Life Before Birth: How Experience in the Womb Can Affect Our Lives Forever

by Arthur Janov

Part 2.

This article will be published in three parts. Part 1 was published in Inside Out, Spring 2010 and Part three will appear in the Winter issue of Inside Out 2010.

This article was first published in JAPPPH, The Journal of Prenatal and Perinatal Psychology and Health, Vol. 23, Number 3, Spring 2009

Anoxia, Reduced Oxygen at Birth and Adult Behavior

It stands to reason that prenatal traumas are generally all encompassing; we should find damage almost everywhere we look. The problem is that without a comprehensive theory that directs us where to look we would never put together heart attacks at fifty with a trauma at minus six weeks.  I arrived there years ago from clinical observation, which is also a valid part of the scientific method.  Research now helps to support these conclusions.

There are several studies that have looked into foetal hypoxia (reduced oxygen) and the results systematically seem to be severe emotional illness later in life (Cannon, Yolken, Buka and Torrey, 2008; Fendt, Lex, Falkai, Henn and Schmitt, 2008). There is more and more information about the later ill effects of traumas at birth and before. It behooves us to communicate with those entrusted with the care of mentally ill patients.  Without this understanding we will not know where to look in order to heal patients.  The information is out there; it is up to us in the helping professions to seek it out.

A question is, “why hypoxia in schizophrenia?”  There are several explanations. What I have witnessed over and again is that the fetus is in danger of dying from lack of oxygen and then does not have the capabilities to combat the trauma, a mother smoking, for example. Lack of sufficient oxygen is a terrible stressor. If it continues, death is in the offing.  Further, it leaves the fetus and baby with insufficient resources to combat future stress. The danger remains as a substrate so that any later trauma can set it off; hence breathing problems.  So anxiety reactions to seemingly non-toxic situations are inordinate and out of keeping with the gravity of the current situation. They have simply reawakened the almost dying while in the womb. It is never a matter of changing attitudes, as those who focus on cognitive processes only would suggest; it is a matter of what shaped those attitudes, in the beginning.

I have discussed the notion of the “critical window” in my other works; it simply refers to a time in life when needs must be fulfilled, and at no other time. We can hug a child all day at age ten but it will not erase the lack of touch for the first 4 months of life which seriously deregulated the whole system and left a legacy of internally imprinted pain, a pain for which one must constantly take pain-killers. And it remains a mystery to the loving adoptive parents who took the child from an orphanage at the age of twelve weeks.

There is no way to make up for that kind of early loss except by going back to relive the original trauma. There is no way to “make up for” this deficit, as much as we might want to. It is set in altered biologic set points. We can treat the damage this does like kidney disease but not its causes. The whole nervous system must retreat to the time when the trauma occurred; it can never be a matter of “remembering.” It has to be organic and systemic memory. That is, part of the precise memory lies in those new set points. And they are wedded to how they first developed, in the first place.

There is a critical window for healthy functioning kidneys. It is sometime in the last trimester of gestation that most kidney cells (nephrons) are developing (up to the 36th week). Nephron development begins just after the eighth week. Trauma here, however subtle, may result in later kidney disease, with no apparent immediate cause. Once that damage is done we can only treat its symptoms, unless and until we address origins.

Physiologic reactions are the base (main building block) that feelings are constructed on. What distorts those physiologic responses will ultimately distort psychological reactions, as well.  If the system is highly activated due to early trauma, chances are we will have a hyperactive individual who will search out projects to keep herself active and busy. If dopamine and other alerting chemicals are in short supply we may later have someone who is apathetic, and who concocts reasons for not doing anything, for not following through. It is not a one-to-one relationship, but we eventually direct our psychology. If we don’t have all of the mobilizing chemicals we need, it stands to reason that the adult, in order to keep matters ego-syntonic (comfortable to the person), will rationalize why he doesn’t try and doesn’t persist.

I will sum up once more: high stress hormones in the carrying mother usually mean high levels in the foetus. The baby who is born with allergies or other problems is already imprinted with trauma. She is born with a higher than normal stress level, which means that new events that are even moderately stressful will engender excessive reactions. All kinds of diseases later on will follow from this. So, even mild allergens can produce a serious allergic reaction, or a migraine. It means there will be impulsive out-of-control behavior, out-of-control because the level of mobilization/vigilance is already high. It doesn’t take much to set it off.

