THE TRAUMA OF BIRTH by Otto Rank Das Trauma der Geburt, 1924; English translation 1929 INTRODUCTION TO THE DOVER EDITION (1993, out of print) by E. James Lieberman One of the most remarkable books in the history of psychology, The Trauma of Birth marked the beginning of the end of the relationship between Sigmund Freud and his favorite disciple, Otto Rank. Rank dedicated the work to his mentor, "the explorer of the unconscious, creator of psychoanalysis." Freud, grateful and gracious, praised it as the greatest advance since the discovery of psychoanalysis. But he had only read the first part. (1) Das Trauma der Geburt was published in 1924, the year Otto Rank turned forty and made his first visit to the United States. Thus Rank brought his new ideas to America, in English, as soon as the book appeared in German. In New York, Rank was hailed as Freud's emissary, a brilliant man who--unlike Alfred Adler and Carl Jung--could express original ideas while remaining faithful to his mentor. Rank became an honorary member of the American Psychoanalytic Association; professionals and laypersons sought him out for brief therapy. Of course there were some, like the influential psychiatrist A. A. Brill, who were jealous or suspicious. When he and Rank's rivals in Europe aroused Freud's anxiety about Rank's deviation from the narrow path of psychoanalytic orthodoxy, Freud withdrew his support of the new ideas. Rank, 28 years younger than Freud, had come to his mentor in 1905, just in time to help start up the psychoanalytic movement as Secretary of the Vienna Psychoanalytic Society. A modest stipend enabled him to complete his PhD. at the University of Vienna in 1912. By then Alfred Adler had been expelled from the movement and Carl Jung was about to go. Rank's career was entirely different: clearly Freud's favorite, he became the mainstay of Freud's inner circle-the Committee, or “Ring.” Then came this book, just a year after The Development of Psychoanalysis, co-authored by Sandor Ferenczi and Rank: both dealt with a more active approach to therapy, and both had Freud's imprimatur until controversy surrounded them. The two books caused a rift in the Committee which Freud could not heal. Pressured by Rank's rivals, he challenged his protégé in letters to New York. Rank, dismayed and furious, counterattacked forcefully, but on his return to Vienna he was reconciled with Freud and the Ring long enough to prepare a move to Paris. From there, beginning in 1926, Rank visited the United States almost every year until finally settling there in 1934. Five years later he died, at 55, a month after Freud passed away in London. The Trauma of Birth was praised, criticized, misunderstood and, finally, ignored after Rank's break with orthodox analysis. Rich with ideas whose time had not yet come, the book brought a rebuttal by Freud in Inhibition, Symptom, and Anxiety (1926), which included a major revision of Freud's theory of anxiety. Unfortunately, other writers took parts of Rank's thesis and oversimplified or distorted it. A recent reprint of the original German version includes a modern introduction which virtually ignores the text but enthusiastically links Rank to natural childbirth (F. Leboyer), primal scream therapy (Arthur Janov), mind-altering drugs (S. Grof) and intrauterine experience. (2) Misinterpretations of the birth trauma theory began soon after its appearance. In 1928, the respected psychiatrist Marion Kenworthy, extending Rank's theory into obstetrics, said the child born by Caesarian section "is prone to be less sensitized--he cries less, is markedly less irritated by the contacts of handling, etc.,--than the child delivered through the birth canal." She warned of "profound nervous and emotional shock, a concomitant of every hard birth experience," urging obstetricians to keep pregnant women on diets to produce smaller babies who would be able to get through the birth canal with less trauma! (3) A recent writer asserts, scornfully (but inaccurately), "Rankians proposed that all children be born by Caesarian section to eliminate birth trauma." (4) Rank bears responsibility for some of the confusion, since he does speak of more and less severe birth traumas. He was too eager to make a strong biological argument, perhaps because he lacked a medical degree with which to bolster his authority. But his basic point is psychological: expulsion from the blissful intrauterine state--separation from the mother―is inevitably traumatic. Caesarian section cannot prevent that. Furthermore, that trauma is the prototype for all anxiety crises: weaning, walking, the Oedipal conflict, willing and choosing anything important--i.e., living