Trauma of Birth, The

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First published in 1924, Otto Rank's The Trauma of Birth took as its starting point a note that Freud added to his The Interpretation of Dreams in 1909: "Moreover, the act of birth is the first experience of anxiety, and thus the source and prototype of the affect of anxiety" (1900a, pp. 400-401n).

Rank set out to identify "the ultimate biological basis of the psychical," the very "nucleus of the unconscious" (p. xxiii). For him this was the physical event of birth, whereby the infant passes from a state of perfectly contented union with the mother to a state of parlous separation via an oppressive experience of asphyxiation, constriction, confinement in the vaginal canal, and so onall feelings recognizable in anxiety states of every kind. It was the struggle against this traumatic experience of birth, in Rank's account, that structured the fantasy life of the child, including the disavowal of the difference between the sexes, infantile sexual theories, and oedipal scenarios. Castration anxiety was a defensive derivative of the anxiety associated with the birth trauma.

Rank supported his thesis with case notes, notably concerned with terminations which according to him always brought up fantasies of a "second birth." But for the most part he relied on data derived from social myths and rites exemplifying what he called "heroic compensation," religious sublimation, artistic idealization, or philosophical speculation. The very abundance of the material thus adduced, and the author's stated aim of accounting for all processes of hominization and all cultural evolution in terms solely of the trauma of birth, were bound to leave the reader perplexed. Rank's evidence nevertheless warrants more attention than contemporary psychoanalysts were willing to accord it. Indeed a multitude of themesfalling, constriction within a narrow space, feelings of being lost in limitless space, the importance of very early relations with the mother, or primitive anxieties foreshadowing castration anxietywere distinctly novel in the psychoanalytic literature as of 1924.

The clumsy presentation of these ideas, however, along with the author's overreaching ambition, the lack of method in his argument, and the failure to buttress his thesis with analytical clinical material, all contributed to the rejection not only of his work but also of Rank himself, who broke with the psychoanalytic movement in 1926 after Freud's condemnation of his ideas in Inhibitions, Symptoms and Anxiety (1926d).

Beyond the question of the weaknesses of Rank's book, it is reasonable to consider what psychoanalytic reasons might have occasioned this rejection of his ideas in favor of the primacy of oedipal conflict as crucial to the organization of neurotic pathology, or of castration anxiety as the prototype under which all other forms of anxiety were subsumed. In a postscript to the French edition of The Trauma of Birth, Claude Girard points out that the position defended by Freud and his followers tended to exclude non-neurotic pathologies as legitimate objects of psychoanalytic exploration, whereas Rank's propositions encouraged the investigation of very early forms of pathology, along with that of the baby's earliest relations with its mother.

Both these avenues of inquiry were further explored subsequently by American psychoanalysts (Greenacre, 1945; Fodor, 1949; Alexander and French, 1946). More recently, Rank's main theme has been picked up with renewed vigor in the wake of object-relations theory, albeit without Rank's reductionism. Thus Wilfred R. Bion (1977) has used the term caesura in theorizing about the experience of a discontinuity in object-relations of which birth is the paradigm case. And Frances Tustin (1981) has described a premature psychological birth in autistic children corresponding to a consciousness of the bodily separation from the object that arises at a stage when the psyche is still unable to form symbols.

Didier Houzel

See also: Anaclisis; Anxiety as signal; Asthma; Birth; Castration complex; Cinema and psychoanalysis; Dream of birth; Inhibitions, Symptoms and Anxiety ; Lines of Advance in Psycho-Analytic Therapy ; Psychic causality; Psychoanalytic splits; Psychoanalytic technique (adults); Termination of psychoanalytic treatment; Trauma.

Source Citation

Rank, Otto. (1924) Das Trauma der Geburt und seine Bedeutung für die Psychoanalyse. Leipzig/Vienna/Zurich: Inter-nat. psychoanal. Verlag. English translation: The Trauma of Birth. London: Kegan Paul, Trench, Trubner, 1929; reprinted, with an introduction by E. James Lieberman, New York: Dover, 1993.


Alexander, Franz, and French, Thomas M. (1946). Psychogenic factors in bronchial asthma. Washington, DC: National Research Council.

Bion, Wilfred R. (1977). Two papers: The grid and caesura. Rio de Janeiro: Imago Editora; reprint, London: Karnac, 1989.

Fodor, N. (1949). The search for the beloved: A clinical investigation of the trauma of birth and prenatal conditioning. New York: Hermitage.

Freud, Sigmund. (1900a). The interpretation of dreams. SE, 4-5.

. (1926d [1925]). Inhibitions, symptoms and anxiety. SE, 20: 75-172.

Greenacre, Phyllis. (1952). The biological economy of birth. In Greenacre, Trauma, growth and personality. New York: Norton. (Original work published 1945)

Tustin, Frances. (1981) Autistic states in children. London: Routledge.

Further Reading

Mintz, I. L. (1975). Evolution of Otto Rank's theory of the birth trauma. International Review of Psychoanalysis, 2, 245-246.