There is a report from the University of Wisconsin (Proceedings, National Academy of Sciences, Jan. 26, 2009) that demonstrates how early stress impacts the immune system. Children who had an abusive early life or had spent time in an orphanage showed a compromised immune system. Even after they were taken out of an adverse environment there was still this damage apparent. The scientists point out that though the immune cells are ready at birth, how they develop and become a dependable cohesive system depends on experience.

The investigators used the control of latent viruses as a measure of immune competence.  People with an intact immune system can usually keep these viruses under control. Those who are neglected, unloved and uncared for cannot function this same way; thus, such afflictions as, the herpes virus which lies latent in many of us is more likely to be activated in those who have poor immune control. Traumatized subjects had higher levels of certain antibodies, indicating that the immune systems were compromised and thus were more likely to manifest overt symptoms of herpes. Those living in a now-stable environment still showed the damage and were more likely to suffer herpes. Early life adversity has enduring effects. The corollary may be, “you cannot love neurosis away.” Later love still does not affect the background state of damage, which sets up a propensity for disease. So some of us react to stress with the appearance of immune disease of various kinds, including, perhaps, HIV; others are able to react and hold down deleterious symptoms with a strong immune system. It all depends on very early experience. So, some immune diseases become full-blown because of early neglect and trauma. If there is no evidence of a compromised immune system, chances are there will be far less serious disease. Why do I mention HIV? Because possibly the same gestational trauma that can alter later sexual hormone output may also at the same time adversely affect the immune system. I have already mentioned that womb-life traumas can also deplete serotonin supplies so that later in life one is continuously uncomfortable, a chronic depression and anxiety because the readjusted set points fixed during gestation are so low.  Even when the person in her adult life is comfortable living a calm existence the malaise is still there.

And it is also possible that in addition to reshaping personality there may be an actual reorganization of the anatomy. The fetus/neonate may reduce its metabolic level to meet the deprivation of oxygen, and possibly moderate its growth rate, all in the service of survival. Smaller bodies utilize less oxygen. At present there is not enough evidence to support this hypothesis, yet to me it represents the evolutionary logic of the human system. Whatever helps survival is what survives. It is clear that the metabolism slows as a self-protecting device; what is important here is that the survival strategy seems to duplicate itself later in life under stressful conditions; not necessarily diminished oxygen but any kind of stress. And of course there are those who fear elevators or enclosed spaces often due to this kind of early trauma. So we have a “freeze” response, a passive, inability to react in situations that are adverse, what I term a parasympathetic dominant reaction. The precursor here is hypoxia, a life-endangering event that occurs in the womb or at birth. The person is fixated in this freeze reaction until the originating event is addressed and relived; not with a different outcome (which would entail redoing history) but with the same outcome, only now it can be experienced for what it is.

This whole notion of insufficient growth (evolutionary logic), the inability of the organism to fulfill its genetic anatomic destiny, could also play into something I have written about before: the growth of limbs as a result of Primal Therapy. We have seen breast growth, as well as feet and hand growth, after a year of therapy. We have seen wisdom teeth descending in 40-year-olds. In short, epigenetic factors, what happens to the foetus and newborn, can block certain aspects of growth and short-circuit genetic tendencies. When that happens, the person, in my experience, is vulnerable to serious or catastrophic disease. There is a mutually destructive war going on in the system between the forces of expression and those of repression. Very often, the same person who has cold extremities is the one who has a lag in one sort of growth or another, often in women, breast growth. Of course there are inherited factors but my point is that we should not neglect key traumatic factors as well.

Reconfiguring our oxygen reduction response is one key way to prevent oxygen damage to the brain. The system does it for us and sends more oxygen to the heart and lungs than to the feet. It also means less possible damage to the heart. If there is a trauma that affects the heart it may not show up for fifty years until the first heart attack. Of course, one way to avoid all that is to provide sufficient oxygen at birth. Failing that, the foetus/newborn will reduce its oxygen demands. But that can mean inadequate cerebral oxygen supplies and lower cerebral metabolism rate, which later can mean learning problems. You know when we say, “He’s got cold feet.” It is true. The person is reacting based on fear and terror, perhaps the same fear accompanying oxygen lack early on.

