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Birth has always been an intriguing phenomenon. At certain times in history it was an accepted belief that a man burdened with crippling disfigurement, meanness of spirit, ill fortune, or madness of mind had been cursed with an unyielding womb or an untimely birth. In the sixteenth century Shakespeare wrote of Richard III:
I that am curtailed of this fair proportion;
Cheated of feature by dissembling Nature,
Deformed, unfinished, sent before my time
Into this breathing world, scarce half made up,
And that so lamely and unfashionable
That dogs bark at me as I halt by them--
. . . have no delight to pass away the time
Unless to see my own shadow in the sun
And descant on mine own deformity.
And therefore. . .
I am determined to prove a villain
And hate the idle pleasure of these days.
This passage points to the understanding of that time that physical pain and damage to the fetus at birth does affect character and behavior; a concept that we in this century tend to dismiss as an old wives' tale.
In the twentieth century the mental health and medical professions have claimed proprietorship over the mysteries of human nature. Otto Rank was the first to place great emphasis on birth. He believed that birth was the individual's original encounter with anxiety and would inevitably plague him throughout his life. Other psychiatric professionals have stressed that birth is the infant's first separation anxiety, which may be triggered by any significant loss in the child's or adult's later life.
In 1969 Arthur Janov introduced primal therapy, and began to observe patients reliving their births. He referred to these experiences as birth primals, and noted that once these primals were connected and integrated with one's present life, patients seemed to enjoy profound changes in the way they felt and behaved. Concurrently, therapists in various other settings began to report similar observations. Unfortunately, many of these therapists attempted to induce birth experiences through artificial methods, such as having the patient crawl along a long mat to be "born," with the therapist waiting to "deliver" him. This superficial approach demonstrates a naivete about the fact that reliving birth involves deep, psycho-physiological pain, and cannot simply be re-enacted symbolically. Birth profoundly influences human development. A violent birth lays the rudimentary structure of what can become a life-long psychiatric disability.
To understand the relevance of birth primals, some terms commonly used in primal therapy need to be clarified. The word "primal" is defined by the Oxford English Dictionary as meaning original, essential, fundamental and pristine. It is an appropriate term in conveying the depth of feeling experiences undergone by patients in primal therapy. The word "feeling" is used often in the psychiatric profession, mostly to describe affects such as sadness, anger, or fear. Usually, when we refer to "the patient's need to express his feelings," what is meant is that the patient has a need to talk about what he is feeling. "Feeling" in primal terms involves something much different. It is a total body release of inner pain. Physical expression of feeling is necessary because there is no true separation of the mind and body. Feelings are an actual happening in the body -- chemical and hormonal. If this were not so, a lie detector test would be useless. When the body experiences any kind of central nervous system impulse, the natural and automatic response of the body is to express this through the neuromuscular system, which involves movement and sound.
At the Certified Primal Therapist Center in Denver the author has had several asthmatic patients. When they begin to talk in a session about a situation that is emotionally loaded, their asthma often recurs. The patient is encouraged to bear with it as much as he can tolerate. As he drops into this body experience, he feels the immense pain of having his supply of oxygen depleted. In time these patients realize that during the asthmatic attack they are reliving an occurrence (birth or intrauterine) when their oxygen was momentarily shut off. When the patient becomes aware of how his present body feelings are symbolic of what has happened to him -- this is a connection. In all cases the original trauma occurred at birth or in the womb. The agony of this moment is expressed with desperate gasping sounds and physical struggle.
Though primal therapy emphasizes feeling, it is not a therapeutic process until what one is feeling is "owned" and placed in perspective in one's present life. This is what is meant by integration. It is an ongoing process. It is only through experiencing deep body feeling, expressing the feeling physically and vocally, learning where the feeling originated and what happened to the body as a result, and integrating the entire process within the context of one's present life, that primal becomes therapeutic.
Although birth primals have become a curiosity in recent years, there are many aspects of it that are not clear to the public. One important factor that primal clarifies about birth is that the primary trauma to the infant is physical. For most people, there are multiple injuries the body incurs during birth which are so frightening and dangerous that the event must be relived a bit at a time. Birth cannot be felt completely in one session.
One of the dangers that the infant confronts during birth is respiratory distress:
The first breath (of the newborn) requires unusual effort by the respiratory muscles. The fetal lungs contain fluid. When the head emerges first from the birth canal, the nose and mouth are at atmospheric pressure while the thorax is still subject to increased intrauterine pressure. Uterine contractions may squeeze the thorax and empty it of much fluid, but some remains. The first inspiration must pull fluid that is 36 times more viscous and 1,000 times denser than air through the fine air ducts. . . .
