Prenatal and perinatal psychology

Prenatal psychology can be seen as a part of developmental psychology, although historically it was developed in the heterogenous field of psychoanalysis. Its scope is the description and explanation of experience and behaviour of the individual before birth and postnatal consequences as well. In so far as the actual birth process is involved one can consider this perinatal psychology. Pre- and perinatal aspects are often discussed together.[1]

Prenatal and perinatal psychology explores the psychological and psychophysiological effects and implications of the earliest experiences of the individual, before birth (prenatal), as well as during and immediately after childbirth (perinatal). Although there are various perspectives on the topic, a common thread is the importance of prenatal and perinatal experiences in the shaping the future psychological development. There is a debate among scientists regarding the extent to which newborn infants are capable of forming memories, the effects of any such memories on their personality, and the possibility of recovering them from an unconscious mind, which itself is the subject of argument in the field. A widespread assumption concerning the prenatal phase was that the fetus is almost completely shielded from outside stimuli. Thus, perception and consciousness would develop after birth. Meanwhile, there is a great number of scientific studies which show clearly that behaviour, perception and learning is already developed before birth. This also holds for nonhuman species, as for rat fetuses acoustic conditioning can be demonstrated.[2]

Psycho-physiological aspects of the prenatal phase

Fetus, connected with the mother by umbilical cord and placenta

The physiological development while in the prenatal phase – especially that of the brain – is of particular importance for prenatal psychology. In the first eight weeks after insemination, the developing child is called an embryo. After the inner organs have developed (from the ninth week on) it is called a fetus.

Prenatal development of the brain

The basis of perception, experience, and behaviour is the brain. While in gestation, a giant neuronal net is developing, delivering the condition for any mental process. About half of the developing neurons become destroyed again while the development of the brain because of the "programmed cell death" (apoptosis). At birth the infantile brain contains 100 billion neurons – as many as in the brain of an adult.[3] At birth, every cortical neuron is connected with about 2500 neurons; after a year, with about 15 000.[4] Synapses develop, and are destroyed, over the whole life span – a process called neuroplasticity.

Motor development

In the 1930s the physiologist Davenport Hooker examined reflexes or reactions, respectively of aborted fetuses extrauterine.[5] Nowadays, the motor skills of embryo and fetus can be examined with ultrasound techniques quite easily. From the eighth week on the embryo moves the rump, shortly after that his extremities.[6] With the means of sonography one could demonstrate that these were not simple reflexes, but also endogenously provoked movements.[7] According to Alessandra Piontelli the fetus shows all patterns of movement, which later can be found in the newborn.

Breath movements can be seen from the 19th week on, with the fetus taking amniotic fluid into his lungs.[8] Eye movements are shown to exist from the 18th week on, from the 23rd week on there are rapid-eye-movements (REM-phases).[9] These are connected with sleeping patterns and dreaming. Fetuses drink amniotic fluid and urinate into it.[10]

Development of perception and prenatal learning

The sense modalities of the fetus develop prenatally and are functioning very well at birth. The examination of such abilities is connected with experimental examination of behaviour, provoked by stimuli. Ray examined vibro-acoustic conditioning of human fetuses. According to Hepper it rested uncertain, if such conditioning was successful.[11] Hepper claims to have repeat such conditioning experiments successfully, with the earliest vibro-acoustic conditioning in the 32nd week of gestation.[12]

Prenatal learning often is examined by using the habituation paradigm.[13] The fetus gets exposed to a stimulus, e.g. an acoustic one. Afterwards the experimenter watches the extinction of the reaction while repeating the same stimulus again and again. This procedure becomes completed by the use of a new stimulus and the recording of the according reaction. When the new stimulus is identified by the fetus as different from the old one, it releases a new pattern of reaction, e.g. accelerated frequency of the heart. If this does not happen, the new stimulus cannot be distinguished from the old focal stimulus. In 1991 a study demonstrated the acoustic habituation by recording the heart frequency of foetuses in the 29th week of gestation.[14] Such studies can be used for examining memory. Fetuses older than 34 weeks of gestation can reproduce learned content over a period of 4 weeks.[15] The earliest vibro-acoustic conditioning is successful at 22-week-old fetuses.[16] Maybe habituation to taste is possible even earlier.[17] Such habituation was also demonstrated in fetal rats.[18]

