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In Wounded by Reality, Ghislaine Boulanger closes the circle on psychoanalytic speculation about the significance of trauma to personality, and goes beyond this to add significantly to both theory and clinical practice. Rado's 1925 paper on dismissing abreaction for understanding and treating the effects of adult onset trauma, with Freud's agreement, pushed the psychoanalytic gaze inward to memories of past trauma (Etchegoyen, 1991, p. 446). It was assumed that childhood trauma determined the reactions to later ones in adulthood. The very concept of trauma was diluted to include sudden hardship or confusion, leaving adult onset horror in an undifferentiated place on the continuum of human misfortune. In this book, there is no doubt. Adults are traumatized when they face imminent and seemingly inescapable death.
In keeping with the relationalist emphasis on the meaning of external events, especially interpersonal aspects of them, Boulanger returns us to the early perceptions that accompanied Freud's development of psychoanalysis. She takes us beyond this point, however, in demonstrating the difference between trauma suffered in childhood and suffered as an adult. In the child, with core ego structure still very much in the making, the ego creates mechanisms for isolating traumatic experience and growing around it. Adults frequently do not consciously remember traumas that beset them when they were children. In great contrast, when they are traumatized as adults, they characteristically and without surcease experience flashbacks, repetitive nightmares, and intrusive horrific images. “[T]raumatic experience is metabolized differently in children, where it is absorbed into different self states; whereas in adults the traumatic memory is not metabolized but often remains psychically indigestible” (p. 12). From disturbed functioning of the brain to disturbed access to ego strengths normally available to a person, Boulanger carefully details how totally adult onset trauma d