The Prenatal Theme in Psychotherapy

Philippe Ploye

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429921803
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book is an attempt to examine whether patients in analysis or therapy can sometimes be said to form a kind of transference that not only operates at a prenatal level but can also lend itself to interpretation just like any other postnatal level of transference.

Chapter One
Review of the literature

. . . and it would be foolish to believe that the mind begins to function only at the moment of birth.

Sándor Ferenczi (1913, p. 219)

I would have liked to include in this review¹ the several references that Freud himself made, in the course of his writings, to the prenatal phase and also some of Abraham's own references to it (e.g. 1913, p. 205), but I felt it might be in order to concentrate on the writings of those authors who, in the way they have referred to the prenatal phase, can be seen to have considered the possibility that foetal modes of functioning and relating can sometimes be repeated in the way that patients relate to the analyst or the therapist, and that the material that they produce on those occasions can therefore be interpreted, not simply as the product or expression of a mere "phantasy", but as the actual re-living and reproduction, in the transference, of a prenatal mode of relating and experience: in other words, that just as patients sometimes appear to be treating and relating to the therapist as if the latter were, say, an unconsciously remembered and re-experienced maternal breast, so they can also sometimes be said to treat and relate to him as if he were their erstwhile placenta, or an unconsciously remembered and re-experienced womb and inside of the mother’s body.

The idea is by no means new. Ferenczi (1913) was, I think, the first to point out that the material produced by patients in analysis sometimes refers, without the patient being aware of this, to the latter’s experience of prenatal life.

Rank considered that certain transferences could be regarded as reproducing, at least at one level, the “physiological connection” that had existed between the mother and her unborn child (1924, pp. 5–6). He also drew attention to the fact that legends, myths, patients’ associations, and so on often contained what appeared to be symbolic references to the act and experience of birth. His paper on the birth “trauma” (1924) was a landmark in psychoanalytic literature, but he made what is now generally acknowledged to have been the mistake of making the working through of this particular “trauma” the central point of his whole technique, thus not only exaggerating the importance of birth in relation to other factors, but also leaving little room for the possibility that being born might also be a welcome “liberation” from adverse prenatal conditions (DeMause, 1982, p. 251)—a little like the break of dawn after a troubled night.

The year 1924—that is, the year of publication of Rank’s book on the birth trauma and its relevance to postnatal psychology—also saw the first of a series of publications of a Swiss analyst, the late Dr G. H. Graber, who in 1971 was to found a study group that then developed into the International Association for Prenatal Psychology (Internationale Studiengemeinschaft für Pränatale Psychologie, or ISPP). This latter Association, which in 1986 became the International Society for Prenatal and Perinatal Psychology and Medicine (ISPPPM), today has many branches all over the world.² Another society, called the Pre- and Perinatal Psychology Association of North America (PPANA), founded by Dr T. Verny (W. E. Freud, personal communication), and an even more recent study group resulted in the foundation in 1991 of the Brazilian Association for the Study of Pre- and Perinatal Psychism (ABREP—the initials being, of course, those of the Portuguese name), by a Brazilian psychoanalyst, Dr Joanna Wilheim, and some of her colleagues (see other references to Wilheim below).

Simmel (1929) observed that when patients were treated “by psychoanalysis” in a hospital environment, the “psychoanalytic situation”—by which he obviously meant the “transference”—was not “restricted to the relations between analysand and analyst” but included “the whole clinic as a kind of extension of the analyst’s personality or as an archetype of the family in general” (p. 79); “the matron and attendants [represented] the mother, the physician the father, the fellow-patients (and sometime the nurses too), the brothers and sisters”. He also pointed out, however, that patients treated by psychoanalysis in this environment tended to “identify their life in the clinic, protected as they [were] by the analysis, with the hidden intra-uterine existence” (p. 86) and that this created a “special kind of resistance” (p. 87). Like Rank, therefore, Simmel seems to have suggested the existence, as well as the interpretability, of prenatal levels of transference.

