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Dreyfuss considers the following factors of decisive importance in the causation of a traumatic neurosis: '1, a penetration of the "protective barrier" or ego; 2, introjection and fixation of the traumatic experience by means of 3, an early linking of such recent experiences with infantile traumatic material; 4, defusion of instincts resulting therefrom with consequent loss of genital primacy; 5, regression to pregenital, particularly anal-sadistic and oral levels of libidinal development'. He feels that the intensity of the trauma and the infantile predisposition (degree of libidinal fixation as the result of infantile traumata) are mutually complementary factors. However, at a later point a view is presented which seems to be somewhat different: 'The breaking through of the protective barrier is nothing but a break-through of infantile wishes, a retur n to the Oedipus situation… The shock itself is a "screen" experience wherein the danger of castration of the childhood period once more becomes actual and real.'
Two excellent case reports and an interesting short story by Jack London are given to illustrate the dynamics of traumatic neuroses. In a final section Dreyfuss discusses the question of whether the observable factors in such neuroses require the assumption of a primary death instinct, or whether they can be as well explained by the turning inward of aggression following the trauma. In the end he leaves the matter open, though it would seem that he leans toward the latter view.