Babies remember musical patterns they once heard in the womb, as W. Ernest Freud – a grandson of Sigmund Freud – could demonstrate.[19] The empirical proof used the registration of heart frequency and motorical activity.[20]

Also the development of speech is based on prenatal learning, as the study of DeCasper and Fifer from 1980 seems to demonstrate.[21] This study used operant conditioning as a paradigm. Several empirical studies demonstrated that prenatal learning exists.[22]

Historical development of psychoanalytical and depth psychological theories concerning prenatal life

Otto Rank (standing, left corner) and other psychoanalysts in 1922

Most psychoanalytical theories assume that the development of objects, the self and even consciousness begins after birth. Nevertheless, some psychoanalysts explicitly write that pre- and perinatal aspects are responsible for certain symptom formations, among them Otto Rank, Nandor Fodor, Francis J. Mott, Donald Winnicott, Gustav Hans Graber und Ludwig Janus. They think that the structuring of the unconscious psyche starts in the prenatal phase. The fetus already has early, emotionally relevant experiences. They assume the existence of perception in several sense modaliaties, states of asphyxia, fears and stress, which are stored and can be remembered after birth under certain circumstances. In psychoanalysis pre- and perinatal topics usually are seen as fantasies. The manifest prenatal content of dreaming or fantasizing of swimming under water while breathing, being inside of a cave, fighting with underwater monsters – are interpreted as re-projections in time onto the early phase.[23] Janus assumes that in many psychoanalytical approaches there can be found contentual and phenomenological aspects close to prenatal psychology – but without explicit references. Janus wrote of the "hidden attendance of the prenatal existence" in the works of psychoanalysts such as Sandor Ferenczi, Carl Gustav Jung, Melanie Klein, Bela Grunberger, Françoise Dolto and others.[24]

In 1924 Otto Rank (1884–1939), one of Sigmund Freud's disciples, published his book The Trauma of Birth (German: Das Trauma der Geburt und seine Bedeutung für die Psychoanalyse). There he stated that the emotional shock of being born is an individual's first source of anxiety. Because of this book the friendship between Freud and Rank came to an end.[25] Rank was of the opinion that birth is connected with an overwhelming experience of fear of the fetus. He also presumed that this trauma was the cause of later anxieties. He also claimed that aspects of the later prenatal phase can be remembered.[26] So already Rank himself had developed the outlines of a true prenatal psychology. In the light of such assumptions he interpreted cultural aspects, e.g. he understood Christian fantasies of the hell as being based on aversive intrauterine situations.[27] In his book, he treated the interpretation of symbols, art and myths by using pre- and perinatal assumptions. Rank believed that a "primal fixation" with the prenatal state is the root of all neuroses and character disorders[28] and developed a process of psychoanalysis based on birth experiences.[29][30]

Donald Winnicott (1896–1971) tried to understand very early forms of symbol formation. He described in several case studies the reenactment of perinatal experiences in psychotherapies, especially of children. A five-year-old boy climbed into Winnicott's jacket and then slit down the pants onto the ground. He repeated this again and again.[31] Winnicott interpreted this game as a regression and a repeating of birth. He presumed that some babies developed a paranoid attitude by having problems at birth, e.g. in the case of asphyxia.[32] Also psychosomatic symptoms (headaches, breast- and breathing problems and feelings of getting choked) were interpreted as possible consequences of birth experiences by Winnicott. Nevertheless, he rejected the assumption of a universal birth trauma.

