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Khan, M.R. (1963). The Concept of Cumulative Trauma. Psychoanal. St. Child, 18:286-306.

(1963). Psychoanalytic Study of the Child, 18:286-306

The Concept of Cumulative Trauma

M. Masud R. Khan

Every phase of theory-making in psychoanalysis has influenced the current concept of trauma and its clinical evaluation (Fenichel, 1937). I shall, somewhat arbitrarily, divide the total span of analytic researches into five stages. This is an artificial division to show what new ideas emerge at which stage. One stage does not cancel out the other. They run parallel, reinforcing and partially correcting each other, and each time a new strand is added to the growing complexity of psychoanalytic metapsychology.

In the first phase, 1885 to 1905, while Freud was postulating the basic concepts for the understanding of the unconsciousdream work, primary and secondary processes, the psychic apparatus, symptom formation, and the etiology of hysteria and obsessional neurosis—the concept of trauma played a very vital and significant role (Freud, 1893), (1895). Trauma was conceived of essentially as (a) an environmental factor that intrudes upon the ego and which the ego cannot deal with through abreaction or associative elaboration: "hysterical patients suffer from incompletely abreacted psychical trauma" (Freud, 1893); and (b) as a state of strangulated libidinal energy which the ego cannot discharge. The paradigm of this traumatic situation is sexual seduction. We have a vivid account by Freud himself (1887-1902, letter 69); (also 1914b) and by Jones describing (1953) how frustrated and demoralized Freud felt when he discovered that these traumatic events of seduction had never actually happened. During this phase the corresponding theory of anxiety is: "Neurotic anxiety is transformed sexual libido" (Freud, 1897). The chief defense mechanism discussed is repression.

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