Excerpts from Must Read Books & Articles on Mental Health Topics
Articles- Part XXI

Sigmund Freud (1917)

I will say at once that it is not an intellectual difficulty I am thinking of, not anything that makes psycho-analysis hard for the hearer or reader to understand, but an affective one--something that alienates the feelings of those who come into contact with it, so that they become less inclined to believe in it or take an interest in it. As will be observed, the two kinds of difficulty amount to the same thing in the end. Where sympathy is lacking, understanding will not come very easily.
      My present readers, I take it, have not so far had anything to do with the subject and I shall be obliged, therefore, to go back some distance. Out of a great number of individual observations and impressions something in the nature of a theory has at last shaped itself in psycho-analysis, and this is known by the name of the `libido theory'. As is well known, psycho-analysis is concerned with the elucidation and removal of what are called nervous disorders. A starting-point had to be found from which to approach this problem, and it was decided to look for it in the instinctual life of the mind. Hypotheses about the instincts in man came to form the basis, therefore, of our conception of nervous disease.
     Psychology as it is taught academically gives us but very inadequate replies to questions concerning our mental life, but in no direction is its information so meagre as in this matter of the instincts.
     It is open to us to make our first soundings as we please. The popular view distinguishes between hunger and love, as being the representatives of the instincts which aim respectively at the preservation of the individual and at the reproduction of the species. We accept this very evident distinction, so that in psycho-analysis too we make a distinction between the self-preservative or ego-instincts on the one hand and the sexual instincts on the other. The force by which the sexual instinct is represented in the mind we call 'libido'--sexual desire--and we regard it as something analogous to hunger, the will to power, and so on, where the ego-instincts are concerned.
     With this as a starting-point we go on to make our first important discovery. We learn that, when we try to understand neurotic disorders, by far the greater significance attaches to the sexual instincts; that in fact neuroses are the specific disorders, so to speak, of the sexual function; that in general whether or not a person develops a neurosis depends on the quantity of his libido, and on the possibility of satisfying it and of discharging it through satisfaction; that the form taken by the disease is determined by the way in which the individual passes through the course of development of his sexual function, or, as we put it, by the fixations his libido has undergone in the course of its development; and, further, that by a special, not very simple technique for influencing the mind we are able to throw light on the nature of some groups of neuroses and at the same time to do away with them. Our therapeutic efforts have their greatest success with a certain class of neuroses which proceed from a conflict between the ego-instincts and the sexual instincts. For in human beings it may happen that the demands of the sexual instincts, whose reach of course extends far beyond the individual, seem to the ego to constitute a danger which threatens its self-preservation or its self-esteem. The ego then assumes the defensive, denies the sexual instincts the satisfaction they desire and forces them into those by-paths of substitutive satisfaction which become manifest as nervous symptoms.
     The psycho-analytic method of treatment is then able to subject this process of repression to revision and to bring about a better solution of the conflict--one that is compatible with health. Unintelligent opposition accuses us of one-sidedness in our estimate of the sexual instincts. `Human beings have other interests besides sexual ones,' they say. We have not forgotten or denied this for a moment. Our one-sidedness is like that of' the chemist, who traces all compounds back to the force of chemical attraction. He is not on that account denying the force of gravity; he leaves that to the physicist to deal with.
     During the work of treatment we have to consider the distribution of the patient's libido; we look for the object-presentations to which it is bound and free it from them, so as to place it at the disposal of the ego. In the course of this, we have come to form a very curious picture of the original, primal distribution of libido in human beings. We have been driven to assume that at the beginning of the development of the individual all his libido (all his erotic tendencies, all his capacity for love) is tied to himself--that as we say, it cathects his own ego. It is only later that, being attached to the satisfaction of the major vital needs, the libido flows over from the ego on to external objects. Not till then are we able to recognize the libidinal instincts as such and distinguish them from the ego instincts. It is possible for the libido to become detached from these objects and withdrawn again into the ego.
      The condition in which the ego retains the libido is called by us `narcissism', in reference to the Greek legend of the youth Narcissus who was in love with his own reflection.  Thus in our view the individual advances from narcissism to object-love. But we do not believe that the whole of the libido ever passes over from the ego to objects. A certain quantity of libido is always retained in the ego; even when object-love is highly developed, a certain amount of narcissism persists. The ego is a great reservoir from which the libido that is destined for objects flows out and into which it flows back from those objects. Object-libido was at first ego-libido and can be transformed back into ego-libido. For complete health it is essential that the libido should not lose this full mobility. As an illustration of this state of things we may think of an amoeba, whose viscous substance puts out pseudopodia, elongations into which the substance of the body extends but which can be retracted at any time so that the form of the protoplasmic mass is restored.