The infant's first inspiration must overcome the forces of surface tension and elastic recoil and tissue resistance. His first expiration is as difficult; if all the air that was inspired is expired, atelectasis would occur . . . with cohesion of the walls of the alvoli, ducts, and bronchioles (Comroe, 1975).
During the birth process itself severe respiratory complications may occur. The umbilical cord may become tangled while the infant is moving through the birth canal or the cord may become knotted around his neck, obviously endangering his life. Until birth is complete, the newborn's only source of oxygen is from the umbilical cord. The infant's experience of reduced oxygen blood levels at a time when he is exerting extreme physical effort to move through the canal, and is suffering immeasurable forcible pressure from uterine contractions, is probably comparable to the sufferings of a human being who has lived through the grueling and sadistic tortures of a concentration camp.
Birth is not mere psychological fright, but a total catastrophic physical assault which the infant's body will never forget. He experiences this threat in every cell of his body. Many patients in primal therapy believe that they were hypoxic during the labor and delivery period, and that they incurred brain damage as a result of the hypoxia. Damage that may be diffuse and, therefore, not grossly observable as in those who are retarded or who suffer cerebral palsy, may be present and exert its effect in what was once considered to be neurotic or psychosomatic symptomatology.
The following is an account of a 29-year-old man whose father, an alcoholic, died at age 51 of cirrhosis of the liver. The young man, although not consistently a heavy drinker, did go on alcoholic binges in which he became severely intoxicated. Here is his description of how oxygen deprivation at birth steered his self-destructive behavior:
I went to Italy for a year when I was 17 and spent most of that time getting drunk -- not drinking, but getting stupefied with alcohol. After a few drinks I lost any semblance of control and fed alcohol into myself until I could no longer stand up or speak, and often passed out. I would wake up in different places each night; churches, gutters, buses, traffic islands. The sensation of gross inebriation before actually passing out was one of inability to focus -- blurring and double vision, sounds crashing incoherently around me in waves, leaden refractory muscles, rubbery skin no longer feeling a part of me; an overall sensation of huge panic leading to a withdrawal from outside sensations until I finally achieved oblivion.
As I have opened up to early physical pain in therapy, I have noticed that when I am triggered in the present, by some dilemma (and often for no reason at all that I can perceive) and when I drop into my birth feeling during a session, I initially fight desperately --pushing at the room corners, arching my back, gripping and tearing at pillows with my hands and teeth, and then gradually and spasmodically, I give up.
My eyes lose all focus, my ears no longer distinguish between sounds; feeling them only as repetitive assaults. My arms and legs -- especially on the left side -- become numb and rigid, and I sense myself withdrawing further and further from my outside until I seem to be inhabiting only small areas of my body. Eventually I may half pass out or go to sleep.
I was struck by how similar these feelings were to those I had experienced when drunk. It seems clear to me that during birth, for reasons which are not quite clear to me, my body and especially my brain was deprived of oxygen for long periods of time and that my body responded by withdrawing slowly and painfully toward its center and toward death.
I know that the pattern of pain I forced on myself through alcohol, and later could re-experience in therapy, seems to have been etched in my brain through lack of oxygen -- a path of damage I always had to tread to the end.
I cannot say that the whole scenario of my birth is clear to me. I do not ever expect it to be. The feelings are so massive yet confusing that I cannot sit down afterwards and piece it all together -- rather I become aware at certain, often unexpected, times of truths about my birth and hence about my life. Truths which are as precious to me now as the oxygen would have been then. But why would I want to repeat that ghastly experience over and over? I was walking around in feelings of dying at birth most of my life. Every time I got triggered into fear and panic, which happened all the time as an adolescent, my body became locked into that sequence of events without being able to find any release.
Drinking became the release, the only resolution I could find and a very appropriate one because it so accurately recreated what had actually happened to me. I cannot avoid that birth feeling, it is a part of the truth of my life; the difference between feeling it and drinking through it is that, with the former, I start to feel myself emerging as a whole, no discrete and warring areas of specialization -- a remarkable consciousness for me -- and with the latter, I get sick, more fragmented than ever, and am just subjecting myself again and again to a horrible experience like a malfunctioning computer running through the same program time after time.
