The focus here in on the idea that the traumatic neuroses represent an irruption of the Real into the Symbolic-Imaginary order which is brought about through the operation of the drive in its incessant ‘scraping’ of surplus jouissance from the Symbolic-Imaginary universe (the ‘external world’). This links closely to the idea of the jouissance of the body and Miller’s concept of the ‘jouissance One’. The difference between this theory and that espoused by what is described as the ‘PTSD paradigm’ lies in the fact that the theory of the traumatic neuroses provides a way to show how the drive and the ‘external world’ are intricately linked to one another, whereas the ‘PTSD paradigm’ maintains a clear demarcation between the ‘external’ and the ‘internal’. The chapter concludes by briefly discussing the question of whether traumatic neurosis should be considered a clinical structure in its own right.