As I have written in earlier work, it is not unexpected that there may be an early oxygen deprivation involved in later Alzheimer’s disease. That is, the brain is in constant adaptation to imprinted reduced brain oxygen. The brain is saying, “I am lacking supplies,” and originally adapted to that lack in various ways. One way includes a change in the amount and strength of certain synapses, which are the gaps between nerve cells that are filled with chemicals that either enhance or slow the neuronal message from one cell to the other. In brief, that earlier adaptation becomes permanent and almost immutable. All of this underlies much of the deep depression I have seen (see Janov Solution, for a more elaborate discussion of this) where a constant hopelessness and helplessness accompany the personality. And of course, there is a drop in core body temperature. As patients get close to these deep early feelings of womb life and birth, the temperature can fall three degrees in minutes as it is being relived. Or, patients deeply depressed can come into a session with a 96-degree reading.

We must be cautious about deciding what key feelings a patient should feel or is feeling.  After observing thousands of sessions over decades I now believe that hopelessness and helplessness lie at the base of so many other feelings. These are the feelings that usually accompany life-and-death gestational or birth traumas. And it is not I who decided this. I simply record what so many patients feel during the reliving.

The point about original reduced oxygen experience is that the whole personality seems to “shrivel up.” It is a constriction rather than an expansion. When she speaks she takes up much less space and air; her words hardly move out of her mouth, and there is an air of fatigue about her. Is it any wonder that she (or he) is less sexual? Again, the whole system slows to adapt to reduced oxygen; the system is doing its best to avoid a mismatch between supply and demand (Singer, 1999). And when there is imprinted low oxygen we might expect slower growth rate. One way we see this is in neonates born to smoking mothers who are often of smaller stature. That in itself assumes trauma somewhere during womb-life maturation. That can foretell of a premature heart attack or cancer later in life. I think it is more likely to lead to cancer than cardiac problems because of the massive repression or inhibition that goes along with this kind of personality. Repression of womb life events is nearly always of life-and-death matters; the repression it engenders is massive, and the result can cause serious distortion at a cellular level. Thus, in my scheme, heart disease is that of expression and cancer of repression. This is clearly not a hard and fast rule, but is something to think about. So many other factors play a role in all this, not to exclude a whole childhood filled with experiences.

There are so many later effects of womb life trauma—namely, diabetes and hypertension. It has been shown that when a pregnant woman is given steroids (the stress hormones), the offspring tends to suffer from high blood pressure (Seckl and Meaney, 2006). In particular, babies born of these mothers show hypertension tendencies just after birth. They note a strong link between stress hormone intake of a mother animal and her baby’s long-term hypertension (in sheep). It seems like the later in pregnancy this occurs, the more permanent the adult high blood pressure. It has to do with the sensory window when a stimulus is most apt to create alterations in functioning. And the reason why this is important is that an anxious mother is delivering stress hormones to her baby/foetus. And so the baby can be said to be born with a tendency to anxiety, as well. One way we know this is that mother’s who are anxious seem to raise the cortisol levels in the amniotic fluid surrounding the foetus. It may seem like heredity but it is not. Epigenetics (or the environment) is at work again.

More is being learned about high levels of stress hormones in the pregnant woman. It is implicated in later diabetes, immune disease, allergies, hypertension and others. There is now a much stronger correlation between mother’s stress level and later dementia. What is most important in all this is that this stress in the mother/foetus compromises the repressive system so that later it will be difficult to hold down surging feelings. The importance of this is that low level imprints cannot be suppressed so that the person has difficulty in concentrating and focusing—attention deficit disorder. A key element of that repressive system is the prefrontal cortex that is pressed into service to counteract feelings that are on the march into awareness—hence, overt anxiety states.

We begin to understand a bit about later drug addiction, which always seems like such a mystery. We are slowly become aware that pain can be installed in the fetal system before she is born. It still needs quelling. It is generally of such high valence (one has only to witness our patients reliving early trauma) that it is logical that one uses painkillers later on. Until we re-direct our focus earlier, we shall never solve these human problems. It is why most drug rehab centers are ineffective.

