The Foetus as a Personality (1977)

I did not choose the title of this presentation. Had I done so, I would have been more careful in my selection of words. The foetus is part of my province of medical practice, and personality is part of yours. But whereas I am sure that you could all define, describe and even recognize a foetus, I am not so confident that I can define personality. One dictionary offers 'what constitutes an individual as a distinct person,' but does not define what the 'what' is. Another dictionary asserts 'the state of existing as a thinking intelligent being.' This definition might lead to the inference that personality increases pro rata with intelligence, or that some people may not have a personality at all if we followed Bertrand Russell's dictum that 'most people would rather die than think and many, in fact, do!' My copy of the late Ken Stallworthy's Manual of Psychiatry is more help with the definition that 'personality is the individual as a whole with everything about him which makes him different from other people,' because we can certainly distinguish foetuses from each other and from other people. With the next sentence-'personality is determined by what is born in the individual in the first place and by everything which subsequently happens to him in the second'-we are really in business. Not only can I tell you what is apparent of what is born in the foetus, but I can also describe the environment in which he lives, the stimuli to which he is exposed, and the responses which he displays. Therefore it might have been more apt to title this presentation 'A day in the life of the foetus,' and together we can revisit a stage of life which we all experienced but which, superficially at least, none of us remembers. Such a journey is justified for several reasons. For many centuries interest in foetal life was restricted to anatomical studies by embryologists or to mechanical problems in delivery as they presented to the accoucheur. The legacies of this era are well known-particularly the attitude that, apart from some aimless kicking which began in the fifth month, the foetus was a placid, dependent, fragile vegetable who developed quietly in preparation for a life which started at birth. In the present century, many disciplines have extended their interests to include the foetus, but in fields from surgery to psychiatry the tendency has been to start with adult life and work backwards-knowing what the adult state was, one worked back to what seemed a reasonable starting point to reach that goal. Therefore, in fields from physiology and biochemistry to education and psychology, there has grown up the habit of regarding the foetus and the neonate as a poorly functioning adult rather than as a splendidly functioning baby. Until recently, the human foetus in situ was inaccessible to study and this seclusion has had two further unfortunate results. First, much reliance has been placed on animal experiment in spite of the fact that there is more variation throughout the mammalian order in reproductive physiology than in the physiology of any other body function. second, for want of experimental verification or repudiation, theories have flourished without serious challenge. As a consequence, at one extreme, J.J. Rousseau and his pupils could regard the foetus as a witless tadpole with a mind like a cleanly washed slate-the tabula rasa-and at the other extreme some interpreters of dreams considered the foetus a skilled voyeur, spying on his parents having intercoursea sort of 'what the butler saw' through the cervix. If, with regret, we must abandon such fascinating conjecture, I hope that we can replace it with equally interesting fact, because recent advances in foetal diagnosis and therapy have provided both the technology and opportunity to piece together a new picture of the foetus. Far from being an inert passenger in a pregnant mother, the foetus is very much in command of the pregnancy. It is the foetus who guarantees the endocrine success of pregnancy and induces all manner of changes in maternal physiology to make her a suitable host. …