In the textbooks on psychotherapy, the terms birth and pregnancy, not to mention the experience of birth and prenatal experience, hardly come up at all. From the point of view of prenatal psychology, this constitutes a systematic distraction from the relevance that experiences at the beginning of life have for an individual's lifehistory.
This is the powerful conclusion to the new book by Ludwig Janus, a book based on extensive self-orientation in psychoanalysis and primal therapies in the broad sense and on a sound knowledge of literature. Janus has been trying to integrate prenatal and perinatal psychology into the broad field of depth psychology for decades. He has also been President of the International Society of Prenatal and Perinatal Psychology and Medicine and co-editor of the society's journal since 1995. His struggle to win support for the cause has been a long one, and he is particularly upset that the early "excommunication" of Otto Rank and his book The Trauma of Birth which was sharply criticised by Freud, has not long since been revised. After this long struggle, Janus is now more relaxed in his analyses and his hopes that perinatal psychology and, more importantly, the wealth of experience in therapy by the wide variety of schools of thought will be integrated in psychoanalysis. The topic has existed in psychoanalysis right from the beginning in a distorted, episodic or mythological form, but it was never reflected in the therapeutic setting. In contrast to the verbal ego required in psychoanalysis, dealing with the preverbal ego of experience often requires changes to be made in the setting: physical contact to provide support and sometimes much longer sessions. This is because early traumas, caused by prenatal shocks, becoming stuck during birth, the experience of attempted abortion, forceps delivery, and huge rejection as a child, for example, are easier to access via physical memories than via verbally encoded ones. Understandably, Janus says therapists should have familiarized themselves with these dimensions by becoming aware of their own early stages of life in order to provide appropriate support to a patient with such early traumas. Janus is also self-critical, emphasizing that in hindsight he sensed indications of an early trauma in many of his patients but, due to a lack of relevant training, was not able to pick up on them properly. However, he also sees the bridges that the pioneers of psychoanalysis built to these early stages, particularly in the London schools of thought. Melanie Klein, Winnicott, Bion and above all Michael Balint are just some of the names worth mentioning here.
Analyzing Little Hans. Janus deals with Freud's fixation on the central significance of the father in neuroses in a competently critical yet sympathetic way. He points out Freud's possible reasons for neglecting the significance of the early mother and for interpreting injuries from the early preverbal years as conflicts with the father, e.g. in his analysis of "Little Hans", whose phobia Janus is inclined to correlate with much earlier ordeals than with the fear of the father. His re-interpretation of the "Wolf-Man", one of Freud's great case studies, is equally plausible. Janus sees early prenatal and perinatal turmoil as the origin. Janus never becomes polemic or harsh, although he is clearly upset by what is often still a rigid refusal by classical analysis to take into account the stages of very early and often very vulnerable formation of identity, stages which, if they are not understood, can take on an unrecognizable yet life-restricting or life-threatening form. The result in many situations in life and in many forms of therapy is that relationships go off the rails. Prenatal and perinatal traumas can lead to severe phobias, to a sensation of impending doom, an emptying of the self, fear of disasters, nervousness, fear of the dark, feelings of constriction, psychosomatic symptoms and intense self-rejection.
If individuals cannot manage to "work through" the disorders in the early family setting, the traumas are preserved, stashed away and suppressed so that they become almost impossible to access and may later unfold their ominous force again in completely unexpected situations. It might be a move that reawakens the terrors of birth, it might be unexpected physical contact or an insult: unforeseeable trigger events that lead to forms of behavior that are difficult to comprehend or to emotional reactions in a state of emergency.
More recent trauma research (war, rape, torture, abuse, disasters) is now making great progress in explaining the reactions of the psyche exposed to early or even late traumas. The different research approaches can thus hopefully be combined in the foreseeable future. Janus' book offers a wealth of useful prospects and desiderata for practice and research. We can only hope that the unpolemic tone of this "wise" book can break down borders.