This man's experience of painful (and probably diffuse) damage to his brain cells during birth continued to occur throughout his life. When, as an adolescent, memory traces of birth pain were triggered, he would turn to alcohol to alleviate an unknown inner turmoil; yet, instead, he was repeating the destructive birth pattern that had originally happened. That is, he became intoxicated, and threw his brain into confusion, delirium, and at times unconsciousness, which was a symbolic repetition of how he felt during birth while he struggled to survive. Amazingly, the symptoms of severe alcoholic intoxication and hypoxia are quite similar.
Other than oxygen deprivation the infant must contend with trauma to his head. Because of the relative size of the infant's head, it must bear the brunt of the pressure at birth whether the delivery is cephalic or breech. Even with the protective covering of the skull bones, the brain is particularly vulnerable. Since the sutures of the skull are not closed, the bones may override and molding may occur to allow the head entry into the birth canal.
Birth injuries occur in the form of softening of the flat cranial bones (craniotabes), facial paralysis, cranial hemorrhage, subconjunctival hemorrhage, fractures, brachial palsy, and many others. Most of these injuries are considered to be temporary; yet they are in fact evidence of the amount of pain the infant must endure from the intense intrauterine pressure, the force of the uterine contractions, and the tightness of the birth canal.
Unfortunately, because some birth injuries appear to heal, they are considered essentially minor problems. No consideration is given to the possibility that such injuries may have a lifelong effect on the individual. The health-care system is based on medical model which infers that an individual is either sick or well. For an infant, once birth injuries have healed he is thought to be well, as long as no obvious permanent birth defects are diagnosed. This is not always so. A fracture, a hematoma, or a cerebral hemorrhage experienced by an adult, through certainly not to be lightly dismissed, is one thing, but a similar type of assault to a newborn is something entirely different.
The infant's nervous system is immature, sensitive, and vulnerable; it is not as sophisticated as the adult's to assist him in coping with his pain. The infant has no concept of time and every experience feels like "forever." This statement is validated by patients who have been in primal long enough to have relived much of their birth trauma. Nevertheless, when they are reliving birth feelings the pain feels as if it is unending.
This perception of unending pain may cause a patient to become hopeless and suicidal. We, in primal therapy, have found that all suicidal feelings arise from the individual's first confrontation with severe pain and near death from morbid conditions in the womb. It is not just the pain that plunges one into suicidal gestures, but these infantile feelings that go with it; that is, the sense of timelessness, that the pain will never end.
During birth, the infant has a reflex in the lower brain which can literally shut off some of the sensory input. As the infant's total consciousness is reduced, he loses some of his ability to fight for survival, and, to varying degrees, relinquishes his participation in the birth process. This only tends to prolong labor, and worsen rather than alleviate conditions. Some infants may have blunted consciousness so extensively, owing to the unrelenting pain, that they are delivered half dead.
This is how many patients who have relived their births describe the way they felt -- dead. Regardless of the specific type of assault, there is no question that birth can be a near correlate to death. For many people with primal trauma, the first nine months and the birth experience may be the closest they ever come to death until that final moment arrives. This encounter with death, either prenatally or at birth, stimulates chemical and hormonal secretions that are elicited in the organism as he struggles to survive.
How the newborn reacts to this threat of death forms the basic constellation of his emotional responses to stress in later life. He may react with alarm or, depending on the preceding conditions of the womb environment, his own nature, and the hopelessness of his attempts to deal with pain, he may "shut down." By "shutting down" we mean that the infant cannot endure the pain of birth and, as his oxygen supply becomes intolerably low, physical struggle becomes maladaptive. The result is a deadening or shutting off of the sensory overload as well as inhibition of motor activity and spontaneous expression.
Within a primal context, we believe that the terror of impending death facing the fetus is what Freud termed basic anxiety. Anxiety is probably considered one of the common denominators of all psychiatric problems. The way anxiety is manifested is, of course, specific to the individual and varies according to whether the anxiety is acute or chronic, how intense it is, and whether it is felt or repressed. Anxiety is often compared to fear because the physical responses in the body are identical -- though anxiety is classified as unreal fear and hence neurotic. Freud considered anxiety to be inherent to human beings. He developed his theory of healthy and neurotic defenses, assuming that defenses are needed to guard against anxiety, and considered some more functional than others. Although he may have asked himself why he believed anxiety must be basic to the human condition, he did not seem to take the question very far.
The actual experience of dying, and the manner in which the body attempted to adapt to this assault will continue to be reexperienced throughout the person's life until he can feel what actually happened to him. Depending on his strengths, traumas, and basic responses (not only birth and intrauterine feelings but childhood feelings as well), he will deal with this memory coded in his nervous system in a way somehow symbolically representative of his early feelings.