     What I have been trying to describe in this outline is the libido theory of the neuroses, upon which are founded all our conceptions of the nature of these morbid states, together with our therapeutic measures for relieving them. We naturally regard the premises of the libido theory as valid for normal behaviour as well. We speak of the narcissism of small children, and it is to the excessive narcissism of primitive man that we ascribe his belief in the omnipotence of his thoughts and his consequent attempts to influence the course of events in the external world by the technique of magic.
     After this introduction I propose to describe how the universal narcissism of men, their self-love, has up to the present suffered three severe blows from the researches of science.
     (a) In the early stages of his researches, man believed at first that his dwelling-place, the earth, was the stationary centre of the universe, with the sun, moon and planets circling round it.
In this he was naively following the dictates of his sense perceptions, for he felt no movement of the earth, and wherever he had an unimpeded view he found himself in the centre of a circle that enclosed the external world. The central position of the earth, moreover, was a token to him of the dominating part played by it in the universe and appeared to fit in very well with his inclination to regard himself as lord of the world.
     The destruction of this narcissistic illusion is associated in our minds with the name and work of Copernicus in the sixteenth century. But long before his day the Pythagoreans had already cast doubts on the privileged position of the earth, and in the third century B.C. Aristarchus of Samos had declared that the earth was much smaller than the sun and moved round that celestial body. Even the great discovery of Copernicus, therefore, had already been made before him. When this discovery achieved general recognition, the self-love of mankind suffered its first blow, the cosmological one.
     (b) In the course of the development of civilization man acquired a dominating position over his fellow-creatures in the animal kingdom. Not content with this supremacy, however, he began to place a gulf between his nature and theirs. He denied the possession of reason to them, and to himself he attributed an immortal soul, and made claims to a divine descent which permitted him to break the bond of community between him and the animal kingdom. Curiously enough, this piece of arrogance is still foreign to children, just as it is to primitive and primaeval man. It is the result of a later, more pretentious stage of development. At the level of totemism primitive man had no repugnance to tracing his descent from an animal ancestor. In myths, which contain the precipitate of this ancient attitude of mind, the gods take animal shapes, and in the art of earliest times they are portrayed with animals' heads. A child can see no difference between his own nature and that of animals. He is not astonished at animals thinking and talking in fairy-tales; he will transfer an emotion of fear which he feels for his human father onto a dog or a horse, without intending any derogation of his father by it. Not until he is grown up does he become so far estranged from animals as to use their names in vilification of human beings.
     We all know that little more than half a century ago the researches of Charles Darwin and his collaborators and forerunners put an end to this presumption on the part of man. Man is not a being different from animals or superior to them; he himself is of animal descent, being more closely related to some species and more distantly to others. The acquisitions he has subsequently made have not succeeded in effacing the evidences, both in his physical structure and in his mental dispositions, of his parity with them. This was the second, the biological blow to human narcissism.
     (c) The third blow, which is psychological in nature, is probably the most wounding. Although thus humbled in his external relations, man feels himself to be supreme within his own mind. Somewhere in the core of his ego he has developed an organ of observation to keep a watch on his impulses and actions and see whether they harmonize with its demands. If they do not, they are ruthlessly inhibited and withdrawn. His internal perception, consciousness, gives the ego news of all the important occurrences in the mind's working, and the will, directed by these reports, carries out what the ego orders and modifies anything that seeks to accomplish itself spontaneously. For this mind is not a simple thing; on the contrary, it is a hierarchy of superordinated and subordinated agencies, a labyrinth of impulses striving independently of one another towards action, corresponding with the multiplicity of instincts and of relations with the external world, many of which are antagonistic to one another and incompatible. For proper functioning it is necessary that the highest of these agencies should have knowledge of all that is going forward and that its will should penetrate everywhere, so as to exert its influence. And in fact the ego feels secure both as to the completeness and trustworthiness of the reports it receives and as to the openness of the channels through which it enforces its commands.
     In certain diseases--including the very neuroses of which we have made special study--things are different. The ego feels uneasy; it comes up against limits to its power in its own house, the mind. Thoughts emerge suddenly without one's knowing where they come from, nor can one do anything to drive them away. These alien guests even seem to be more powerful than those which are at the ego's command. They resist all the well-proved measures of enforcement used by the will, remain unmoved by logical refutation, and are unaffected by the contradictory assertions of reality. Or else impulses appear which seem like those of a stranger, so that the ego disowns them; yet it has to fear them and take precautions against them. The ego says to itself: `This is an illness, a foreign invasion.' It increases its vigilance, but cannot understand why it feels so strangely paralysed.
