A Viennese by birth, Rank was a brilliant member of Freud’s coterie, but Freud broke with him over his “one-sided” emphasis on the birth trauma and his innovations in therapy. In this country he had an influence on the development of short-term techniques, but a far greater effect in the field of social work than in psychiatry. The functional school of social work, with its emphasis on inner change rather than social adaptation, is largely due to him.Rank stated his basic views in The Trauma of Birth, published in 1924. In it he argued that terror experienced during the birth process affects our later course of development and may establish a susceptibility to neurosis. He believed that all of us have a lasting urge to return to the serenity of the womb, as evidenced not only in the child’s struggle against separation from his mother, but in the satisfaction achieved through sexual intercourse. We also have an instinct, however, to break away and develop ourselves as independent beings. Rank termed these two contradictory impulses “life fear” and “death fear,” and viewed human existence as a battle between them.See BIRTH TRAUMA, ADOLESCENCE (THEORIES).As the individual grows, he develops a healthy “counterwill,” or will to independence, directed originally against his parents and generated by the death fear. This drive is always opposed by a desire to conform and unite with others, a drive that originated in the impulse to return to the womb (life fear). The individual who can successfully resolve the conflict between these two fears, and achieve genuine creative independence, Rank termed an “artist.”THERE ARE MANY APPROACHES TO THERAPY29. (Above) A clue to suicide. In analyzing this painting, the therapist detected a suicidal urge—not in the macabre figures, which are common in the work of mental patients, but in the white bird ascending to heaven to escape them. See ART THERAPY. 30. and 31. (Below) Symbolic paintings of a schizophrenic girl. The one on the left was produced at the start of therapy, the one on the right at the end when she was on the road to recovery. See ART THERAPY THERE ARE MANY APPROACHES TO THERAPY 32. A group therapy session in a mental hospital. See GROUP PSYCHOTHERAPY.33. Hypnotic regression, used in recapturing repressed experiences. In returning to an earlier age through suggestion, this nineteen-year-old girl wrote exactly as she did at ten and six, then scribbled like a preschool child. See HYPNOTHERAPY.34. Occupational therapy in a mental health clinic. See OCCUPATIONAL THERAPY.THERE ARE MANY APPROACHES TO THERAPY Patients in crumbling attic quarters of an outdated custodial institution with nothing to occupy their time and little chance for treatment. See MENTAL HOSPITAL.36. A modern mental hospital ward, with its comfortable, morale-building living quarters. Compare this with the bleak surroundings of the older custodial institution.THERE ARE MANY APPROACHES TO THERAPY37. Typical posture of an autistic child, withdrawn and unresponsive. See AUTISM, AUTISTIC CHILD, WITHDRAWAL.38. A withdrawn schizophrenic child is rewarded for making progress toward reality by receiving tokens that enable her to obtain candy, trinkets, and a motorboat ride. See BEHAVIOR THERAPY, REINFORCEMENT, SCHIZOPHRENIC REACTIONS (Therapy).The “average man,” however, can do little more than adapt himself to the conventions of society, and will inevitably find himself confused when social change is rapid.In Rank’s theory, a neurotic is a “frustrated artist,” a man or woman who tries to live his own life but is unable to function effectively. There are two principal sources for this incapacity. The individual may suffer from an excessive life fear (inability to handle separation from the mother), and react by becoming overly aggressive or overly submissive toward other people. Or he may suffer from an excessive death fear (fear of losing himself in union with other people) and become withdrawn and detached from life. In either case he is assailed by anxiety and needs help.The object of Rankian therapy is to enable the patient to accept himself as a separate, independent human being without feeling guilty or anxious. The therapist does not use the Freudian technique of free association, but depends heavily on the process of transference—that is, he uses the patient’s relation to himself as the therapeutic instrument. His attitude is friendly and accepting, and he serves as a sympathetic sounding board and critic throughout. He also keeps the therapy focused on concrete experiences in the patient’s daily life, past and present, constantly encouraging him to move in the direction of creative independence by trying out more constructive and trusting relationships with other people, at the same time avoiding the two extremes of aggressiveness and submissiveness. As a further impetus toward independence, the patient is given the responsibility of setting a time limit for the therapy, and of deciding when he is ready to navigate on his own.