I have mentioned earlier that if we bring a mother of a child/patient into a session where she hugs and kisses him, nothing changes. But if she stays outside the clinic while her son relives the early lack of love, everything changes. And this is why we cure addictions; love is not the answer. The lack of it is. That is the historic reality. Feeling that lack alters and normalizes many hormone levels. Our cortisol research showed that after deep reliving over months, there was a normalization of cortisol levels. As I often say, “You can’t love neurosis away.” What we are addicted to is, need. If we don’t feel the early unfulfilled need, then the addiction seems like some immutable or innate force. It is not. One mistake we must not make is to try to alter the patient’s reality by providing a different ending to an old hurt. The system is constantly reacting to that hurt. If we change it to our liking we are no longer addressing reality.

So much happens to us in the womb; so much as been ignored in terms of their long-term effects that many diseases remain a mystery because we are looking at the wrong place at the wrong time with the wrong tools. What I am learning is that events in the womb explain so much about later life. As already noted, if you bend an emerging twig you are bound to get a distorted tree. The question has always been, “How early is early?” This is where epigenetics is relevant. A group at Washington State University led by Matthew Amway, found that gestational experience in animals that sways the genetic unfolding, can show effects for three generations. They found that exposing pregnant adult rats with defective sperm could engender many diseases including cancer in adult animals. Females avoided mating with other rats that were also exposed during gestation. And this went on, not only for the life of the adult, but also with their offspring, as well. It seems that the system itself knows how to behave given certain biologic deficiencies, and it is always in terms of what is best for heredity; what gives us the best shot of succeeding in life. So when we cannot explain some trait in adults by heredity we may have to reach back several generations to explain it. This gives us a new perspective on so-called psychological problems in adults. When we do an intake interview of prospective patients it has to be thorough enough to include prenatal life (and transgenerational effects too).

We can now only guess as to what traumas occurring to the pregnant mother continue their effects on grandchildren. It isn’t just that the mothers underwent trauma, but that trauma alters her basic physiology, and that alteration may have lifetime effects on herself and her offspring. And so when a grandchild develops heart problems or cancer in his 30s, we may have to rethink the probable causes; seeing what kind of pregnancy his grandmother underwent. It’s a stretch but it is something to keep in mind. Was it wartime? Or were the prospective grandparents fighting all the time? Was grandma depressed? Was she a heavy smoker or drinker during her pregnancy? There is a whole host of new variables to consider.

An example

Someone is born with all kinds of allergies from birth on; a history of emergency clinic visits for all kinds of infections, asthma, breathing problems due to allergies, and in general, a very deficient immune system. Here is where we need to push back the envelope and direct our attention to those early months in the womb. When we do, we often find out that the mother was quite anxious and/or depressed. Or sometimes the marriage is falling apart. Or in one case, as her belly got big the husband was turned off and sought out an outside relationship. The mother was crestfallen, fell into a depression, and had a baby that was born with a diminished immune system. In short, this was something that got its start early on in the pregnancy.

Don’t forget that the immune system, in some respects, is our first nervous system, getting out infectious organisms and other invaders, and organizing defenses against them. This includes secreting some of the same painkilling neurotransmitters we know about today. What starts out to defend us ends up hurting us. If the immune system is compromised, there is a good chance that natural killers cells will be compromised as well. This is something we discovered in our research with St. Bartholomew’s Hospital, London. Natural killer cell levels normalized after one year of our therapy. We made several different measurements before therapy and after one year.

That fact that we normalize this basic physiologic system means that patients do indeed relive very early origins. I believe that no cognitive/insight therapy could ever alter the natural killer cell system. They have recently discovered that planting electrodes into the brains of heavily depressed subjects could ease serious depression. But what if we could have access to those deep brain centers without brain surgery? Would not that be preferable? I think we can.  We have had very good results with depressives.

Huot and colleagues (2004) have shown that a mother’s depression when pregnant negatively impacts the baby. This is not the case of a mother who is depressed at the time she gives birth. The investigators found that stress hormone levels reacting to a minor stress stimulus (arm restraint) predicted negative responses in infants. There was a particularly negative effect if the woman was depressed during the first two trimesters. In short, the effects on in utero life endure. And it is predictive, given certain kinds of adverse events that impact the foetus. And, it seems the earlier the trauma, the more devastating. Here again we see how important events that happen during womb life are more important than post-birth experience. It has been a saying of mine for decades: The more devastating and early the trauma, the more devastating the symptom. The symptom is often deeply located because the origins are also registered deeply in the most primitive of nervous systems—the brainstem and a bit of the limbic system. This often tells us how early and how hurtful the imprint is. Its depth in the physical system is another indictor of how early the trauma.

