4. Physiology at birth

In the intrauterine condition, the fetus is only a biological reality in contact with another biological substance; the amniotic fluid. There is no psychic activity in the uterus: mental activity will start at birth when irreversible changes occur both in the body and in the brain. In the homeostatic condition where no harmful stimuli are present, organs and apparatus developmental processes occur. Toward the end of pregnancy, from the 23rd to 24th PCW, the fetus has the possibility to survive when "coming to light", but until it is in the intrauterine condition it cannot be considered alive in terms of body and mind functioning. The fetus will become a human being when stimulated by light, an absolute new feature which will determine the activation of the brain. Whereas tactile stimulation is not new to the newborn as it was previously enveloped in the amniotic fluid of the intrauterine environment, light is a completely new stimulus. Recent studies have provided biological data that can be related to the psychic dynamic happening at birth and firstly theorized and

### Physiology of Human Birth and Mental Disease DOI: http://dx.doi.org/10.5772/intechopen.82216

These develop in the subplate zone, creating temporary synaptic circuits and normally wait months before being relocated in the cerebral cortex, their final target [10, 12, 13]. In the occipital zone, the subplate's main function is to organize the optical orientation columns. Moreover, this is an area of intense synaptic activity where endogenous stimuli trigger specific fetal electrical activities: the spontaneous transient activity (SATs), which can be traced through electroencephalography (EEG) [14]. Its role is to organize and structure neuronal nets in the fetal brain (the thalamus cortical connection) and to give origin to transient circuits. This activity ends at birth when the permanent cortical circuit and the externally driven cortical circuitry, situated in the cerebral cortex will be activated [12]. The subplate has a fundamental role in brain plasticity and some of its neurons survive after birth until adolescence and early adulthood as subcortical interstitial neurons of the gyral white matter [12]. In the subplate zone, excitatory neurons which work with the gamma-aminobutyric acid (GABA) are implied in the connectivity and cerebral cortex structure development. At birth, GABA will become the major neurotransmitter inhibitor (and will play this role for the whole life) determining a change in the cerebral electrical activity of the newborn. This switch is triggered by the retina light stimulation [15]. These scientific observations consistently support the Theory of Birth formulated by Massimo Fagioli. The concept of viability has been strictly related to capability to react to sensorial stimuli that will occur at birth [11]. Other author highlight how cortico-cortical and thalamo-cortical connections, the subplate, the SAT and the somatosensory reactivity are all present at the same time when the capability to survive has been reached at 23rd–24th PCW. This has been linked with what will occur after birth [16]. In particular the sensation experienced in contact with the amniotic fluid which is a fundamental prerequisite to realize what Fagioli called "memory fantasy" [1, 16]. When the fetus is in contact with the amniotic fluid, can the uterus be considered a closed system. At the same time the fetus's brain electrical activity has the only role to organize and structure neuronal networks. At birth this condition will completely change in the dramatic passage from the intrauterine condition to the external world: the organization and the fetal brain function will be modified. The subplate as guide and cytoarchitectonic structure disappears, the SATs frequencies decrease until their presence on the EEG disappears and regular waves, which are correlated with alive condition, will appear [12, 14]. The GABA neurotransmitter function changes as previously stated. Finally the external environment condition is now dramatically different for the newborn. This determines

Psychology of Health - Biopsychosocial Approach

a drastic caesura between the intrauterine and the extra uterine condition.

related to the psychic dynamic happening at birth and firstly theorized and

In the intrauterine condition, the fetus is only a biological reality in contact with another biological substance; the amniotic fluid. There is no psychic activity in the uterus: mental activity will start at birth when irreversible changes occur both in the body and in the brain. In the homeostatic condition where no harmful stimuli are present, organs and apparatus developmental processes occur. Toward the end of pregnancy, from the 23rd to 24th PCW, the fetus has the possibility to survive when "coming to light", but until it is in the intrauterine condition it cannot be considered alive in terms of body and mind functioning. The fetus will become a human being when stimulated by light, an absolute new feature which will determine the activation of the brain. Whereas tactile stimulation is not new to the newborn as it was previously enveloped in the amniotic fluid of the intrauterine environment, light is a completely new stimulus. Recent studies have provided biological data that can be