     Psychiatry, it is true, denies that such things mean the intrusion into the mind of evil spirits from without; beyond this, however, it can only say with a shrug: `Degeneracy, hereditary disposition, constitutional inferiority!' Psycho-analysis sets out to explain these uncanny disorders; it engages in careful and laborious investigations, devises hypotheses and scientific constructions, until at length it can speak thus to the ego:
     'Nothing has entered into you from without; a part of the activity of your own mind has been withdrawn from your knowledge and from the command of your will. That, too, is why you are so weak in your defence; you are using one part of your force to fight the other part and you cannot concentrate the whole of your force as you would against an external enemy. And it is not even the worst or least important part of your mental forces that has thus become antagonistic to you and independent of you. The blame, I am bound to say, lies with yourself. You over-estimated your strength when you thought you could treat your sexual instincts as you liked and could utterly ignore their intentions. The result is that they have rebelled and have taken their own obscure paths to escape this suppression; they have established their rights in a manner you cannot approve. How they have achieved this, and the paths which they have taken, have not come to your knowledge. All you have learned is the outcome of their work--the symptom which you experience as suffering. Thus you do not recognize it as a derivative of your own rejected instincts and do not know that it is a substitutive satisfaction of them.
     `The whole process, however, only becomes possible through the single circumstance that you are mistaken in another important point as well. You feel sure that you are informed of all that goes on in your mind if it is of any importance at all, because in that case, you believe, your consciousness gives you news of it. And if you have had no information of something in your mind you confidently assume that it does not exist there. Indeed, you go so far as to regard what is "mental" as identical
with what is "conscious"--that is, with what is known to you--in spite of the most obvious evidence that a great deal more must constantly be going on in your mind than can be known to your consciousness. Come, let yourself he taught something on this one point! What is in your mind does not coincide with what you are conscious of; whether something is going on in your mind and whether you hear of it, are two different things. In the ordinary way, I will admit, the intelligence which reaches your consciousness is enough for your needs; and you may cherish the illusion that you learn of all the more important things. But in some cases, as in that of an instinctual conflict such as I have described, your intelligence service breaks down and your will then extends no further than your knowledge. In every case, however, the news that reaches your consciousness is incomplete and often not to be relied on. Often enough, too, it happens that you get news of events only when they are over and when you can no longer do anything to change them. Even if you are not ill, who can tell all that is stirring in your mind of which you know nothing or are falsely informed? You behave like an absolute ruler who is content with the information supplied him by his highest officials and never goes among the people to hear their voice. Turn your eyes inward, look into your own depths, learn first to know yourself! Then you will understand why you were bound to fall ill; and perhaps, you will avoid falling ill in future.'
     It is thus that psycho-analysis has sought to educate the ego. But these two discoveries--that the life of our sexual instincts cannot be wholly tamed, and that mental processes are in themselves unconscious and only reach the ego and come under its control through incomplete and untrustworthy perceptions--these two discoveries amount to a statement that the ego is not master in its own house. Together they represent the third blow to man's self-love, what I may call the psychological one. No wonder, then, that the ego does not look favourably upon psycho-analysis and obstinately refuses to believe in it.
     Probably very few people can have realized the momentous significance for science and life of the recognition of unconscious mental processes. It was not psycho-analysis, however, let us hasten to add, which first took this step. There are famous philosophers who may be cited as forerunners--above all the great thinker Schopenhauer, whose unconscious `Will' is equivalent to the mental instincts of psycho-analysis. It was this same thinker, moreover, who in words of unforgettable impressiveness admonished mankind of the importance, still so greatly under-estimated by it, of its sexual craving. Psycho-analysis has this advantage only, that it has not affirmed these two propositions which are so distressing to narcissism--the psychical importance of sexuality and the unconsciousness of mental life --on an abstract basis, but has demonstrated them in matters that touch every individual personally and force him to take up some attitude towards these problems. It is just for this reason, however, that it brings on itself the aversion and resistances which still hold back in awe before the great name of the philosopher.

Fantasy, Memory and Reality Testing
Jacob A. Arlow, M.D. (1968)

Reality testing, one of the most important of the functions of the ego, is relatively easy to define but quite difficult to comprehend. It is part of a conglomerate of ego functions which include such activities as perception, memory, object relations, sense of reality, superego, and the more recently discussed concept of reality constancy (19).
     As used in psychoanalysis, reality testing refers to the ability to distinguish between perceptions and ideas. It is quite different from the philosopher's concept of the nature of reality. As defined in analytic terms, emphasis is placed upon the differentiation between representations of what is external--of the object world--from representations of what is internal--of the self or of mental life. The feeling of reality is not necessarily a part of perceptual experience. It does not have the sense of immediacy that characterizes consciousness. There is nothing in the quality of the perceptual experience which makes it apparent at once whether a mental representation is external or internal, real or unreal. An additional mental function, perhaps a set of mental functions, have to be called upon in order to make this decision. This operation has to be applied to all data registered at that station of mental experience that we call awareness.