In his book The Search for the Beloved: A Clinical Investigation of the Trauma of Birth and Prenatal Condition of 1949 the British-American psychoanalyst Nandor Fodor (1895–1964) traced certain forms of anxiety back to unprocessed and repressed birth experiences following Rank's assumptions, who had been his psychoanalyst.[33] Fodor interpreted dreams, experiencing the lack of oxygen, claustrophobia and sexual disorders and their etiology, which he explained by assuming specific pre- and perinatal experiences.

Francis John Mott (1901–1980) was a disciple of Fodor and the first author who concentrated on the placenta as the first object of the fetus.[34] He wrote, that the fetus fears his placenta as a "blood sucker" or experience it as a "feeder" or "life-giver".[35] His work an prenatal aspects is connected with his speculative assumptions on a quasi-religious design of the universe.

Material emerging from sessions of psychedelic psychotherapy using LSD and other hallucinogenic drugs was the foundation for research into the enduring effects of pre- and perinatal experiences in adult life conducted by Frank Lake, Athanasios Kafkalides (1919–1989) and Stanislav Grof. Grof went on to formulate an extensive theoretical framework for the analysis of pre- and perinatal experiences, based on the four constructs he called Basic Perinatal Matrices. Lake and Grof independently developed breathing techniques, following Wilhelm Reich (1897–1957) as an alternative to the use of psychedelic drugs, which was subject to considerable legal difficulty from the mid-1960s onwards. A related technique called Rebirthing was developed by psychotherapist Leonard Orr in the 1970s, and Core Process psychotherapy trainees relive presumed birth trauma as part of their training.

The US-American social scientist Lloyd deMause (born 1931) compiled in his essay from 1981 the psychoanalytic approaches to prenatal mental life as well as the physiological findings of the human ontogenesis concerning fetal development. He took several assumptions from the works of Grof and Mott, but left away their metaphysical implications completely. In his own approach he assumes, that the placenta becomes the first object of the fetus, namely in two split versions: a positive and a negative one, he called the "nurturing" and the "poisonous placenta".[36] DeMause presumed that in every gestation – especially at the end of this period – there are problems of supply with oxygen for the fetus. Because of physiological conditions the placenta would not be able anymore to supply the growing fetus with enough oxygen. This would give rise to states of pain and deprivation. Pre- and perinatal experiences lead to a mental script, a kind of pattern, to which later experiences would be connected with and internalized. He calls the experience of successive good and painful states the "fetal drama", long precursing the well known "oedipal drama" sensu Freud. Besides these theories about prenatal psychology deMause also developed approaches in the field of psychohistory – a system of cultural psychological assumptions, which explain historical processes and phenomenons by using psychological theories. Especially aspects of childhood history and prenatal psychology play an important role.

Fetus at 14 weeks (profile)

In 1992 the Italian child neuropsychiatrist Alessandra Piontelli (born 1945) published a study in her book From Fetus to Child: An Observational and Psychoanalytic Study (1992). Using sonography she examined the behaviour of 11 fetuses. The fetuses showed a very complex behavioural repertoire and were quite different concerning their forms of activities.[37] They reacted to stimuli in complex ways. Piontelli's study suggested that certain prenatal experiences determined later mental life. Psychological traits, e.g. enhanced oral activity, were recognizable in the prenatal phase, and also after birth. Piontelli interpreted her observations in psychoanalytical terms. Piontelli saw a remarkable continuity between pre- and postnatal mental development. Her study is important, because it combines the assessment of empirical data with the observation of single case studies in the postnatal phase and also in infancy. Her study use equally the methods of academic psychology together with the hermeneutics of psychoanalysis, what makes it unique in the scientific landscape.

