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It is at present held that psychoneuroses have three determinants: (1) a constitutional factor; (2) the infantile history and infantile traumata; (3) a possible adult trauma. Any physical or emotional shock contributing to the development of a neurosis is called a trauma. When such a shock occurs in adulthood and immediately precedes the outbreak of a neurosis, we call this shock an adult trauma.
The psychiatric conception of the pathogenic significance of this adult trauma has a varied and interesting history. At first it was assumed to be essential to the production of a neurosis. In the latter half of the nineteenth century, Charcot and the French psychiatrists attempted to explain its mode of action. According to them it gives rise to such sudden terror in the patient that he falls victim to it as he would to a hypnotic command; that is, the fright, once it has been experienced, acts upon the patient from within, like a command received under hypnosis. Moebius, to whom Breuer and Freud make reference, introduces a new factor which he claims to be just as important to the pathogenesis of hysteria as the hysterical constitution—a so-called hypnoid state.1
The nature of this hypnoid state is not clearly known. All that Moebius knows about it is that in this state the patient has no resistance and becomes the plaything of outward circumstances which act upon him. This hypnoid state can be brought about by hypnosis, by great physical debility, or by unusual emotional upheavals.
Breuer and Freud, in their publication of 1893, ber den psychischen Mechanismus hysterischer Phänomene, which marked the beginning of psychoanalysis, also came to the same conclusion. Two years later, in Studien über Hysterie, Breuer