Psychic Trauma: A View from Self Psychology

The concept of psychological trauma

Our interest in psychic trauma is closely related to our interest in the etiology—the causes and sources of psychological injuries. We know from the evidence of numerous observations that certain types of events are predictably followed by a very high incidence of what we usually call psychological illness. Our concern with the conceptualization of trauma is our attempt to understand the connection between these causes and their effects. We want to understand the processes that lead from etiological events to pathological outcomes

Let us start with a clinical vignette:

Vignette 1 (Acutely overwhelming trauma) A young combat soldier comes to the clinic with complaints of insomnia, nightmares, weight loss, irritability, uncontrollable rages, and constant debilitating anxiety A brief history reveals that these symptoms began after he and his platoon were pinned down for several days of unremitting shelling and mortar fire during which more than half his comrades were either killed or wounded The symptoms started after his rescue by a unit sent for their recovery. In nightly nightmares he relives the terror he experienced on the battlefield

Clinical observation here clearly points to a connection between a causative event—being in imminent and mortal peril—and an effect—a readily observed and described set of symptoms Indeed, this type of cause and effect is common enough to have earned the label traumatic neurosis, and its etiology is generally conceptualised to be massively overwhelming trauma. When we attempt to understand