The Inner World in the Outer World: The Phenomenology of Posttraumatic Stress Disorder from a Psychoanalytic Perspective

In his preface to the first edition of the Interpretation of Dreams, Freud states, “Psychological investigation shows that the dream is the first member of a class of abnormal psychical phenomena of which further members such as hysterical phobias, obsessions and delusions are bound for practical reasons to be a matter of concern” (Freud, 1900, p. xxiii). It seems that the time has come to include posttraumatic stress disorder (PTSD) in this group of psychical phenomena. For the author, this addition clarifies the structural dynamics of the thought processes that are occasioned by exposure to severe trauma and to the formation of PTSD symptoms. This article addresses the formation of chronic PTSD symptoms from a psychoanalytic perspective by considering PTSD as prototypical of anxiety disorders in the same way hysteria was considered prototypical of neurotic disorders 100 years ago. Freud ventured the idea that there will come a time when “the formation of (the) conceptions of the world and of the soul” (p. 2) could be subjected to the same processes as the formation of one's dreams.

The objective is to offer psychodynamic formulations derived from the trauma-psychology perspective (Emery, Emery, & Berry, 1993). Unlike the oedipal and ego psychologies, which focus on the cathectic dynamics of the psyche, the emphasis in trauma psychology is on the structural dynamics of consciousness or