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This is a unique presentation of detailed material from the analysis of a Vietnam veteran, and explores many issues of post-traumatic psychopathology. The thirty-seven-year-old patient entered analysis fifteen years after the war. Before the war he was reasonably well adjusted, but on his return he manifested somatic symptomatology; his old defenses had crumbled, interfering with love and work. There follows a sensitive reconstruction of many details of his war experiences, as well as childhood memories and transference re-enactments, leading to discovery of intense guilt over his own aggression in the war, and somatic identification with his victims.
There is discussion of the different theories of post-traumatic psychopathology, those emphasizing predisposition as determining the meaning of adult trauma, and those emphasizing predictable post-trauma pathology regardless of childhood fixations or conflicts. Here symbolic meanings of the event are seen as less relevant to the form of subsequent symptoms. The author's theoretical position and clinical material demonstrate a more complex multifactor model encompassing both points of view.