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Rosen succinctly presents material pertinent to the reconstruction of a traumatic event during the treatment,—which must have been a complicated and unusual psychotherapeutic undertaking,—of a professional man with marked feelings of derealization bordering on schizophrenia. Rather than feeling anxious, he had bizarre bodily sensations and often needed to deny reality. Reality was forced upon him when the doctor discontinued treatment because he did not pay his bills. After work resumed it was brought out that at age three he had witnessed his mother's attempted suicide by hanging. He cried dramatically at the recollection. There was steady progress in treatment thereafter.
The author believes that repression was not available to the patient as a child and adult, partly because the event had been denied by his parents, so that he defended himself against intense affect by the more primitive identification with the hanging mother. 'It is the repetition of this traumatically fixed defensive pattern which would be responsible for turning current threatening affects into somatic sensations, with the partial loss of object cathexes, which is experienced with each recurrence as the symptom complex of derealization.'
Rosen closes with a brief general discussion of reconstruction, suggesting that the phase of psychic development in the child as well as the neurosis of the significant parent at the time of the event influences the means of defense employed. This patient was at age three in a transitional state of ego development, when he was separating fantasy from reality. This, plus his parents' denial of the reality, influenced his choice of identification and derealization as defenses.