The Traumatic Syndrome

The premise of this paper is that the traumatic syndrome is a unitary phenomenon. By this I mean a circumscribed entity which has a definable beginning, course, and ending during which certain consistent patterns manifest themselves. The “traumatic syndrome”—or parts thereof—has received the following designations: traumatic neurosis, traumatic neuroses of war or peace, shell-shock, war neuroses, combat fatigue, effort syndrome, post-concussion syndrome, lightning neurosis, railroad spine, compensationitis, and even malingering. (1)

The traumatic syndrome is neither a neurosis nor a psychosis, although there may appear as concomitant manifestations during its course any or several of the well-known neurotic or psychotic syndromes. The traumatic syndrome is due to a break in the relationships of a system of defense built around the “basic conflict.” This defense system Horney has called the protective structure. (2) It exists as a consequence of the individual's perversely using his constructive energies and positive qualities which can be freed for creative purposes when the defense system is no longer necessary. Since the individual is rarely totally consumed in the service of his protective structure, some of his energies and positive qualities are directly used constructively. When I say a break occurs in the relationships of the protective structure, I mean within the structure itself and in its relationship to those constructive parts of the individual which are not involved in its service. It is not the protective structure, an entity, which breaks but the relationships in a process that change. What “breaks,” then, is an organization within a structure having neurotic and healthy components, to be followed by a reorganization and realignment which may be better or worse or simply different.

Qualitatively and quantitatively, such a break may be limited or extensive. In a life span it may happen many times. It may occur because of unfavorable pressures which incr