TRAUMATIC NEUROSIS

The term traumatic neurosis designates a psycho-pathological state characterized by various disturbances arising soon or long after an intense emotional shock. In the second half of the nineteenth century, a number of observations corresponding to a clinical picture of this kind were reported, typically in the wake of military action or railroad disasters, and related either to hysteria or to neurasthenia. Yet it was Hermann Oppenheimer who, in 1889, introduced the term itself into the lexicon of psychiatry.

Freud was to construct his theory of the neuroses on the model of traumatic neurosis. However, by stressing the sexual character of the precipitating factor and the possibility that the action of traumatic neurosis could be deferred, rather than the fright occasioned by an accident's actual threat to life, he jettisoned what had hitherto constituted the specificity of the category. Furthermore, by taking into account predisposition for and tolerance of trauma, as well as the trauma's significance in the subject's history and mental organization, Freud relativized and reduced the notion of shock and its etiological import. The whole issue was destined to achieve its full immediacy only when historical events brought the war neuroses to the fore, prompting Freud to reconsider traumatic neurosis, first in 1916 in his Introductory Lectures on Psychoanalysis and once again in the context of his great theoretical revision of 1920.

For Freud, the economic point of view then became predominant. He accentuated the character of the trauma as at once somatic (the "disturbance" freed up the flow of excitations) and psychic ("fright"). In Freud's words, "The symptomatic picture presented by traumatic neurosis approaches that of hysteria in the wealth of its similar motor symptoms, but surpasses it as a rule in its strongly marked signs of subjective ailment . . . , as well as in the evidence it gives of a far more general enfeeblement and disturbance of the mental capacities" (1920g, p. 12).

Traumatic neurosis does not have the same meaning for psychoanalysts as it does for psychiatric clinical practice. The psychoanalytic characterization includes repetition: The patient relives the initial trauma, and this manifests itself in every situation, whether transference-related or not. The function of nightmares is to express the anxiety that was absent at the time of the original incident. Such repetitive manifestations reveal a fixation on the trauma as well as an attempt to discharge excessive tension in incremental fashion (that is, to work through it).

Clinically and theoretically, it is important to eschew the mistaken application of the term traumatic neurosis to the posttraumatic state (or syndrome), since posttraumatic syndrome refers to a physical (usually cranial) trauma and to disorders related to an emotional shock. Such states cannot in fact be brought under the heading of neurosis in a psychoanalytic sense. Here Freud himself ran into perplexities that led him to assign traumatic neuroses first to the class of the actual neuroses and then to that of the narcissistic neuroses. Traditional psychiatry, as reflected in the third edition of Diagnostic and Statistical Manual of Mental Disorders (DSM -III), has renamed traumatic neurosis as "posttraumatic stress disorder," and while one might question its objectivizing use of stress, this approach does have the merits of avoiding the nosological trap of the neurosis/psychosis dichotomy and of viewing the issue from an interdisciplinary standpoint.

FranÇoise Brette

See also: Trauma.

Bibliography

Barrois, Claude. (1988). Les névroses traumatiques. Paris: Dunod.

Ferenczi, Sándor, et al. (1921). Psycho-analysis and the war neuroses. Vienna: International Psycho-Analytical Press.

Freud, Sigmund. (1916-1917a [1915-1917]). Introductory lectures on psycho-analysis. SE, 15-16.

——. (1920g). Beyond the pleasure principle. SE, 18: 1-64.

Oppenheim, Hermann. (1889). Die traumatischen Neurosen. Berlin: A. Hirschwald.

Further Reading

Casoni, D. (2002). 'Never twice without thrice': Outline for traumatic neurosis. International Journal of Psychoanalysis, 83, 137-160.