Because the baby can be born with higher than normal stress hormone levels, and because the immune system works in seesaw fashion with cortisol (high stress, low immune function), the foetus has possibly set the stage for a lifetime of immune problems. Here is where genetics plays a role; high stress in the foetus will affect those areas with genetic vulnerabilities. After all, what is the meaning of high levels of stress hormone during foetal life? It means an input that agitates the system to be chronically alert and mobilized. And when the neurologic system can no longer shut off that input, we have the makings of an enduring Primal imprint. So we have a newborn with a high level of agitation already set in place many weeks earlier. Here is ADD (attention deficit disorder) waiting to happen as forceful information from very early on intrudes into the thinking apparatus. The neurons seem to be adrift, and the top-level cortex cannot focus on one thing because of the constant internal input, from the bottom-to-top and from the right-to-left brain. Too much information creates overload. Overload creates shutdown. Shutdown produces symptoms.

Over time, the deleterious results can range from impulsive tendencies to migraine and high blood pressure (to hold down the imprinted input). It is then no mystery when the child cannot concentrate or sit still. It is redundant to call it attention deficit hyperactive disorder, since it already is a matter of hyperactivity of brain function. It is not enough to know that there are high levels of stress hormones in the baby; we need to know what causes it, in the first place. We change deficient natural killer cell levels of the immune system after one year of our therapy into normal levels. These cells key function is to watch out for cancer-developing cells and pounce on them in an effort to contain them. So a mother’s distress while pregnant can spell life-endangering effects on her baby, not the least of which is later cancer. The earlier the trauma occurs during womb life, the more disastrous the effects. That is our important secret life.

What can be done about this? Treating it first and foremost, then make sure it will not come back. How do we do the latter? By reliving the earliest womb-life events. How do we do that?  Well, luckily, each new harmful or adverse experience that remains unintegrated is re-represented later on in a higher level of the nervous system and is coded as the outsider or enemy. It is indeed a threat to the organism because of its load of pain. So a certain frequency has a load factor that is enormous. And, as I stated, it may be that specific frequencies tie these events together. When we explore these ramified events and begin to relive them, we are also reliving deeper and earlier aspects of the feeling and/or pain. And that is how we relive purely physiologic brain-stem responses without ever acknowledging it. With an MRI we may be able to measure such things as where anxiety is organized and what each level’s contribution is to the overall state of anxiety. We have done four separate brainwave studies and found a shift of power from right to left and from back of the brain to the front (Hoffman and Goldstein, 1981).

When there are certain kinds of triggers, the brain conjures up its related history, intact. It kindles like-minded feelings together and their physiology. That is why our behavior is so compulsive and unwavering; our history motivates us all of the time. We are largely victims of our deep unconscious brain. We can only reach deeper into the remote past as we gain more and more access to deeper levels of brain activity. We need to have good access to our feelings first, then very early brainstem events. That takes time but it can be done. The beginning deformity of cells can well begin in the womb with mother’s anxiety due to her own history or due to her marital circumstances. In any case, the foetal system needs to gather its resources to shut down excessive input. Here is where many cells are evolving and gathering their identity, but instead there is massive repression and, ultimately, physiologic deviation, even at the cellular level.

One patient had three siblings all “messed up” and depressed, according to her. It remained a mystery why all of them were so disturbed as her parents were indeed loving, until she had very early Primals (a systematic reliving of early trauma). She learned that there was a civil war in South America, which lasted many years. The father left the family to go and fight, coming home occasionally to make babies. The mother was in desperate straits with no money, no one to turn to, and fearful of the constant raids into her village. The children, even in foetal life, suffered. She was a loving mother whom the children adored, but with a neglected womb-life, which should not be ignored. It had far-reaching effects. It therefore is an indicator of what went on during foetal life. Can we imagine a doctor learning about a stroke with her patient and then examining his foetal life?

