoted in Lake, Tight Corners in Pastoral Counselling, 3.

73Jessie Taft, Otto Rank: A Biographical Study Based on Notebooks Letters Collected Writings. Therapeutic Achievements and Personal Associations (New York: Julian Press, 1958).

74Lake writes that these persons "inflamed his [Freud's] fear 'lest the whole of his life's work be dissolved by the importance attached to the trauma of birth."' (Lake, Tight Corners in Pastoral Counselling, 3).

75Fodor, Freud, Jung and Occultism.


Otto Rank began his study of the possible effect of birth experiences in 1904, finally publishing The Trauma of Birth in 1923. This work, which clearly laid the groundwork for an understanding of the effect of pre-natal events on subsequent functioning, 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,"76 and that "we are led to recognize in the birth trauma the ultimate biological basis of the psychical."77 He continued: "We have recognized the neuroses in all their manifold forms as reproductions of, and reactions to, the birth trauma."78

What makes Rank important for an understanding of prenatal "psychology" are his allusions to the significance 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."79

Building on Rank's work, Donald W. Winnicott, a British pediatrician and psychoanalyst, continues to push the "primal" influence back earlier, alluding more strongly to the importance of pre-natal life. Although, like Rank, his primary emphasis was still on birth as an event "etched on the memory"80 that manifested itself in the stresses of later life, he also alludes strongly to the possible effect of the prenatal period, extending back as far as conception, upon the developing psyche. He writes:

76Rank, The Trauma of Birth, quoted by Frank Lake, "Primal Integration Work," SeIf & Society, 15 (1987): 168 (Lingdale Archive #118).

77Rank, The Trauma of Birth, xiii.

78Rank, The Trauma of Birth, quoted by Lake, "Treating Psychosomatic Disorders Relating to Birth Trauma," 229.

79Rank, The Trauma of Birth, quoted by Lake, "Primal Integration Work," 168. Lake also quotes Rank as stating: "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."

80Winnicott writes that "there is evidence that personal birth experience is significant and is held as memory material. When birth trauma is significant, every detall 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." (Winnicott, quoted by Lake, "Primal Integration Work," 169).


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.81

An American contemporary of Winnicott's was Phyllis Greenacre, who, in her book Trauma Growth. and Personality also makes allusions to the possible impact of the prenatal environment, but subsequently seems to back away from the implications. She writes "The fetus moves, kicks, turns around, reacts to some external stimuli by increased motion.82 Indeed, research showing the increase of fetal heart rate and fetal movements to such stimuli as loud noises and maternal nervousness would indicate that these are signs of anxiety, as they would be in the child or adult.

While Greenacre retreats from any kind of affirmation of a distinctly "fetal anxiety",83 she did affirm that anxiety-like responses in the fetus give rise to a predisposition to anxiety in the child and adult. She summarizes her own ambivalence to birth and pre-birth anxiety when she wrote that "perhaps the struggle of birth is at once too terrifying and too inspiring for us to regard it readily with scientific dispassion. "84

While Freud, Rank, Winnicott, Greenacre and others all made allusions to the possible importance of the prenatal, it is in the work of Nandor Fodor and his follower, Francis Mott, that the prenatal is specifically emphasized. It is Fodor's work The Search for the Beloved: A Clinical Investigation of the Trauma of Birth and Pre-Natal Conditioning, which was published in 1949, that really marks the beginning of the modern "prenatal psychology" movement. As is clear with the title of the book, the first part of the book was devoted to birth trauma, while the second part is devoted to the "Traumata of the Unborn."85 Mott's work was primarily based upon the analysis of various case histories, particularly dreams. He differentiates his work from Rank's: "Otto Rank made the first attempt to biologize psychoanalysis. His approach was philosophical; mine is clinical and independent of his claims."86

81Winnicott, quoted by Lake, "Primal Integration Work," 169.

82Greenacre, Trauma Growth arid Personality, 54.

83Ridgeway writes: "She [Greenacre] was persuaded by Freud (after his break with Rank) that the fetus and the newborn child behaved in ways that had 'no psychic content."' (Rhea Ridgeway, The Unborn Child [Great Britain: Wildwood House, 1987], 62).