     A great deal has already been learned concerning how the function of reality testing develops but much still remains to be understood. Reality testing develops gradually. The early stages of this process are particularly difficult to study. In addition to the maturation of the essential ego apparatuses, the vicissitudes of development are very important. All workers in the field see the development of reality testing as a gradual evolution in the child from an attitude toward the world which is self-centered, pleasure seeking, animistic, and magical, to a later capacity to differentiate between inner fantasy and objective reality (9, 12, 29).
     There is yet another dimension to reality testing. According to Hartmann (20) it consists of the ability to discern subjective and objective elements in our judgment of reality. Learning to do this is an unending process. Essentially this is the principal task which the analyst poses to his patient. He helps the patient to delineate in his assessment of and response to reality the contribution made by inner, subjective pressures from the past. In this paper I hope to demonstrate that how reality is experienced depends for the most part on the interaction between the perceptions of the external world and the concomitant effect of unconscious fantasy activity.

      The perceptions of reality are sensed against the background of individual experience. Memory, recording conflicts, traumata, vicissitudes of the drives and of development are organized in terms of the pleasure-unpleasure principle into groups of schemata centering around childhood wishes. These make up the contents of a continuous stream of fantasy thinking, which is a persistent concomitant of all mental activity and which exerts an unending influence on how reality is perceived and responded to.
     How can one describe in functional terms the interplay of these forces? It is as if the perceptual apparatus of the ego were operating at the same time in two different directions. One part of it looks outward, responding to the sensory stimuli of the external world of objects. The other part looks inward, reacting to a constant stream of inner stimulation. The organized mental representations of this stream of inner stimulation is what I call fantasy thinking. It includes fantasies and the memory schemata related to the significant conflicts and traumatic events of the individual's life. Fantasy thinking may be conscious or unconscious. It is a constant feature of mental life. It persists all the time that we are awake and most of the time we are asleep.
     The data or contents of our fantasy thinking become known to us through the process of introspection. There is no direct antonym to the word introspection which we could conveniently juxtapose to it and then apply to the process of perception of stimuli from the external world. Etymologically exterospection would be correct but it seems an awkward term. Traditional usage refers metaphorically to the functional separation of these two concomitant orientations of perception in terms of the inner eye and the outer eye.
     How does the external perceptual apparatus of the mind function? According to Freud (16) so long as there is consciousness all external sensory stimuli are passively and indiscriminately received. He states: '. . . cathectic innervations are sent out and withdrawn in rapid periodic impulses from within into the completely pervious system Pcpt. Cs. So long as that system is cathected in this manner, it receives perceptions (which are accompanied by consciousness) and passes the excitation on to the unconscious mnemic systems; but as soon as the cathexis is withdrawn, consciousness is extinguished and the functioning of the system comes to a standstill. It is as though the unconscious stretches out feelers, through the medium of the system Pcpt.-Cs., towards the external world and hastily with. draws them as soon as they have sampled the excitations coming from it' (p. 231). In another publication written in the same year as the one just quoted, Freud (17) returns to the subject but this time he states that the cathectic energy innervating the perceptual system originates in the ego. From the context of the two different quotations it would appear that in the former he was concerned with the utilization of the perceptual apparatus in the service of the pleasure dominated unconscious wishes; in the latter he was concerned with the ego function of judgment achieving mastery over repression and at the same time achieving independence from the rule of the pleasure principle.
     The data of perception are not experienced in isolation. They are experienced against the background of the individual's past development and are checked against earlier perceptions and the memory traces which they have left. Stimuli are selectively perceived in terms of the mental set operative in the individual at the time. The mental set is determined both consciously and unconsciously, consciously by the nature of the task before the individual, unconsciously by the cathectic level of the dominant unconscious fantasy system. Percepts become meaningful almost immediately as they are perceived because they are compared with other data and integrated into memory schemata.
     Certain aspects of the development of this process were carefully studied by Freud (17). He wrote that at the beginning the essential task of judgment, as far as reality testing is concerned, is to determine whether something which is present in the ego as an image can be rediscovered in perception (reality) as well. The process of reality testing develops this way, he says, because 'all presentations originate from perceptions and are repetitions of them. Thus originally the mere existence of a presentation was a guarantee of the reality of what was presented. The antithesis between subjective and objective does not exist from the first. It only comes into being from the fact that thinking possesses the capacity to bring before the mind once more something that has once been perceived, by reproducing it as a presentation without the external object having still to be there. The first and immediate aim, therefore, of reality testing is, not to find an object in real perception which corresponds to the one presented, but to refind such an object, to convince oneself that it is still there' (pp. 237-238).