Low birth weight is associated with slow foetal growth and lack of development of various physical systems. If the newborn is abnormal in any respect, even birth weight, we may assume that something abnormal may have happened during gestation. Babies of depressed mothers are more often of low birth weight. At least, let’s consider it. Babies with low birth weight lack muscle, something that follows her into adulthood. Here is a quote from the Helsinki Birth Cohort Study: “We have shown that the risk for coronary heart disease and type 2-diabetes or impaired glucose tolerance is further increased in 60- to 70-year-olds who were small at birth, thin or short in infancy, but put on weight rapidly between 2 and 11 years of age. A similar growth trajectory has been shown to predispose to type-2 diabetes or impaired glucose tolerance” (Canoy, et al., 2009, abstract).

People who suffer stroke tend to be thin or short at two years of age. There is evidence that these early events can lead to hypertension later on, which is an important risk factor for both coronary heart disease and stroke. The point is that when a child is born out of the curve of normalcy (too fat or too thin), it may be an indication of some abnormality during gestation. I will discuss in a moment the now-significant amount of research on high stress levels in the pregnant woman and its effect on the heart of the baby whose physiology closely adheres to the mother. Also, we need to study Alzheimer’s disease as it relates to gestational trauma as well as birth difficulties. Is there a correlation between gestation/birth trauma and much later dementia? Certain height and weight problems at two years of age are a well-accepted indicator of childhood emotional problems. Growth of the fetus relies heavily on adequate oxygen supplies. Because of the large brain, which uses a good deal of oxygen, there is a physiologic demand for more and more. As stated previously, if these supplies become limited for any number of reasons, the body growth will slow down so that the brain can be left intact. Hence, lower foetal weight. Let us keep in mind that cancer can develop and live without oxygen, and maybe that adapting to lower levels of oxygen in the womb is part of an explanation for some cancers later.  Deprive a cell of a majority of what oxygen it requires and you may have one key element in the origin of some cancers. This can only be a hypothesis.

In experimental animals, it was found that anything that increased foetal stress hormone levels could result later on in elevated blood pressure, anxiety and hyperglycemia. And when we fiddle with stress hormone levels, we increase the likelihood of later cardiac crises. Cortisol levels are also heavily implicated in signaling the birth process to begin. And if it begins too soon we might look at the maternal stress factor.  Cortisol is a stress hormone because it sets in motion the alarm signals to combat too much and too strong of an input. When it goes on for a long time it accelerates the possibility of dementia and a whole host of other diseases. Primal imprints do exactly that; maintain a high level of cortisol for a lifetime; the danger is imprinted and the body continually reacts to it. All of these reactions as an ensemble are how we remember the trauma physiologically. Our beginning patients are uniformly high in cortisol, normalized after one year of therapy.

In nearly every study of prenatal life, there is the implication that high stress hormone levels in the pregnant woman can result in hypertension and cardiac problems later on in the offspring. Infants of mothers, who were diagnosed as anxious before pregnancy, had significantly higher stress hormone levels. Neuropsychologist Paula Thomson (2007) explains: “Prenatal stress responses are dependent on the mother’s stress level. But how babies show it is through a limited physiologic vocabulary” (2007:100). She believes that the foetal stress response is already skewed and, given later stress, the earlier stress response does not change. It can be blocked, diverted, covered over, but it remains pristine clear. Thomson (2007) maintains that stress states in the prenate and neonate can be recognized by elevated heart rate, and greater activity levels in gross body, single and multiple limbs with higher reflex activation. The prenate and neonate may show mistimed diffuse movement and overt grimacing; and will be rather clumsy and have a lack of coordination. All this can be a predictor of later heart disease. That is only if we look at the problem in a gestalt overview. Thomson further states and other researchers agree:

One overarching goal of this article is to help clinicians understand the potential deleterious effects of prenatal stress … It is hoped that increased knowledge of prenatal stress will inform psychotherapeutic treatment protocols, especially when treating severely traumatized and dissociative patients who may themselves have suffered early prenate stress. Further, when these patients become pregnant, appropriate treatment for the mother may benefit the offspring. When clinicians provide therapeutic intervention to a pregnant woman the prenate may also be affected (Field, 2001; Ponirakis, Susman and Stifer, 1998:88).

