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Certain patients who had been imprisoned in concentration camps show a traumatically acquired personality change2 in which, together with frequent pseudo-neurasthenic symptoms, there is a severe impairment of psychical integration. In some such patients we find, as part of this impairment, a tendency to dissociative phenomena which did not exist previously, and which has, therefore, to be considered as a subsequently acquired disposition. These phenomena are distinguished by states of altered consciousness in which highly traumatic, dissociated material emerges, this being elaborated generally in a repetitive and sadomasochistic way. The material consists of real experiences of the traumatic past, of traumatic experiences of other persons with whom the patients identify, of pure fantasies, and mostly of a combination of all these. The real experiences had frequently been undergone while the patients were in a semi-stuporous condition; the fantasies, however, originate in daydreams. Consequently, the ideational content of these phenomena, never having reached full consciousness, could not acquire ego-integration.
These dissociated states occur in short attacks, often lasting from seconds to minutes only. Contact with the outer world is disturbed. Frequently a detail of current reality which associatively triggers off an attack, merges with the dissociated ideas, and thereby becomes interpreted delusionally. In other attacks the dissociated ideas impinge on reality, thus creating a double consciousness. In yet other cases, normal consciousness alternates with the pathologically altered one. After the attack, insight into it, together with some memory of it, prevails.
The consciousness of these patients is habitually hazy, their attention is inexact, easily exhausted and fluctuating, and their concentration is severely impaired. This general lowering of mental functioning probably facilitates their tendency to dissociation. Daydreams eventuate, which, through