creatively--and, finally, dying. choosing anything important--i.e., living creatively--and, finally, dying. The Trauma of Birth sets forth a number of interrelated ideas which are crucial to all of Rank's subsequent work in theory and therapy: the pre-Oedipal phase of development; the importance of the mother; end-setting in therapy (whether brief or long-term); separation; the notion of will; and self-creation or psychological rebirth. The book sparkles with gems of insight set in solid historical, philosophical, anthropological, artistic and literary foundations. Lay readers who feel dazzled or bewildered by some of the theoretical acrobatics should take solace in the fact that Freud had similar feelings. Rank gives Freud credit for various ideas in the book, notably that birth is the primal anxiety, and that setting termination time in analysis can be useful. Rank wrote this book to praise Freud, not to defy him. Rank's hope and need for Freud's approval kept him from seeing the hazards of leaping forward, farther than Freud was willing to let him go. Perhaps such faith in a mentor is essential for a disciple to take the big creative risk. The alternative--not to care--is unthinkable in the case of these two remarkable men. Nowadays we forget the degree to which Freud's psychology was father- centered prior to The Trauma of Birth. Rank was quite aware of this pervasive ideology in science and society: "It has been noticed, especially in recent times, that our whole mental outlook has given predominance to the man's point of view and has almost entirely neglected the woman's" (p. 36). This sets Rank apart as the first feminist in Freud's inner circle. Today, of course, we take for granted that the mother-child relationship is crucial in the earliest formative phase of development, but then psychoanalytic theory presented a strong father threatening castration, and a mother whose importance was more erotic than nurturing. The birth trauma is followed by two normal developmental separations: weaning and walking. Only later does the Oedipal drama become central--and then modified somewhat. (5) The debate over Rank's theory raged around this point, since the Oedipus complex had become synonymous with Freudian theory and clinical practice. To Rank, separation from the analyst at the end of treatment recreated the birth trauma. Analysts and patients confirmed Rank's observation that the ending of treatment brought forth dreams and strong emotions replete with birth symbolism. And Rank brings in Socrates as midwife to the birth of the self through insight (p. 181): the perfect example of knowledge aiding experience. Rank felt that analysis was often too intellectually ritualized, blocking rather than facilitating change, which depends upon ritualized, blocking rather than facilitating change, which depends upon experience as much as insight. As the table of contents indicates, this book ranges through art, anthropology, religion, philosophy and psychology, with an anchor in biology: Rank chose “anchor” to describe the biologically rooted anxiety which is the crux of his thesis (p. 187). To sum up: we are violently expelled from uterine bliss, threatened with asphyxia along the way. Our lives are dedicated to finding that bliss again, by adapting the world-as-mother to ourselves or vice versa. We repress the birth trauma and the prenatal memory of bliss, but play out the representations of both in every aspect of living and dying. We are anchored to life in large part by (literally) breathtaking anxiety that prevents regression to a state of fetal mindlessness, on the one hand, or suicide, on the other. Life is hard, and the periods before and afterwards are infinitely better (not the Nietzschean epigraph) but we are trapped in our human status, half animal, half divine. We are trapped, and anxiety keeps us from simply exiting. Having said this, Rank takes us in big leaps from era to era and culture to culture, cradle to coffin, Sphinx to Eden to Golgotha. He is a virtuoso interpreter of “the whole development of mankind, even of the actual fact of becoming human” (p. xxvii). Rank cites many authors, including some Freud would view askance, like Stekel, Jung, Adler and Tausk. Rank does find fault with Jung and Adler, and always praises Freud, yet with the praise comes some audacious analysis. Rank credits Josef Breuer with the discovery of psychoanalysis as did Freud (p. 183); Rank commends Freud's diligence on the difficult path and faults those who defected, but then also criticizes those Freudians who “interpreted the master's teachings all too literally” (p. 184): this must have galled his conservative rivals on the