     It would seem that this would be a simple enough task for the mind; but this is far from the fact. As Freud noted, the reproduction of a perception as an image--in other words, how we recall parts of our experience--is not always a faithful one; it can be modified by omissions or by the fusion of a number of elements. The process of testing a thing's reality must then investigate the extent of these distortions. If one cannot be sure that the image (or set of images) that he is trying to rediscover
in the form of a perception (of reality) actually corresponds to the earlier perceptions which the image supposedly reflects, reality testing becomes difficult indeed.
     The most powerful influence distorting the image of the past and contributing to the misperception of the present is the intrusion of unconscious fantasy thinking. During our busy wakeful life, dominated by the reality principle, we are only intermittently aware of the persistent intrusion into our conscious experience of elements of fantasy thinking. Nevertheless the stream of perceptual data from the external world which passes before the outer eye is paralleled by a stream of perceptual data from the inner world which passes before the inner eye. Although Freud wrote often about the process of exteroception (Pctp.Cs.) he said little about the so-called endopsychic observer. Perhaps he took it for granted that psychoanalysts, so fully involved in their own and in their patients' introspection, required little instruction in this area. His description of the process of free association as given in the Introductory Lectures is probably his most definitive statement on the subject. What the patient does while associating freely on the couch is compared to a train traveler looking out of the window and reporting as much as he is able to of the scenes flashing by his view. There is much more that he notices than he reports but he does the best he can. Free association in the analytic situation, it should be emphasized, corresponds to the reporting aspect of the experience. The really significant part of the analytic situation is the concentration of attention on the process of introspection, that is, the creation of a set of conditions that minimize the contribution of the external world and enhance the emergence of derivatives of the inner world--the world of fantasy thinking (3, 8).
     Because dreams are perhaps the richest and clearest expression of fantasy thinking and because dreams are part of the experience of sleep, several authors have linked the emergence of daydreams, fantasies, and other regressive, visually experienced phenomena with alterations in the state of consciousness resembling sleep. Lewin (27) says: 'Psychoanalysts are now aware that subtle signs of the sleeping state may be intermingled with thinking, particularly in free association, but in general and in "nature" also, so as to say, even when there is no conscious somnolence'. He supports his statement with a quotation from Kubie (24): 'We are never really totally awake or totally asleep. These are relative and not absolute terms. Parts of us are asleep in our waking moments and parts of us are awake in our sleeping moments, and in between lie all the gradations of states of activity and inactivity.'
     One can hardly take issue with Kubie's statement; however, Lewin's formulation seems to beg the question, inasmuch as from the outset his statement defines sleep in terms of dreaming. It does not follow that because when we are asleep, we dream, that when we dream (or daydream or have other similar, related experiences), we are asleep. I emphasize this point because clinical experience demonstrates how daydreaming may intrude upon the conscious experience of the individual at all levels of wakefulness and somnolence. In a previous contribution (s) I dealt with the ubiquitous intrusion of daydreaming activity into conscious experience, under circumstances which Lewin would say corresponded to the state of 'nature'. Several clinical experiences were cited from the daily lives of patients. In some of these experiences while the patients were alert and vigorously involved in reality oriented activity, their judgment of reality and their response to it was completely distorted by the intrusion of an unconscious fantasy. Actually this kind of distortion is one of the essential features of the neurotic process and of the transference. Aphoristically we may describe the state of mind in such patients by stating that while the outer eye was perceiving quite accurately the sensory stimuli from reality, the inner eye was focused on a fantasy. The response of the patient was appropriate enough, not in terms of reality, but in terms of the inner, unconscious fantasy.
This is the approach we use all the time in connection with neurotic symptoms. We understand our patients' anxiety not in terms of the realistic situation, but as a misperception of reality in terms which are appropriate for the contents of the unconscious fantasy. It would seem difficult to maintain that every time a neurotic patient experiences a symptom he is undergoing an alteration in the state of consciousness. In some instances alterations in the state of consciousness do occur, but they represent the effect of and not the cause for the emergence of an unconscious fantasy. I have presented material previously describing how in certain distortions of the sense of time (1), in the deja vu experience (2), and in states of depersonalization (6), the state of consciousness and/or the experiencing of reality were altered in consequence of the defensive needs of the ego resulting from the pressure of an emerging fantasy. To return to Lewin's statement, it would seem that it is not the subtle signs of sleep that we perceive intermingled in our thinking, but the subtle evidence of the intrusion of fantasy thinking.
