Traumatic Elements in the Analysis of a Borderline Case1

Before going into the details of the case here considered, a few notes on trauma which can be kept in mind during the description will be useful. Although this presentation is primarily clinical, it will also be useful to provide at least a skeleton theoretical framework in which the traumatic neurosis can be placed.

Ordinarily the psychic apparatus maintains an equilibrium between external stimuli, tension within the organism, and discharge. When the influx of stimuli is so great and so rapid that it cannot be assimilated, we call the resulting condition a traumatic neurosis; when the discharge is severely blocked, we call it a psychoneurosis (4). We understand that these are relative concepts and that there is an inverse relationship between the quantity of stimulus and the amount of blockage necessary to precipitate a neurosis. What happens to the excess stimuli that cannot be assimilated? Freud (6) began the answer to this question and has done the basic work in such studies. His original observations on the method of mastering traumatic stimuli by repetition are fundamental. The change from passively experiencing stimuli to actively repeating them is an important step in mastering them. This occurs not just in those major events which we call traumatic situations, but in many minor crises occurring constantly in daily life, the trauma of which is often mastered by prior rehearsal and subsequent repetition. As we know, Freud went on from this mechanism of handling traumata to develop it into the principle of the repetition-compulsion which overrules or displaces the pleasure principle. Thus he finally evolved his concept of the death instinct; but here we are concerned only with the question of mastering intense stimuli.

With a sudden overwhelming stimulus the 'protective stimulus barrier' is destroyed, leaving the ego flooded with excitement which it is helpless to handle (3). The healthiest and most economic method, other than appropriate discharge, i