References

For an overview see: Lloyd DeMause: The fetal origins of history. In: Lloyd deMause: Foundations of Psychohistory.Creative Roots, New York, 1982, p. 244–332; Ludwig Janus: Die Psychoanalyse der vorgeburtlichen Lebenszeit und der Geburt. Centaurus, Pfaffenweiler 1993, S. 1–72; Ralph Frenken: Symbol Plazenta: Die Pränatalpsychologie der Kunst. Springer, Wiesbaden 2015, S. 5–61.
Smotherman, William P.; Robinson, Scott R. (1994). Classical conditioning of opioid activity in the fetal rat. In: Behavioral Neuroscience, 108 (5), S. 951–961.
Otwin Linderkamp, Ludwig Janus, Rupert Linder, Dagmar Beate Skoruppa: Entwicklungsschritte des fetalen Gehirns. In: International Journal of Prenatal and Perinatal Psychology and Medicine. 21(1/2), 2009, (S. 91–105), S. 91. Similarly: Carolin Sheridan Hubert Preissl, Niels Birbaumer: Wie reagiert das fetale Gehirn auf Reize? Untersuchungen mit fetaler Magnetoenzephalographie. In: Karl Heinz Brisch, Theodor Hellbrügge (Hrsg.): Der Säugling: Bindung, Neurobiologie und Gene. Grundlagen für Prävention, Beratung und Therapie. Klett-Cotta, Stuttgart 2008, S. 32.
Otwin Linderkamp, Ludwig Janus, Rupert Linder, Dagmar Beate Skoruppa: Entwicklungsschritte des fetalen Gehirns. In: International Journal of Prenatal and Perinatal Psychology and Medicine. 21(1/2), 2009, S. 99.
Davenport Hooker: The Prenatal Origin of Behavior. University of Kansas Press, Lawrence, Kansas 1952.
Heinz F. R. Prechtl: Wie entwickelt sich das Verhalten vor der Geburt. In: Carsten Niemitz (Hrsg.): Erbe und Umwelt: Zur Natur von Anlage und Selbstbestimmung des Menschen. Suhrkamp, Frankfurt am Main 1987, (S. 141–155), S. 142.
Alessandra Piontelli: From Fetus to Child: An Observational and Psychoanalytic Study. London 1992, S. 28.
Heinz F. R. Prechtl: Wie entwickelt sich das Verhalten vor der Geburt. In: Carsten Niemitz (Hrsg.): Erbe und Umwelt: Zur Natur von Anlage und Selbstbestimmung des Menschen. Suhrkamp, Frankfurt am Main 1987 (S. 141–155), S. 143.
Heinz F. R. Prechtl: Wie entwickelt sich das Verhalten vor der Geburt. In: Carsten Niemitz (Hrsg.): Erbe und Umwelt: Zur Natur von Anlage und Selbstbestimmung des Menschen. Suhrkamp, Frankfurt am Main 1987 (S. 141–155), S. 146; Alessandra Piontelli: From Fetus to Child: An Observational and Psychoanalytic Study. London 1992, S. 32.
Alessandra Piontelli: From Fetus to Child: An Observational and Psychoanalytic Study. London 1992, S. 31.
P. G. Hepper: Fetal memory: Does it exist? What does it do? In: Acta Paeditrica. supplement, 416, 1996, S. 16–20. (S. 17). Spelt repeated these experiments in 1948. G. Hepper: Fetal memory: Does it exist? What does it do? In: Acta Paeditrica. supplement, 416, 1996, S. 16–20 (S. 17).
P. G. Hepper: Fetal memory: Does it exist? What does it do? In: Acta Paeditrica. supplement, 416, 1996, S. 16–20 (S. 17).
See Daniel N. Stern: Die Lebenserfahrung des Säuglings. Klett-Cotta: Stuttgart 1993, S. 65 ff.
J. W. Goldkrand, B. L. Litvack: Demonstration of fetal habituation and patterns of fetal heart rate response to vibroacoustic stimulation in normal and high-risk pregnancies. In: Journal of Perinatology. 11(1), 1991, S. 25–29. (S. 25).
Chantal E. H. Dirix, Jan G. Nijhuis, Gerard Hornstra: Aspects of Fetal Learning and Memory. In: Child Development. 80 (4), 2009, S. 1251–1258.