“One of the most dramatic changes occurs in the first moment of conception. The primitive cell carries the blueprint for an individual who has never existed before and will never exist again” (Thompson, 2007:101). While in the womb, he is having the most important experiences in his life, because nearly all of it is of life-and-death significance. This is what Freud should have addressed when he was developing his theory of psychoanalysis. Here lies the deep unconscious: a dark place with no exit and no words. Biologic responses dominate.  In order to relive, we have to include all of our physiologic processes, not just cerebral memory. The first step is to acknowledge these facts; a much more difficult step is to fashion a therapy for them. I think we have done that.

One of the key factors in high levels of maternal cortisol is the increase in the chances of a lost baby, or at the least some kind of prematurity. Again, those stress levels descend into the fetal system and change the baby in ways we are still learning about. Babies born to depressed mothers have higher levels of cortisol than normal. Here was what Lauren Kaplan and colleagues have to say about this: “In utero environment sculpts the uniquely plastic fetal brain resulting in long-term maladaptive patterns of behavior and physiology.” (2008:249)

What researchers are now reiterating is that womb-life can inalterably affect the lifetime of the offspring. And, it is not only behavior that is altered but the physiology as well. To make it even more dramatic there is now evidence that it can change the anatomy. Does this mean a change in Primal Theory? Absolutely, it pushes the envelope much earlier for when imprints start and for their widespread enduring effects. It means that how the birth trauma is played out, and reacted to, depend on earlier life circumstances—womb-life.

Information is now amassing as research continues into a heretofore unexplored area. There is an article in the November 14, 1998 British Medical Journal by Marc Bygdeman and B. Jacobson entitled “Obstetric Care and Proneness of Offspring to Suicide as Adults” that suggests that “through a process of imprinting certain individuals might subconsciously create a traumatic situation during the act of suicide that produces a sensation similar to that experienced during birth” (1998:1346). This could be a quote from one of my books. What they found was that those who committed suicide violently were more often exposed to complications during birth. Strangely, those mothers who were drugged did not result in suicide by the offspring. But there is the implication that the adult whose carrying mother used drugs may be more likely to be addicted to drugs. The implication seems to be that opiates given during birth reduce the impact of the trauma and are, hence, less likely to produce suicide-prone individuals. But already in the womb we are learning how drugs ease pain. What my theory states is that when provoked by a certain hopelessness in the present, which is not overwhelming in itself, it can trigger off—resonate—with earlier imprinted hopelessness during birth and sets off an attempted suicide; because it not only triggers the original traumatic feeling but all of the circumstances around it. Thus suicide tries to put an end to the agony. And when drugs were given to the mother to ease her pain it, at the same time, eased the suffering of the baby. Thus, later on, one turns to drugs to ease pain, a replication of the earlier event. And when emotional pain is inordinate drugs are the mode of choice for suicide. It worked when it was a matter of life-and-death. One reason that current psychotherapy has not been profoundly effective is the factors that produce current behavior are far, far earlier than we might have imagined. To ignore all of this research is dangerous for the patient because it means she stands little chance of resolving suicidal feelings without this understanding. So, it can again mean life-and-death for the patient. This is to say nothing about chronic withering depression that usually gets its start in the womb or at birth. (See The Janov Solution for a full discussion).

We do know that each level of brain function can incorporate the previous lower level and represent its sense or meaning to higher levels, which then code it in terms of the specific function/structure of that level. As the imprint is registered it will take on a new coloring as it moves upward. Hypoxia as a choking, suffocating sensation on the brainstem level becomes being suffocated by one’s husband on the emotional level; and then there is the last level rationalization for the lack of freedom in a given situation. The patient starts with the latter, “She suffocates me”, and then over time moves downward until she arrives at the Primal event that started it all.

So early memories become elaborated on higher levels of brain function and are incorporated into those levels and interpreted differently depending on the level of brain tissue. But they are not separate entities. It is all an ensemble of levels that produces a complete memory. When we relive a non-verbal pain or trauma in infancy we are at the same time reliving the residue from earlier in womb-life. The events are united under a resonance factor that makes a higher level of brain function trigger off a deeper and more remote feeling. To put it differently, each early preverbal imprint is ramified on higher levels so that feeling fully on the higher level automatically has us feeling the earlier aspects of the feeling. Because of this we can overreact or underreact to events in adult life. As we see in our therapy, it may be one cause of erectile dysfunction—the feeling of being overwhelmed because of even slight pressure to function in the present. Or experienced as the inability to get going at work.