4. Physiology at birth

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described by Massimo Fagioli in 1972. Moreover, several authors have interpreted these biological data in the light of this theory [11, 16]. In the central nervous system the retina, through the pupil, is the only part of the cerebral matter open to external stimuli. At birth, photo-retinal stimulation triggers an immediate pulsional reaction specific to humans which is a specific biological feature of Homo sapiens, denominated by Fagioli as annulment pulsion (pulsione di annullamento) [1, 4–6, 17]. Recent scientific studies have shown that a single photon is sufficient for the activation of retinal cells [18]. As soon as it passes through the pupil and hits the retina, light immediately determines the brain's activation. This happens within a timeframe of the order of femtoseconds, so as to trigger the chain of chemical and physical events leading to the activation of brain circuits [19]. It has been studied that at birth the activation of the brain through visual connection and occipital cortex stimulation is faster than other cortical stimulation nervous pathway for the activation of vital processes such as respiration [20]. In addition, it has been shown how light is involved in the functional change of the GABA neurotransmitter at birth [15]. The newborn experiences a dramatic change, passing from the homeostatic condition in the amniotic fluid to the completely new extrauterine condition. The newborn reacts to the aggressiveness of the external non-human world (such as light, air, noise, cold) by closing the eyes and 'making it dark'. By doing so the newborn makes mentally disappear the external inanimate material world and at the same time, it would tend make itself disappear too. This is the pulsional defensive and non-conscious reaction defined by Fagioli as annulment pulsion. Through this pulsion, the mind of the newborn by wishing of returning to the previous stage makes both the external world and itself disappear. However, this cannot happen as the brain has been activated by light and the mind is now functioning together with the body. The fetus does not exist and neither the conditions that allowed its existence. The newborn cannot return into the darkness of the intrauterine condition. If the newborn managed to make itself "disappear" as a body-mind reality, it would not attach to the breast, and this wouldn't permit a natural movement toward another human being. The newborn would die. Thus, it is not possible for the newborn to annul its birth because something impedes this pulsion to turn into auto-destruction: vitality [1]. Vitality, a specie-specific human feature, has its roots in the capability to react that develops at 24th PCW and is strictly connected to the biological reality of the body. At birth the capability to react arises in the newborn, making possible the reaction to the light stimuli. This reaction is the annulment pulsion which simultaneously activates vitality. At birth vitality and the annulment pulsion are merged together. This latter does not exist independently, as it occurs in serious mental illness on a non-conscious level. Moreover, as it was previously stated, this would lead to the newborn's death. The fusion between vitality and annulment pulsion becomes 'fantasia di sparizione' or disappearance fantasy [1]. This formulation was theorized and firstly published by Massimo Fagioli in 1972. Since then, this theory has been confirmed by further investigation and research. The author brings together two concepts that identify two inherently and antithetical human features. Fantasy is related to imagination and therefore to the creation of something that did not exist before. However, 'disappearance' implies that something that existed before now does not exist anymore. This concept may sound contradictory but it is indeed able to express a creative act that happens without awareness in the newborn (which is a non-conscious act). Similarly, at birth, the newborn, by making the external non-human world disappear, creates the first image-idea of itself. This is the first creative act of the newborn, the first human thought. As the external inanimate world disappears in the newborn's mind, vitality allows the formation of a first undefined image. (Fagioli called this first image inconscio mare calmo, providing a clear visual image). At birth, the newborn realizes a first sensorial memory of the experience had in the previous homeostatic

condition. According to Fagioli's theorization, in the first moments of life the newborn realizes a memory-fantasy of the experience had in the intrauterine condition, from the sensation with the skin in contact with the amniotic fluid, (memoryfantasy of the sensation had before), and a first image of itself as 'libidinal and psychic self'; at the same time, the newborn by recreating in its mind the condition of wellbeing and calmness previously experienced, imagines the existence of another human being similar to itself. In those first moments of the newborn's life from the pulsional and vital rejection of the inanimate world, the certainty of an existing breast arises; that is, a human being similar to itself to whom to direct its feeling. In conclusion, the newborn makes the external world disappear, but not itself or its natural tendency toward another human being. This is the psychodynamic result of the first reaction to the external non-human world. For further references we suggest Chapter 2 in [1]. It is important to reaffirm that the annulment pulsion at birth is not isolated as it is merged with vitality. Together they become disappearance fantasy, which is creative and not destructive. According to Fagioli specification, these two specific human features the annulment pulsion and vitality, arising immediately in 'coming to light', make the newborn indifferent to the inanimate external world and at the same time enable the creation of the capability to imagine [21, 22]. This capability to imagine is a fundamental human dimension throughout all life. Indeed a loss or alteration of this dimension is founded in most psychiatric pathologies as I will further explain in the following paragraphs. The capability to imagine is an exclusive human characteristic, which begins at birth and develops throughout life. The first human thinking, which begins as image and non-conscious mental activity, represents the basis of any creative activity. The capability to imagine is realized at birth in the short span of time between the light stimulation and the subsequent pulsional reaction with the activation of the respiratory muscles by the central nervous system. Physiologically it occurs in those first instants of life when the newborn appears to be inert and it still not crying nor breathing. Only after this short span of time the newborn wails and moves. This is a common experience in the delivery room: a suspended moment, a bunch of seconds when the newborn is still and not wailing. However, as previously explained the light has already hit the retina therefore the brain has been activated and the mind is functioning. Although the newborn appears still and silent, it is already alive and human. This is how the biological formation of human psyche occurs. To sum up, light is the absolute new feature. Annulment pulsion toward non human reality and vitality determine disappearance fantasy as the capability to imagine, the creation of the first internal image and the certainty of an existing breast. The 'Human Birth theory' proves that the first act in the newborn's life is an autonomous psychic act. This is an individual creation arising from the biological reality through the reaction to light. Human life starts, when at birth mental activity begins. In our whole life, this activity will never cease, neither during the night. It will stop only at the death of the individual. Therefore, the lifetime of a human being is all comprised within an interval that starts when light activates the brain, while the end corresponds to the cessation of mental activity. During the night human thoughts will express themselves through images as non-conscious thought. The interpretation of oniric images and the presence or lack of affection concealed in these images is at the core of psychotherapy according to the Theory of Birth.

