Trauma and Symptom Formation

The basic infantile trauma usually designated as primal scene, which may be conceived of as a primary pavor nocturnus and which is reflected in the infantile pavor nocturnus attacks, instigates repression as well as attempts at reparative mastery. Later situations—such as reinforcement of libido in puberty, frustrations—resuscitate the threat from past traumata and the attempts at their mastery. Under certain conditions, like severity of the past traumata or their excessive libidinization, these attempts result in a repetition of the traumatic situation evoking a regression to pathogenic primary defences and renewed attempts at magic mastery (ego regression). This pathogenic regression has to be warded off by additional secondary defences. The symptom combines a counter-reaction against the primary defences incited by the break-through of the trauma with a renewed attempt at its magic mastery.

In hysteria, the somatic discharge of anxiety produced by the break-through of the repressed seems to be used for counteracting pathogenic primary defences as well as for a magic acting out of renewed reparative mastery. The somatic reactions may constitute the pathway to the conversion symptoms. In phobia a specific situation which restimulates an infantile impulse and thus revives the infantile trauma initiates an attempt at reparative mastery. Its failure provokes anxiety and pathogenic defences. The specific situation acquires the quality of danger and has to be avoided. Compulsion neurosis is characterized by the greater strength of pathogenic regressive defences of greater automatic (compulsive) character as a consequence of a more traumatic background. They become the main threat and are warded off by reaction formations and magic counteractions, undoing, isolation, etc. The stronger the underlying trauma, the more extensive the ego regression, which explains the successively growing prevalence of magic thinking, and of acting out. In perversion the revival of the infantile trauma seems to be responded to by the magic acting out of libidinized primary defences together with magic acting out of reparative mastery. In psychosis, the alarming character of the infantile trauma is due to the morbidity of the underlying anxiety process (insufficiency of anabiotic defences). In this case the reparative repetition of the trauma represents an exorbitant threat and elicits extreme irrational responses involving an extensive invasion by the primary process; on the one hand, there are incessant attempts at reparative magic mastery with hallucinations, identification, projection, introjection, repression, denial, etc., and on the other, there is a desperate acting out of all available defences, discharge reactions and counter-reactions, such as clinging, perversion, agitation, catatonoid reaction, depersonalization, depression, etc., including the whole gamut of the various forms of symptom formation.