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Horowitz describes a systematic effort to study stress response syndromes and their treatment. It is his purpose to make explicit some models for conceptualization and communication so that the complex phenomena involved can be open to further scientific exploration. Viewed in this perspective, the attempt can only be praised and, in some measure, elaborated by its reviewers, whatever their particular vantage point. In this review, I shall survey the content
of his thesis and then briefly discuss the use of psychoanalytic concepts in the work.
Early in the volume a case history of a traumatic neurosis is set forth to serve as a focus for discussion throughout the book. It is buttressed by descriptions of field observations of a variety of traumatic life events. Analogous studies from the experimental laboratory are described; these examine responses to film strips with traumatic and neutral content. Having thus confirmed the natural history of stress response syndromes, the author abstracts some general phases of response following a stressful event. They are: 1) an initial outcry, with the realization that the event has occurred; 2) a phase of denial and numbness; 3) intrusiveness of the traumatic content in a repetitive form in thought, emotion, and/or behavior; 4) working through, a phase of ideational and emotional processing of the traumatic content; and 5) completion, involving acceptance of the event and its implications, or the development of stable distortions, with a loss of the peremptory quality of denial and unbidden intrusive recall.
The author then shifts from a phenomenological to a dynamic approach, formulating explanatory models for the phases of denial and intrusion which are based on psychoanalytic theory and cognitive processing. The analytic explanation draws on parallel features of the stimulus barrier for perception and the repression barrier for memory. In both instances, a feedback loop serves to control entry for the sampling and