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IN THIS PAPER I SHALL PRESENT THE CASE HISTORY OF A PATIENT suffering from a combat neurosis, whom I treated many years ago over a prolonged period of time. The patient presented a great number of diagnostic and therapeutic problems which were not easy to resolve. Similar issues have arisen with the emotional casualties of the current war in Vietnam and, it seems to me, are as puzzling to the therapist today as they were 30 years ago. It therefore
seemed timely to me to review, in connection with this case, the psychoanalytic literature on traumatic war neuroses.
In addition, this patient's life history illuminates several theoretical issues, only one of which I have singled out for detailed discussion, namely, the general problem of mastery. This case raises an especially interesting question—one that we also encounter in other deeply regressed patients whose functioning in one area of their lives not only has remained intact but is in fact unusually successful. Why this is so, I am unable to answer; but what my case demonstrates is the following: precisely the same ego functions, when applied to the one area of the patient's interest, were highly effective, while in all other areas they failed him.
The patient's birth was uneventful. It was his mother's second pregnancy, the first having terminated in a miscarriage. His mother had been apprehensive throughout her pregnancy with the patient because of this first loss. He was breast-fed for 10 months, weaned quickly and with no apparent difficulty. There were no feeding difficulties. Toilet training was begun at 6 m