Dr. Arthur Janov is the Director of The Primal Center, Santa Monica, California. Creator of Primal Therapy ( Dr. Janov is a prolific author, educator and clinician, whose recent works focuses on the prenatal and perinatal periods. This article is a portion of an upcoming book. Contact information: or (310) 392-2003. Free access to Dr. Janov’s recent essays can be found on his blog at:


Bygdeman, M. and Jacobson, B. (1998). Obstetric care and proneness of offspring to suicide as adults: Case control study. British Medical Journal, 317(7169), 1346-9.

Cannon, T. D., Yolken, R., Buka, S., and Torrey, E. F. (2008). Decreased neurotrophic response to birth hypoxia in the etiology of schizophrenia. Biological Psychiatry, 64(9), 797-802.

Canoy, D., Pouta, A., Ruokonen, A., Hartikainen, A. L., Saikku, P., and Järvelin, M. R. (2009). Weight at birth and infancy in relation to adult leukocyte count: a population-based study of 5619 men and women followed from the fetal period to adulthood. Journal of Clinical Endocrinology and Metabolism. Retrieved March 2009 from:

Fendt, M., Lex, A., Falkai, P., Henn, F. A., and Schmitt, A. (2008). Behavioural alterations in Rats following neonatal hypoxia and effects of clozapine: implications for schizophrenia.

Pharmacopsychiatry, 41(4) 138-45.

Field, T. (2001). Targeting adolescent mothers with depressive symptoms for early intervention.

Sage Family Studies Abstracts, 23(3), 275-407.

Field, T., Diego, M., Hernandez-Reif, M. and Fernandez, M. (2007). Depressed mothers’ newborns show less discrimination of other newborns’ cry sounds. Infant Behavior and Development, 30(3), 431–435.

Field, T., Diego, M., Dietera, J., Hernandez-Reifa, M., Schanbergb, S., Kuhnb, C., Yandoc, R. And Bendelld, D. (2004). Prenatal depression effects on the fetus and the newborn. Infant Behavior and Development, 27(2), 216-229.

Hoffman, E. and Goldstein, L. (1981). Hemispheric quantitative EEG changes following emotional reactions in neurotic patients. Acta Psychiatrica Scandinavica, 63(2), 153-64.

Huot, R. L., Brennan, P. A., Stowe, Z. N., Plotsky, P. M., and Walker, E. F. (2004). Negative affect in offspring of depressed mothers is predicted by infant cortisol levels at 6 months and maternal depression during pregnancy, but not postpartum. N.Y. Academy of Science, 1032, 234-236.

Jacobson, B. and Bygdeman, M. (1998). Obstetric care and proneness of offspring to suicide as adults: Case-control study. BMJ, 317, 1346-49.

Kaplan, L., Evans, L., and Monk, C. (2008). Effects of mother’s prenatal psychiatric status and postnatal caregiving on infant biobehavioral regulation. Early Human Development, 84(4), 249 256.

Ponirakis, A., Susman, E.J., and Stifer, C.A. (1998). Negative emotionality and cortisol during adolescent pregnancy and its effects on infant health and autonomic nervous system reactivity. Developmental Psychobiology, 33, 163-174.

Singer, D. (2004). Metabolic adaptation to hypoxia: Cost and benefit of being small Respiratory Physiology and Neurobiology, 141(3), 215-228.

Singer, D. (1999). Neonatal tolerance to hypoxia: a comparative-physiological approach. Comparative Biochemistry And Physiology. Part A, Molecular and Integrative Physiology, 123(3), 221-34.

Seckl, J. R. and Meaney, M. J. (2006). Glucocorticoid “programming” and PTSD risk. Annals of the N.Y. Academy of Science, 1071, 351-378.

Thompson, P. (2007). “Down will come baby”: Prenatal stress, primitive defenses and gestational dysregulation. Journal of Trauma and Dissociation, 8(3), 99-113.