     These considerations are pertinent to the initiation of the anxiety signal. When the ego becomes aware of the threatening development of the danger situation associated with the emergence of an instinctual demand, it institutes the signal of anxiety to stimulate the function of defense. How does the ego become aware of the threatening danger? What data does it use to reach such a conclusion? My answer would be: from the data of introspection, from the perception, mostly outside of consciousness, of the contents of the stream of fantasy thinking. Introspection of fantasy thinking provides the data leading to the conclusion that a danger may develop and the individual then begins to feel anxious. In this last instance, the endopsychic observer (Descarte's res cogitans which Lewin [26] has so brilliantly and wittily elucidated for us) acts like an internal psychoanalyst, observing the stream of fantasy thinking and making an interpretation for himself before the disturbing material appears in undisguised, panic-provoking form. The interrelation of the successive contents in the stream of unconscious fantasies under those circumstances would resemble that of certain sequences of dreams with which we are familiar. I refer to those series of dreams where each one conveys the same instinctual wish, one dream following another, the manifest content of each dream progressively less disguised and less distorted than the previous one, until the final dream appears--a dream with manifest content so distressingly close to the dangerous unconscious wish that panic develops, sleep is broken off, and the patient awakens as from a nightmare.
     Free association in the psychoanalytic situation represents an artificial method for tapping samples of the constantly flowing stream of fantasy activity. There are however natural, spontaneous sources of information concerning what is contained in fantasy thought. Children daydream frequently, vividly, and often report them openly. Many retain this capacity into adult life. Freud (14) called the primitive, self-centered world of daydreams the individual's secret rebellion against reality and against the need to renounce pleasurable instinctual gratification. Masturbation fantasies are a particularly striking example of vividly experienced daydreaming associated with instinctual gratification. Creative people are particularly perceptive of their fantasy thinking. Many retain a capacity for vivid visual daydreaming to a remarkable degree.
     Young children regularly intermingle their perceptions of reality with wishful fantasy thinking and sometimes find it hard to distinguish in recollection between what was real and what was imagined--between what constituted fantasy and what constituted accurate memory. The intensely visual nature of children's fantasies endows them with a quality of verisimilitude. As the individual grows older and reality increases its domain at the expense of the pleasure principle, visual daydreams and visual memories become fewer. There are notable exceptions, some of which have been referred to above.
     Most adults probably have explicit, conscious fantasies many times during the day only to forget them as promptly as they do night dreams--and for the same reasons. The experience of being an analysand provides the conditions, the training, and the motivation to take note of the fleeting fantasy thoughts and to hold them fast, long enough to examine them. The constant inner stream of fantasy thinking nevertheless produces many derivatives which present themselves, often unexpectedly, to the inner eye of introspection. In fleeting thoughts, misperceptions, illusions, metaphors of speech and action, the analyst can detect the influence of unconscious fantasy. As I have suggested, the aesthetic effectiveness of metaphor in literature is derived in large measure from the ability of metaphorical expression to stimulate affects associated with widely entertained, communally shared, unconscious fantasies (5). Roheim (31) said that the mythology of a people is an indicator of their dominant psychological conflicts. Mythology thus is a culturally organized, institutional form of communal daydreaming (3). The same is clearly true of many aspects of religious and artistic experience. A person's favorite joke or the kind of humor he generally prefers usually leads directly to the nature of his fantasy thinking inasmuch as every instinctual fixation is represented at some level of mental life in the form of a group of associated unconscious fantasies (cf. Ref. 34).
     Evidence of the subtle intermingling of fantasy thinking with the perception of everyday reality may take the most subtle of forms and may be overlooked if one is not alert to its operation. Two examples will illustrate what I mean. In a session during which he was working through certain memories and fantasies connected with the primal scene, a patient mentioned quite in passing--or at least so it seemed--that he had seen a former professor of his, a respected and friendly father. figure. He had wanted to approach this man and greet him but, for reasons which he could not understand, felt extremely inhibited and failed to do so. The patient went on to say: 'Perhaps it was because Professor X was busy at the time putting on his galoshes. It would be an awkward time to disturb him.' Or another patient, a woman, one of a set of identical twins whose fantasy thinking was dominated by impulses of hostility and competition toward her sibling, impulses which were fought
out in the inner vision of her mind on the intrauterine battlefield. She reported: 'While I was cleaning out the closet and getting rid of a lot of junk, I remembered a dream I had the night before'. The patient went on to relate the dream which concerned an underwater struggle in a diving bell with a shark which threatened to devour her. In both patients, reality was metaphorically perceived in terms of fantasy thinking. In other words, disturbing a man putting on his galoshes was like interfering with a person having intercourse; emptying junk out of a closet in reality was in fantasy killing a rival in a claustrum. The adventitious words describing the realistic setting in which introspective data are perceived exemplify this process in daily analytic work. Like the comments which a patient makes about the form or structure of a dream, these adventitious comments may be considered part of the inner fantasy. Thus if a patient says: 'As I stepped into the elevator, or as I entered the door of the building, I had the following thought', the analyst should be alerted to the possible intrusion of some fantasy about penetration of the body or incorporation into it. Similarly if the patient introduces some idea with a statement: 'While I was in the bus', he may be introducing thereby a fragment of a fantasy of pregnancy or of being within a claustrum.
