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One analytic theory asserts that 'the traumatic neurosis is a struggle to reëstablish mental equilibrium following a sudden large influx of excitation'. Another analytic assertion is that 'neurotic symptoms are substitute satisfactions, contrary to the ego's wishes, for disturbed sexual function'. Dreyfuss tries to harmonize these apparently discordant statements, and as his title indicates mainly from the standpoint of theory. However, the reader soon realizes that the theoretical considerations are based on rich clinical experience. Dreyfuss finds that in the traumatic neurosis, sexuality is markedly disturbed, even to the point of a loss of genital primacy. To say that the trauma is unconsciously conceived as a castration is not an adequate explanation of this fact; instead, according to Dreyfuss, among the various psychic energies mobilized to master the trauma are also genital energies, perhaps as a last reserve, and that all psychic energies lose their specificity in the general emergency.
'Part of the energy belonging to the ego system, and up to this time cathectedly fixed, are mingled with instinctual quantities till now belonging to unconscious instinctive functions.' This results in a sexualization of ego functions not unlike that seen in conversion hysteria. 'In hysteria a repressed impulse or a traumatic memory is slowly, persistently forced into the realm of the ego… In traumatic neuroses, the ego surprised and momentarily weak, yields to the repressed, or rather to the force of instinct in general'. Eventually the ego fears not alone the threatening external world whence the trauma came, but also the inner world which was mobilized by the trauma. Dreyfuss speculates as to 'diffusion of instincts' in this mobilized inner world and disputes certain of Kardiner's ideas, considering a distinction between damming up of ego instincts and a general damming up of libido as superfluous. The paper concludes with some therapeutic suggestions.