Committee, and shows how confident he was of his mentor's favor. Rank then takes up the separation of Freud and Breuer, “the severance of the pupil from his master” (p. 186), a brilliant piece of analysis, unintentionally prophetic of what was about to happen in his own life. Freud's break with Breuer occurred when the younger man was 40! (6) Could Rank have failed to see the parallel in the present situation? Just as a virtuoso musician may miss notes in an otherwise brilliant performance, so Otto Rank overreaches now and then, or misses something apparent to the outsider. Rank lived through Freud's breaks with Adler, Stekel, Jung and Tausk and he knew about Breuer and Fliess. But Rank also knew he was unique in Freud's checkered history of collegial relationships; he expected to be able to spread his checkered history of collegial relationships; he expected to be able to spread his wings and still return to the nest. He was wrong, and both men were hurt deeply by the break. Rank probably could have remained under Freud's wing by yielding, but would not or could not. As for Trauma of Birth, Rank admitted “some of the criticism is just,” but defended his general position and rebutted Freud's arguments forcefully. (7) Freud believed that the analysand presents a baby to the analyst at the end of therapy. This book, a birthday present to Freud, was Rank's baby. Freud did not like it any more than Laius liked Jocasta's baby. I find an ironic Oedipal metaphor here: The baby could not live in Freud's house; Rank would not kill it, so he had to leave. Did the baby, like Oedipus, kill the father? Hardly: Freudian analysis flourished, especially in the United States, Rank's adopted home. The book was not translated into English until 1929, without the original dedication. In 1930 A. A. Brill denounced Rank as mentally ill, and ousted him from the American Psychoanalytic Association. Worse yet, Rank's analysands who wanted to be members of the American or the International Psychoanalytic Association had to be reanalyzed by an orthodox Freudian! This reprint appears in the midst of a Rankian renaissance and at a time when brief therapy has become part of the mainstream. Otto Rank is the founding father of brief therapy, and even orthodox psychoanalysts are belatedly discovering this man's indispensable contributions to the Freudian enterprise. After over half a century, I hope this book will join the works of Freud and Ferenczi again in their timeless search for understanding of the human psyche and society. --E. JAMES LIEBERMAN 1. Freud to Ferenczi, 24 March 1924. See Lieberman, E.J., Acts of Will: The Life and Work of Otto Rank. New York: Free Press, 1985 (paperback ed. Univ. Massachusetts Press 1993), pp. 219 ff. 2. Das Trauma der Geburt und seine Bedeutung für die Psychoanalyse. von Peter Orban. Frankfurt: Fischer, 1988. 3. Kenworthy, M. “The Prenatal and early post-natal phenomena of consciousness.” In The Unconscious: A Symposium, Intro. Ethel S. Dummer. Freeport, NY: Books for Libraries Press, 1966 (Knopf, 1928), pp. 178- 200. 4. Feher, Leslie. The Psychology of Birth. York: Continuum , p. 14. 5. Lieberman , E.J. “Why Oedipus loved his father,” in The Harvard Mental Health Letter,:12 (June) 1991. 6. Rank returns to the Freud-Breuer conflict in Seelenglaube uns Psychologie (1930); Acts of Will, p. 323. 7. Rank, O. Literary Autobiography (1930). In Journal of the Otto Rank Association (30):3-38, 1981. See also his review of Freud's Hemmung, Symptom und Angst in Mental Hygiene :176-188, 1927, also in JORA ,2 (7): 34-50,1969, translated from Genetische Psychologie, Teil I (1927), 24-40. There is an old story that King Midas had hunted for the wise Silenus, the companion of Dionysus, for a long time in the woods without catching him. But when he finally fell into his hands, the King asked: “What is the very best and the most preferable thing for Man?” The demon remained silent, stubborn, and motionless; until he was finally compelled by the King, and then broke out into shrill laughter, uttering these words: “Miserable, ephemeral species, children of chance and of hardship, why do you compel me to tell you what is most profitable for you not to hear? The very best is quite unattainable for you: it is, not to be born, not to exist, to be Nothing. But the next best for you is—to die soon.” Nietzsche : The Birth of Tragedy. CONTENTS page Preface xi The Analytic Situation 1 Infantile Anxiety 11 Sexual Gratification 30 Neurotic Reproduction 46 Symbolic Adaptation 74 Heroic Compensation 106 Religious Sublimation 117 Artistic Idealization 141 Philosophic Speculation 167 Psychoanalytical Knowledge 183 The Therapeutic Aspect 200 Index 218