Balint (1937) described what he called the stage of “archaic” or “primary object-love”, held by him to be the “very earliest stage of extra-uterine mental life” (p. 103)—an interesting phrase that suggests some agreement with Ferenczi’s belief (1913, p. 219) in the possibility of some degree of intra-uterine mental life. According to Balint, the attempt by certain patients to recreate in their sessions the experience of “primary object-love” involved the search for a “love” that was not an “oral, oral-sucking, anal, genital, etc.” kind of love, but “something on its own” (1937, p. 101); it aspired to a “tranquil, quiet sense of well-being” (pp. 98, 102). It could be regarded as object-directed because its withdrawal brought forth instantaneous and “extremely violent reactions” and “insatiable cravings” reminiscent of addiction (p. 102) or of the “very noisy, dramatic and vehement” reactions produced by the sudden interruption of air supply—that is, by the withdrawal of the object “air” (1951, p. 145). As Balint rightly pointed out, air supply was something we normally took for granted, and in the same way as we can hardly see “any signs of satisfaction” when “the need for air is gratified” (p. 145), so satisfied primary object-love, too, is “silent”, almost impossible to detect since all we see is the “state of quiet, tranquil well-being” (p. 144). This dependence on the object air (the underlining of which was in my opinion long overdue in psychoanalytic literature and theory), as well as his several references to “addiction” or “addiction-like states” (1935, p. 193; 1937, pp. 97, 102; 1952, p. 246), were Balint’s way of illustrating what he considered to be the other main characteristic of primary object-love, namely its “almost absolute dependence on the object” (1951, p. 145; emphasis in original).

Now, as Graber pointed out (1972, pp. 60–61), Balint’s description of what he conceived as satisfied “primary object-love” is very evocative of what one could imagine to be the “silent” and “quiet” state of intra-uterine “well-being” if the pregnancy is a happy and normal one. The stage of prenatal “love”, too, is, moreover, characterized by an “absolute”, life-and-death sort of “dependence on an object”, namely the body of a mother on whom the unborn child depends for an uninterrupted supply of oxygen and nutrients and for also having its wastes immediately and continuously disposed of. Furthermore, prenatal “love” itself could be said to be “not oral, oral-sucking, anal, genital, etc.”, but “something on its own”.

Balint does not, however, appear to have considered for very long the possibility of equating the search for “primary object-love” with the search for prenatal or uterine “love”; he seems, in fact, to have decided against it. The reason for this seems to have had something to do with what both he and Ferenczi had felt to be the ineffectiveness, when a patient showed some difficulty in achieving a complete “surrender” of himself “in love or in treatment”, of telling the patient that although the latter probably wished to regress “to the mother’s womb”, he was also afraid to do so lest coming out of the regression would mean a traumatic birth all over again. Both Ferenczi and Balint had observed that such interpretations, although readily accepted by patients, “hardly touched them emotionally” (Balint, 1935, p. 71). This seems to have been the reason why Balint, although recognizing the similarity between the state of “primary object-love” and the prenatal state, eventually gave up interpreting what he called the “colourless ‘regression to the mother’s womb’”, feeling such interpretations to be “unreal” and “phantastic” compared to the vividness of affects “called forth” by interpretations that addressed not only the wish, but also the reluctance, to surrender to “passive” or “primary object-love”.³ I cannot, of course, be sure of this, but I would imagine that when these words were written, analysts’ comments to their patients about “regression to the mother’s womb” would have said little if anything about the possible existence of foetal forms of “transference”, foetal “aggressivity”, or the wish to live inside the analyst in a parasitical, destructive, object-seeking and object-related sort of way. If so, this could perhaps explain what Balint reported as the failure of his and Ferenczi’s interpretations to “touch” patients “emotionally”, or the lack of “colour” he complained about. Notwithstanding this, I think it quite likely that Balint’s description of frustrated “primary object-love” may eventually come to be seen as an unwitting description of frustrated intra-uterine “love”.

