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There has been considerable revision and elaboration of the role played by a particular childhood experience in the dynamics of an adult neurosis since the first publication of the Studies in Hysteria(2). The development of Freud's thinking on this subject (3), (4), (5) and the direction of later revisions is clearly indicated in the discussion of fixation upon traumas in the Introductory Lectures(6). In this context Freud comments: "Everything said today relates only to symptom formation in hysteria. Even the obsessional neurosis shows great differences, although the essentials are the same. … Similar and more extensive deviations still are found in the other neuroses, in which field researches into the mechanisms of symptom formation are not yet complete in any direction."
The following case of the reconstruction of a severe childhood trauma at about the age of three and a half years, in a patient suffering from the symptoms of derealization, bears directly upon this problem. It emphasizes the role of identification as another mechanism for the resolution of the traumatic experience, and re-emphasizes the position of the reconstruction of the "traumatic fixation" in the advance of both theory and therapy.
The patient was a twenty-seven-year-old professional man who was referred for treatment several weeks after the onset of his acute