Tracing the Roots of Panic to Prenatal Trauma

INTRODUCTION For the past five years I have worked with a patient in my practice who suffers from panic attacks. I will call her Miriam. Her panic attacks usually begin with a feeling of tightness in her chest, as if "an elephant were sitting on it." Connected with this sensation of suffocation are heart palpitations so strong she believes she's suffering a heart attack, dying, or losing her mind. Miriam has always been a person who never let herself lose control in her life; otherwise she risked having a panic attack. Due to her overwhelmingly powerful anxieties our therapy sessions took place over the telephone. The crises that brought Miriam to therapy were panic attacks that were triggered by two car accidents, one shortly after the other. She suffered whiplash injury, which resulted in headaches and severe back and neck pain (sometimes so agonizing she thought of killing herself). The car accidents followed the end of a traumatic divorce that had gone on for two years and had threatened her with losing custody of her son. Though the car accidents were stressful enough in and of themselves, it seemed there must have been an earlier cause for Miriam's distress. Miriam's traumatic family history holds the key: Prior to Miriam's birth, her mother had aborted a baby girl in the seventh month of pregnancy. The baby was aborted at home, survived for several hours without care or nourishment, and finally died. Miriam's mother's problems continued with Miriam; she was vomiting constantly, losing weight, and was ultimately thinner when she gave birth than when Miriam was conceived. Another crisis presented itself as the day of Miriam's birth approached. It was a Saturday night when her mother's labor started and she went to the hospital. Although her cervix had already dilated, because the hospital staff was tired, they gave Miriam's mother morphine to stop labor. Ironically, the next day labor had to be induced to force the birth. Because of her mother's medical crisis and because Miriam appeared to be dead, the newly born baby was laid aside. Only later did someone notice that the baby girl was still alive, and only then was Miriam cared for. Because of her mother's critical condition, Miriam was separated from her for a week after birth. Another factor was that Miriam's mother suffered her whole life under a psychotic mother (Miriam's grandmother). Were the whiplash injuries, or the divorce and custody battle, or Miriam's birth history the root of her panic attacks? It was the recapitulated physical and emotional pain of the fearfully traumatic divorce trial and the whiplash injuries that catapulted Miriam to reconnect with her mother's physical and emotional pain from the trauma before and during her pregnancy, and both their birth experiences which made it possible for Miriam to seek help in resolving her pain. An important question is whether Miriam's mother ever completely mourned for her aborted baby before Miriam was conceived. Because her mother probably had not been able to connect with and resolve her feelings of grief, sadness, and probable guilt at the death of her first baby, Miriam was born with her mother's same unresolved feelings. THE HISTORY OF PRENATAL AND PERINATAL PSYCHOLOGY Here I introduce the present knowledge of prenatal and perinatal psychology and psychotherapy. It began with the 1924 book by Otto Rank, The Trauma of Birth. Rank, together with his patients, recognized that the roots of neurotic development can always be traced back to the birth experience and that the neurotic pains of his clients could not be completely understood outside of this context. In the 1950's Hungarian psychoanalyst, Nandor Fodor, who was living in the United States, detected that every strong anxiety dream was ultimately a dream about one's own birth. Who isn't familiar with dreams of terrifying flight without having the control to move or prevent the imminent danger? Or the dream of being swallowed by a huge swirling vortex and then falling furthest depths. …