84deMause, Foundations of Psychohistory, 248, quoting Phyllis Greenacre, "The Biological Economy of Birth," Psychoanalytic Study of the ChiId 1(1945): 40.

85"The book is actually divided into three "books", the first titled "The Trauma of Birth" (pp.3-204), the second "Return to the Womb" (pp. 207-299), and the third "Traumata of the Unborn" (pp. 303-379).

86Fodor, The Search for the Beloved, v.


All of the major components of Lake's M-FDS can be discerned in Fodor's work. Lake saw his research as confirming and building upon Fodor's, and others, such as Mott's and Grof's work. Fodor affirmed, as Lake later did, the importance of birth for later development, the therapeutic effect of re-experiencing birth and prenatal life, the specific problems raised by particular maternal habits87 and behavior such as rejection of the fetus and attempted abortion. Fodor affirms, as did Lake, that the prenatal period is more crucial than birth for subsequent functioning. He writes:

The release of the trauma of birth is the introductory phase of the integration of pre-natal trauma. The more vital phase concerns the shocks suffered prior to birth. In order to release these shocks, the mind must take cognizance of their existence and nature.88

Finally, Lake's affirmation of the primacy of the first trimester can also be found in Fodor's work. He approvingly quotes Sadger:

I believe first of all that which all my patients assert, that the embryo already feels plainly whether its mother loves it or not, whether she gives it much love, little love, or none at all, in many instances in fact in place of love sheer hate.89

Francis Mott is as explicit in his emphasis upon intrauterine life as Fodor is. His fundamental principle was that "every psychological feeling derives from an older physical feeling." For instance, the very basic psychological sense of "I" is originally derived from the physical sensation of contact between the fetal skin and its environment.90

Thus, the bi­directional flow of blood from mother to fetus as mediated by the placenta through the umbilical cord, gives rise to the physical "feelings" of aggression, submission, emptiness,

87"The life of the unborn is not necessarily one of unbroken bliss. The unborn child is dependent on his mother's blood-stream for oxygen, for food, and for the elimination of its waste products. There are many maternal afflictions that affect and perhaps weaken the child before birth. Many children seem to start post­natal life with a handicap." (ibid., 396).

88ibid., 400.

89J. Sadger, "Preliminary Study of the Psychic Life of the Fetus and the Primary Germ," The Psychoanalytic Review, 28 (1941): 336, quoted by Fodor, The Search for the Beloved, 306.

90Ridgeway, The Unborn Child, 64.


fullness, giving and taking that is the basis for subsequent psychological "feelings". Mott utilized the term "umbilical affect" to designate this exchange, defining it as the "feeling state of the fetus as brought about by blood reaching him through the umbilical vein."91 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."92

Stanislav Grof's work is contemporaneous with that of Mott's. His analysis, however, is less dependent upon dreams as the content for his ruminations and very dependent upon LSD-assisted abreactions. On the basis of an analysis of over 3000 LSD-therapy sessions, Grof described four "Basic Perinatal Matrices", the first of which he called the "Life in the Womb."

This matrix, according to Grof, was 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"93 or the negative recollections the 'bad womb' situation such as fetal crises, emotional upheavals in the mother and attempted abortions.94

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. The third phase involves the actual process of birth while the fourth dealt with the early post-natal experience.

It was in this general milieu that Lake formulated his own thinking with regard to birth and subsequently, to prenatal life. Some of his own work was contemporaneous with others, especially Grof's and Mott's. The views of Lake and all those who preceded him in this area have never been widely affirmed or accepted.

Following is a review of some of the present available data that appears to lend support to Lake's M-FDS. As with neonatal and postnatal physiological and psychological processes, those of the prenatal can be organized into several categories, including movement, sensation, learning, memory, affect, dreaming, and the much more elusive and difficult-to-determine categories of personality and consciousness.

91Moss, "Frank Lake's Maternal-Fetal Distress Syndrome: Clinical and Theoretical Considerations," 203.

92Lake, "The Significance of Birth and Prenatal Events in Individual, Family and Social Life," S1.

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

94Lake described this phase of Grof's Basic Perinatal Matrices: "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 my 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." (Lake, "Perinatal Events and Origins of Religious Symbols, of Symptoms and Character Problems: The Possibility of Reliving Birth and Its Effects").

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