Marie Bonaparte (1938) wrote that although she had “no desire to endow the cells with a psychology” (p. 215), she wondered whether the fear that certain women have of being “penetrated, perforated or ripped open” by the male could be the reactivation of some sort of protoplasmic memory of having been perforated or broken into, as an ovum, by the sperm at conception (p. 214).⁴ She also wondered whether certain castration fears in males could go back to the sperm’s biological experience of protoplasmic “disintegration” and “loss of substance” within the ovum after penetration (p. 216). She thus appears to have been thinking in terms of destructive forces operating at the biochemical level during conception. Other writers—Fodor (1951), Lietaert Peerbolte, (1975, pp. 24–41, 293–294), and, more recently, Wilheim (1988)—have considered this possibility since then.

Karl Menninger (1939) pointed out that if we were to accept Freud’s notion of a life instinct the aim of which is to build and of a death instinct the aim of which is to destroy, it would be illogical and inconsistent to make an exception of prenatal life and declare the latter to be conflict-free: “if living and dying, construction and destruction, loving and hating deserve the appellation of instincts, and are to be regarded as fundamental and universal, we are logically obliged to conceive of them as operating in some way within the personality of the unborn child” (p. 440).

Accordingly, Menninger suggested that “at the time of fertilization the self-destructive tendencies of both male and female parents [were] temporarily overcome [by their union] . . . with the result that a tremendous impulse [was] given to the life instinct drives of the new individual”. Although the sentences that follow do not say this explicitly, I get the impression that they can be interpreted as Menninger’s proposal that after the union of the gametes thus “neutralizes” for a while their respective death instincts,⁵ the foetus is then protected from its own death instinct “by the influence of the surrounding maternal body”; and that although its self-destructive impulses temporarily re-emerge at birth with the separation from this body, they are once again “more or less neutralized” by their deflection on to the postnatal mother and the support given by her.

In that same 1939 paper, Menninger quoted extracts from a 1937 article by Devereux on the beliefs of certain primitive Indian tribes concerning the “psychology” of the unborn child; his interest in that article seems to me to confirm that his hypothesis came very near to including a notion according to which the embryo and foetus would also be conceived as averting the threat of their self-directed destructive impulses (death instinct) by deflecting these, in utero, on the inside of the mother’s body. In other words, Menninger seems to me to have come very close to formulating the hypothesis of a prenatal, object-seeking and object-related form of aggressivity that is directed at the inside of the mother’s body from within.

Greenacre (1941, 1945) is well known for her pioneering work on the mother–foetus relationship and for raising the question of whether the foetus’s reactivity to certain—presumably unpleasant—stimuli could be regarded as what she called a “pre-anxiety” kind of response. If we accept Melanie Klein’s view that anxiety results from the ego’s fear that it will be annihilated by its own destructive impulses unless it can deflect these outwards onto something or someone else (1946, p. 298), acceptance of Greenacre’s notion of a prenatal precursor of anxiety would presumably necessitate including that of a prenatal precursor of aggressivity such as “pre-aggressivity”. Clifford Scott (1949, p. 144), Winnicott (1949, p. 141), and, later, Money-Kyrle (1968, p. 692 n.3), to quote but a few, have also expressed their own interest in the prenatal phase and in the possible usefulness of further research into this field.

Fodor (1949, 1951, 1962) is acknowledged by several writers as one of the pioneers in the field of prenatal research, particularly with respect to his use of dreams (1951) as a means of reconstructing prenatal experience and events. He seems to have been responsible for having introduced the term “conception shock”. As we saw, Marie Bonaparte had suggested the possibility of such a “shock” as far back as 1936, although without using the same word. Fodor was also interested in the possible relevance of foetal modes of awareness to parapsychological phenomena.

Lietaert Peerbolte (1951, 1952, 1975, pp. 42–54) may well have been the first to suggest the possible existence of placenta “symbols” and hence the possibility, when such presumed symbols appear in damaged form in patients’ material, of reconstructing cases where prenatal suffering had been caused or contributed to by placental defect, malfunction, or injury. In addition to being interested, as mentioned earlier, in the possibility of “conception shock” (1975, pp. 24–41, 134–144, 185, 293–294), Lietaert Peerbolte, like Fodor, was also interested in the possible relevance of foetal modes of awareness to parapsychological phenomena. In the second half of his book, Psychic Energy (1975), he gives a list of Fodor’s publications concerned with parapsychology and psychoanalysis (p. 265).