Perhaps he might become a war hero constantly confronting death, or a physician attempting to save other lives when it is really his own near death that terrifies and drives him. Perhaps he would become a recluse, fearful of leaving his home and imagining threats everywhere or catatonic, acting out through his body posturing the death feelings inside him.
Possibly he would struggle with suicide through his life, like Ernest Hemingway -- holding a gun in his mouth every morning for years until he finally pulls the trigger. We've all seen people like Hemingway -- or more recently Freddie Prinze -- somehow bent on their own death or unusually frightened of it. They are difficult to help because the memory of their pain is buried so deeply in their nervous system, unknown to them, and in most cases, unknown to those who are trying to help.
What is important to emphasize is that birth feelings need to be felt by those who have primal pain, for unfelt pain remains in the central nervous system and forms the driving force for maladaptive and "sick" behavior. The explanation to have for this is that in the embryo, fetus, or newborn, the lower brain and the spinal cord are more developed than the higher brain centers, i.e., the cerebral cortex. This is adaptive in that, in order to survive, the fetus can react to stress and trauma.
Yet, the fetus does not have a fully developed cerebral cortex and cannot know in the adult sense what is happening to him. If the womb environment is extremely depriving and foreboding, and the birth process is violent, the organism can only experience life as dangerous. He has limited reactions to danger -- neuromuscular, autonomic, chemical -- all of them physical and a function of the primitive and lower brain. Later stress will evoke these autonomic reactions, such as panic or shock.
As the nervous system encounters trauma and damage, they become coded in a way that the original insult develops associative tracts to other areas of the brain. For example, take one aspect of birth, the incredible uterine pressure exerted on the infant resulting in the sense of feeling crushed. If, as the infant develops, his parents behave toward him in an overbearing or oppressive manner, and if he in turn is not able to respond to his feelings, he may learn to associate and interpret any type of verbal or physical aggression with his birth.
Since the birth experience was so extremely painful, overwhelming, and "crushing," he does not gain the capacity to deal with his parents and other people in an assertive manner. Even as an adult he cannot react naturally to adult stresses such as criticism, but instead relates to the situation with the old feelings of being attacked. Many patients state that before primal therapy everything was a matter of life or death. What they were feeling was the body memory of their intrauterine and birth experience, which at that time was a matter of life and death.
One of the abilities of the cerebral cortex as it develops in the child is to integrate primal pain in such a way that the central nervous system and the organism can function as a whole. Very few parents are aware of primal pain and are unable to help the child integrate it. As the infant or child attempts to discharge pain through expression of feelings and physical movement the parents will often express disapproval in a hundred different ways. They, unaware of their own primal pain, are not able to provide the child with significant meaning to his outbursts or his hurts. The child does not grow as he was meant to grow. Instead he learns to defend against the pain which he cannot release and must contain. To add further injury, the child, in feeling the disapproval of his parents, begins to experience the same negative reactions to his own pain. This in effect labels the very thing that is real and true to the child and his life as bad. We see the adult suffering not only with anxiety, depression, or inappropriate behavior that he cannot seem to control, but hating himself because of it. This causes further shutting down of the real self, and a stronger reinforcement of crazy and defensive behavior.
The function of the cerebral cortex then is to repress and symbolize the pain recorded in the lower brain. If, in addition, life is intolerable for the child, the entire central nervous system becomes overloaded. The brain works against itself, and becomes fragmented and split in order to shut off as much of the pain as possible while still enabling the person to function. When a great deal of brain activity is needed for repression, or if the nervous system is extremely overloaded with pain, the person's responses to life situations are both limited and stereotyped, a characteristic of neurotic and psychotic behavior. In some, the repressive activity is successful in holding the pain below the level of the person's awareness, but at the high cost of deadening their lives. Others, unable to repress the agony within, act out in a more impulsive and bizarre fashion.
The tragedy of unfelt and nonintegrated pain is that the cerebral cortex, which was meant to provide human beings with a rich understanding of themselves and their world, functions instead in repressing the pain stored in its underlying structures. The price one pays for this is a brain that functions more in a defensive than in an open manner. Human beings then become split from their self -- unconscious and unfeeling. The life for which they fought so hard as a small organism is not what it could be. They are either deadened to all feeling or flooded with pain they are too frightened to feel.
This article was originally printed in Perspectives in Psychiatric Care.
Reprinted from Perspectives in Psychiatric Care with Permission of Nursecom, inc, Philadelphia, PA 19107.
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