     This constant intermingling of fantasy and perception helps make it clear why memory is so unreliable, especially memories from childhood, because in childhood the process of intermingling perception and fantasy proceeds to a very high degree. Klein (22) and Joseph (21) in recent contributions have called attention to the many problems concerning the function of memory which remain to be solved. What is forgotten and what is remembered? What can and what cannot be recalled? Just where in the therapeutic process do we place the recollection or retrieval of the memory of a childhood experience? How does a patient come to have a sense of conviction, a feeling about the reality of a childhood experience which is reconstituted by way of reconstruction, reconstruction which utilizes primarily the data available from screen memories? Both Klein and Joseph, following Hartmann (20), call attention to the need to redefine some of these problems in terms of the structural theory. Joseph in particular stresses the importance of approaching these problems from the point of view of the defense function of the ego.

      In reviewing the early literature of the subject, I was struck by the fact that there were many more references to forgetting than to remembering. Sometimes the only reference to be found under memory was 'See Amnesia'. The juxtaposition of memory to amnesia was of course a major element in the topographic theory based, as it was, on the essential dichotomy of mental contents into what could and could not be remembered. This led to some interesting formulations which, superficially viewed, seem like amusing paradoxes. For example, the hysteric whose problem is amnesia suffers mainly from reminiscences. He cannot recall the important events which shaped his life, yet his recollections are characterized by a 'wonderful freshness of memory'.
     The resolution of this paradox is contained, of course, in Freud's early paper on screen memories (13). Like so many of Freud's ideas, the ideas contained in that paper have to be rediscovered periodically. If we review that classic paper in the light of our present knowledge we can understand screen memories as an exquisite example of the mingling of fantasy with perception and memory, the raw material for the construction of the screen memories originating from many periods of the individual's life disguised and rearranged in keeping with the defensive needs of the ego. The same principles we understand today operate in the construction of dreams, fantasies, and in what Kris (23) has called the 'personal myth'. We can thus amend Freud's original statement to read that the recognition of how the ego operates in the service of defense tends to diminish the distinction between memory and fantasy. Freud goes on to say: 'It may indeed be questioned whether we have any memories at all from our childhood: memories relating to our childhood may be all that we possess. Our childhood memories show us our earliest years not as they were but as they appeared at the later periods when the memories were aroused. In these periods of arousal ... memories did not ... emerge; they were formed at that time. And a number of motives, with no concern for historical accuracy, had a part in forming them, as well as in the selection of the memories themselves' (13, p. 322).
     In the context of intrapsychic conflict, the ego integrates drives, defense, memory, fantasy, and superego in keeping with the principle of multiple function (33). What we think was real, or what we think really happened, is a combination or intermingling of fantasy with perception of reality. When memory and perception offer material which is in consonance with fantasy thinking, the data are selectively perceived and the memories are selectively recalled and used as material to serve as a vehicle for the unconscious fantasy. When we are able to undo the defensive distortion which the ego has imposed upon the material, we can see that the fantasy contains the kernel of what really happened. This is not the objective reality which can be observed by outsiders and validated consensually. This is almost impossible to recollect because what the child experiences is at the very moment of experience a complex intermingling of perception and fantasy. This complex intermingling is what 'really' happened as far as the individual is concerned. Only through the process of inference can the analyst sometimes elucidate from the material that part of the individual's recollection which belongs to objective history, as it were, as opposed to the patient's personal 'mythological' past.

     I would like to illustrate my point by citing a reconstruction of the past based upon the interpretation of a fantasy. There is nothing particularly unusual or striking about this example. Every experienced analyst will recall many similar instances from his own practice. For purposes of discretion certain details have been changed and displaced, but the essential features of the material, namely, the relationship of the interpretation to the data, has not been altered in any significant way.
     This material is taken from the case of a male adult who spent several years of his early childhood, perhaps as many as three, possibly four, in his parents' bedroom. Except for some few peripheral or tangential memories like the sounds of neighbors quarreling, the patient could remember nothing of the events in the bedroom. However, his life story, his character formation, the symptoms which he developed, the nature of the transference, and how he behaved toward his children during their oedipal phase all bore more than ample testimony of how deeply he had been affected by this early experience.
     He developed into a pseudo-imbecilic 'detective'. He noticed nothing but knew everything. He was constantly looking but never seeing. What he could not remember, he kept repeating. In all sorts of 'innocent' ways he managed to stumble upon and interfere with couples engaged in private activities. A constant trend which appeared in dreams, fantasies, and sometimes in real life behavior contained the elements of disturbing a performance or a spectacle in which a father image was figuring in a prominent and successful role. His favorite joke was about a famous Shakespearean actor whose successful performance was ruined by absurd and obscene requests originating from some obscure member of the audience sitting in the back stalls of the balcony.