Freud affirmed [23], they cannot be considered as isolated, autoerotic and narcissistic beings [24]. Nowadays it is a proven fact that cognitive development is affected by early social relationship and by the newborn activity. Moreover, recent studies carried by Murray have confirmed the idea that infants begin to make connection to the world since the very beginning [25]. This study, based on observation and experimental approach, demonstrates the early communication ability shown by infants. As early as the first month of life, the newborn smiles without being able to distinguish to whom. At the same time the newborn is able to interact with other human beings approaching its visual area, through visual contact. During the second month, although the vision is not completely formed, the infant begins to make visual connection with the mother's face. (Visual acuity gradually develops over the first year of life and it will be completely formed at the age of two. In the earliest months of life the baby can differentiate only lights, shadows and sharp movements). According to Murray, during the second month of life the intersubjective primary phase begins. During this time the infant starts to smile and to socially interact with his/her parents that can now recognize their infant as human. Moreover at this stage, mirror neurons and the parent's tendency to imitate sounds and gestures of their infant play a fundamental role. These factors help to develop a sense of reciprocity and trust. Through their careful presence parents can provide love and affection to their infants, addressing their needs and guaranteeing a safe attachment [25]. It is well known that early experiences during the first year of life will have a major impact on the onset of mental illness during adolescence and early adulthood. B. Beebe has confirmed the existence of four type of attachment (secure, avoidant, ambivalent, disorganized) which had been previously identified by her mentor Stern. In her recent work is highlighted how a disorganized attachment during the first year of life can have dramatic consequence in adulthood, resulting in serious mental illness. Beebe also hypothesizes the importance of mirror neurons in early relational experiences [26]. Although these relevant experimental studies and observations should be considered the object of further research, we think that the core of this discussion does not lie in the behavioral and emotional mirroring. What is central is rather the infant's need to find confirmation of its feeling and identity in the interhuman relationship. Obviously it is necessary to consider that developmental processes, cognitive and emotional acquisition and the act of processing experiences are directly related to biological activities, neurofunctional mechanism and remodeling of the neural networking. The latter is still partly unknown and we do not intend to deny nor underestimate their role believing that they should be considered object of further investigation. We should remember that brain neural plasticity reaches a peak during the first year of life and continues developing until the age of 18–30 [10, 12]. However, we must point out the limits founded in the approaches previously mentioned. Although they highlight the importance of interhuman dynamics during the preverbal period and take into account the centrality of nonverbal communication (gesture, body posture, facial and vocal expression, physical or non-physical contact), they still mainly consider a relational context in which adult behavior and consciousness are the main agents. These act together with the primitive infant consciousness, which is considered as "internal operative models" shaped on the base of experience [26]. One of the major limits of these neuropsychological approaches lies in the complete absence of research on the origin of irrational and non conscious mind. According to the theory of birth, the infant non-conscious mind is the first to be formed in human beings and for a quite a long time will be the only function. The non-conscious mind is strictly connected to the infant body. In fact, body and mind are born together in "coming to light" with a drastic separation that marks the end of the conditions that guaranteed the fetus existence. We should recall how investigating the human birth

Physiology of Human Birth and Mental Disease DOI: http://dx.doi.org/10.5772/intechopen.82216

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