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As psychoanalysts we are most comfortable dealing with the kind of material we derive from our clinical practice: fantasies, conflicts, resistances, defenses, couched in familiar terms of classical formulations. However, our complacency is disturbed by patients who do not fit comfortably into these conceptions. Such difficulties have developed for me in trying to deal with a very large population of survivors of the Nazi Holocaust. Repeatedly, in my early publications, I despaired over the possibility of understanding the phenomena of the post-traumatic residues and the process of traumatization in terms of classical conceptions (Krystal, 1968, 1971).
Finding that I could not explain all the phenomena observed in survivors, particularly the concentration camp inmates, I proceeded to describe the findings, hoping that they would eventually add up to material by which the process of traumatization and recovery could be understood in greater depth and accuracy. I was finally able to formulate a concept of massive traumatization (1978a) that corresponded to what I had learned from my patients. In these formulations I tried to understand the common basis of their experience and to account for the occurrence of certain symptoms not previously explainable. Such post-traumatic pictures included alexithymia, inhibitions in the capacity for self-caring, anhedonia, continuation of extreme hypervigilance, depressive and masochistic patterns, as well as characteristic personality patterns.