Meetings of the New York Psychoanalytic Society

DISCUSSION: Dr. Phyllis Greenacre reviewed the psychoanalytic concept of trauma. She stated that one must specify whether traumatic events or experiences have occurred, when they occurred during development, and how sustained they were. Furthermore, in psychoanalysis the relationship of the biological to the psychological is ambiguous, and a dichotomy rather than a parallelism is assumed. Certain aspects of the earliest phases of development, the early ego and libido, are considered biological. Yet the requirements of psychoanalytic therapy set limits to our understanding the biological organism in view of the fact that therapy is carried on only via psychological means. Thus all of psychoanalytic theory is perforce weighted on the psychological side.

In her experience, severe early trauma so threatens the organism as to cause a total, organismic, survival response. The obligation to repeat is organismic and intermingled with instinctual satisfaction; reliving is an attempt at achieving better internal harmony. Early, severe, sustained trauma with its profound organismic reaction causes a disorganization of the developmental phase with regression, not progression as Dr. Lipin suggested. The trauma is denied in an archaic way. If too severe, death follows; if the trauma is survived and successfully overcome, a normal phase hierarchy ensues. Later, massive repetitions of the trauma are, however, masochistic phenomena. Patients in whom these early disturbances caused by the trauma are biologically rooted are not good cases for treatment because preverbal stages are not analyzable. The therapeutic alliance is hard to establish and then becomes intertwined with the transference and leads to 'acting out', while massive denials impede treatment.

Dr. Heinz Hartmann addressed himself to the relationship of observation to concept in the paper, and to the use of some of the terminology. The repetition compulsion is a construct, not a clinical entity; other repetiti