L. R. Leader, P. Baillie, B. Martin, E. Vermeulen: The assessment and significance of habituation to a repeated stimulus by the human fetus. In: Early Human Development. 7(3), 1982, S. 211–219 (S. 211).
P. G. Hepper: The beginnings of the mind: evidence from the behaviour of the fetus. In: Journal of Reproductive and Infant Psychology. 12, 1994, S. 143–154. (S. 143).
William P. Smotherman, Scott R. Robinson: Classical conditioning of opioid activity in the fetal rat. In: Behavioral Neuroscience. 108 (5), 1994, S. 951–961.
W. Ernest Freud: Remaining in Touch. Gesammelte Schriften 1965–2000. Zur Bedeutung der Kontinuität früher Beziehungserfahrungen. Konsequenzen aus der psychoanalytischen Entwicklungspsychologie für die Prophylaxe früher Schädigungen. Edition Déjà-vu, Frankfurt am Main 2003, ISBN 3-9805317-4-0.
D. K. James, C. J. B. Spencer, B. W. Stepsis: Fetal learning: a prospective randomized controlled study. In: Ultrasound in Obstetrics and Gynecology. 20, 2002, S. 431–438. Richard Ferner Parncutt: Prenatal development. In: G. E. McPherson (Hrsg.): The child as musician. Oxford University Press, 2006, S. 1–31.
Anthony J. DeCasper, William P. Fifer: Of Human Bonding: Newborns Prefer Their Mothers' Voices. In: Science. 208 (4448), 1980, S. 1174–1176.
Overview in: David K. James: Fetal Learning: a Critical Review. In: Infant and Child Development. 19, 2010, S. 45–54.
Ludwig Janus: Die Psychoanalyse der vorgeburtlichen Lebenszeit und der Geburt. Centaurus, Pfaffenweiler 1993, S. 21–75.
Ludwig Janus: Die Psychoanalyse der vorgeburtlichen Lebenszeit und der Geburt. Centaurus, Pfaffenweiler 1993, S. 55.
Robert Kramer: Einsicht und Blindheit: Zur Aktualität von Otto Rank. In: Psyche. 53, 1999, S. 158–200.
Otto Rank: Das Trauma der Geburt und seine Bedeutung für die Psychoanalyse. Fischer, Frankfurt am Main 1988, S. 98.
Otto Rank: Das Trauma der Geburt und seine Bedeutung für die Psychoanalyse. Fischer, Frankfurt am Main 1988, S. 142.
Maret, Stephen (2009), Introduction to Prenatal Psychology, Church Gate Books, p. 16, ISBN 9780578089980
Rank, Otto (1952), The Trauma of Birth, New York: Richard Brunner
Rank, Otto (1932), The Myth of the Birth of the Hero and Other Writings, New York: Random House
Donald W. Winnicott: Birth Memories, Birth Trauma and Anxiety. In: Collected Papers: Through Pediatrics to Psychoanalysis. Routledge, New York 1949, (p. 174–193), S. 177 ff.
Donald W. Winnicott: Birth Memories, Birth Trauma and Anxiety. In: Collected Papers: Through Pediatrics to Psychoanalysis. Routledge, New York 1949, (p. 174–193), p. 185 ff.
Fodor, Nandor (1949), The Search for the Beloved: A Clinical Investigation of the Trauma of Birth and Prenatal Condition, New Hyde Park, NY: University Books
Lloyd DeMause: The fetal origins of history. In: Lloyd deMause: Foundations of Psychohistory.Creative Roots, New York, 1982, p. 249 ff.
Francis J. Mott: The nature of the self. Wingate, London 1959, p. 82 ff; p. 181 f.
DeMause, Lloyd (1982). The fetal origins of history, pp. 258. In: “Foundations of psychohistory.“ New York: Creative Roots. ISBN 0-940508-01-X.
Alessandra Piontelli, From Fetus to Child: An Observational and Psychoanalytic Study, Routledge, London, 1992. See also: Alessandra Piontelli, Luisa Bocconi, Chiara Boschetto, Alessandra Kustermann, Umberto Nicolini, Differences and similarities in the intra-uterine behaviour of monozygotic and dizygotic twins, Twin Research, 1999, 2, S. 264–273 (S. 270 ff.)