Mott’s extensive research into the prenatal symbolism contained in dreams (1948, 1959, 1964) and in myths (1960) should be of great interest to anyone engaged in psychoanalytic or psychotherapeutic work. His whole work is a thorough-going study of what he regarded as the prenatal foundations of the postnatal human “mind”, and his research into what he, too, believed to be instances of placental symbolism has been of great help in stimulating my own interest in the subject.

Melanie Klein (1952a, p. 263) wrote in a footnote that “recent studies of prenatal modes of behaviour” (she quoted in this respect Gesell’s 1945 book, Embryology of Behaviour) provided food for thought about the existence of a “rudimentary ego . . . already at work in the foetus”. (See also below for a more detailed reference to Klein’s 1957 volume, as well as to her work in general.)

Kelsey (1953) uncovered what he described as unconscious memories of conception or of prenatal life in his treatment of certain patients by hypnoanalysis.

Evans (1955) presented material from the analysis of a boy in the latency period which not only showed the latter’s unconscious awareness of the umbilical cord and the way it had connected him with his mother’s body, but also her own awareness of the light that the boy’s twisting of some string to form a rope appeared to shed on the connection and relationship he had formed to other people, including herself (pp. 63–64).

A. Rascovsky too, like Melanie Klein, expressed his belief (1956) in the possible usefulness of conceiving of a rudimentary ego that would already be at work in utero. He made an interesting reference to the Greek legend in which Ulysses and his companions owe their escape from the cave to the fact that Ulysses manages to blind the one-eyed giant Polyphemus who guards it. If I have understood him rightly, Rascovsky saw the blinding of this cyclopean eye—or “I”—as a symbolic allusion to the way in which the “prenatal nucleus of the ego and the characteristics of its vision” must first be “superseded” and left behind at birth before the individual can fully emerge from the uterine “cave” into the outside world (p. 286). I have asked myself whether this prenatal, cyclopean “eye” or “I”, notwithstanding Rascovsky’s suggestion concerning its possible “phylogenetic” origins (p. 288), could also be susceptible to a “placental” interpretation, according to which a placental “eye”—or “I”—would be conceived as “looking into” the inside of the mother’s body, and as being itself “killed” at birth. (Regarding this possible placental interpretation of the prenatal “eye” or “I”, chapter three suggests the possibility of making some kind of link between the functions of the placenta and those of the postnatal ego. See also below for further reference to the work of Rascovsky and his collaborators.)

Mahler, Pine, and Bergman (1975) have contributed much to our understanding of the almost constant overlap into postnatal life and behaviour of prenatal modes of functioning and relating, and hence to our awareness of the importance of interpreting such overlap in the transference whenever appropriate.

In one of her later works (1957, p. 179), Melanie Klein wrote that “how far [the prenatal state] is undisturbed must depend on the condition of the mother and possibly on certain unexplored factors in the unborn infant”; and that “unpleasant experiences” in utero, “together with the feeling of security in the womb”, may precede and “foreshadow” the postnatal good breast/bad breast type of dichotomy.

It seems reasonable to suppose that by “unpleasant experiences” Klein was referring to the kind of events she described as giving rise to what she called “persecutory anxiety”. We also know that she saw such “anxiety” as the ego’s fear of being overwhelmed or annihilated by the self-directed aggressivity of its own death instinct (1948, pp. 278–279) and that, in agreement with Freud, she held that the ego dealt with this threat by deflecting ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• ACKNOWLEDGEMENTS
• FOREWORD
• Introduction
• 1 Review of the literature
• 2 Clinical material
• 3 The placenta and its possible role in ego development
• 4 Notes on placental symbolism
• 5 Additional remarks about the literature concerned with prenatal life
• REFERENCES
• INDEX