     The privacy of the analytic twosome accordingly was highly consonant, one could say congruent, with elements in his fantasy life. As analysts we understand that external, realistic elements which are consonant with fantasy elements are selectively perceived and seem to have the capacity to intensify the cathectic pressure of unconscious fantasy. Under these circumstances the fantasies tend to come to the fore in the sense that they produce more and clearer mental derivatives or propel the individual toward some form of action. In this respect their dynamic thrust resembles the role of the day residue in dream formation. Day residues are selected for inclusion in dreams not so much because of their neutral, inconspicuous nature as for the fact that they are congruent with or reminiscent of certain important fantasies or memory schemata. There is, accordingly, a reciprocal interplay between reality and fantasy, selective perception on one side, cathectic intensification on the other. For our pseudo-imbecilic detective therefore the analytic situation, one could say, was made to order.
     During the period when we were working on the problem of oedipal rivalry as it came up in the transference and in connection with his son, the patient reported the following fantasy:

I had a fantasy that I came for my session and headed toward the couch. You were annoyed with my behavior in the analysis and decided to terminate treatment. I wanted to go to the couch but you waved me to the chair and told me that the treatment was over. I objected violently. I became very angry. I rushed to the couch, laid down and said I would not budge. You decided that if I did not move you would call the police to remove me. Your next patient was around. You told her to wait. You would go on with her as soon as you got rid of me. In the fantasy you were also frightened. You thought that I could get away from the police and come back to get you.

The key to the understanding of the fantasy came in the first associations which dealt with the theme of reversal of roles, the patient taking the analyst's role, the analyst becoming the patient. Other associations concerned the sexualization of the analytic situation, the couch as a bed, the attractive woman patient as an object of our competitive rivalry, three people in a room where only two should be, biding one's time until one gets rid of a rival, how weak and helpless people need the police in situations where their own physical force is insufficient.
     By invoking the principle of dream interpretation concerning opposites, the fantasy could be explored as a reversal. With the knowledge of the previous material, of the transference situation, and of the associations, this fantasy could be interpreted first in terms of the transference and then much more meaningfully as a reconstruction concerning the past. At the level of transference the patient is angry and jealous. He wishes to get rid of me but I cling to my possessions. He will use greater force, throw me out, and claim my position, my office, and the attractive woman patient as a special prize. As a reconstruction of the past, the interpretation could be quite precise because of the unusually rich material. The patient in his parents' bedroom had awakened from sleep and tried in various ways, or perhaps many times, to get his father to abandon the bed, hopefully for good. But the father persisted in returning to his bed and there was very little that the weak and small oedipus could do. If only he could call the police or perhaps some criminals. They are stronger, they would get rid of father, take him away, and the little boy could enjoy mother for himself. Of course father is strong. He could get away. He would be very angry. He could return and punish the little boy. (The patient's childhood neurosis consisted of a fear of criminals who might intrude during the night and kidnap or injure him.) The interpretation was confirmed at the next session in a dream which recapitulated all the events mentioned above and carried the reconstruction further by introducing the element of relations with the mother and giving her a child.
     What can we say about this fantasy and the reconstruction built on it? What was real in the sense that it actually happened and what was unreal in the sense that it was only imagined? Distracting the father, calling him from his bed, a temper tantrum, perhaps, and the father returning and persisting in possession of his bed and his mate--these are all events which possibly could have happened and presumably did happen. The calling of the police (or the robbers) assuredly did not happen.
The appreciation of the role of police or the significance of kidnaping may even date from a later period. Whether at any time the patient overtly expressed to his mother the classical oedipal wishes is hard to say. Probably he did. Yet in the fantasy, all elements are given equal weight in a well-integrated story that seems consistent, logical, and realistic, if not probable. The point is that the intermingling of real events, real perceptions with the elements of fantasy and wishful thinking
must correspond quite closely to what the patient actually experienced as a child at the time. External perception and internal fantasy were intermingled at the time of the experience and together they formed the reality which to the patient was the record of his past. It was upon this confused fantasy thinking, which was dynamically effective in influencing so many aspects of his life, that the inner eye of the patient remained consistently focused.
     This is what I think is the proper understanding of the concept 'psychic reality'. It is not a fantasy that is taken for the real truth, for an actual event, but the 'real' recollection of a psychic event with its mixture of fact and fantasy. This becomes the dynamic reality for the patient under the influence of the traumatic events which live on in his inner fantasy. Subsequent events and perceptions of reality are selectively organized into memory schema consonant with inner fantasy thinking.

     To recapitulate, in keeping with the synthetic function of the ego and the principle of multiple function, the traumatic events in the individual's life and the pathogenic conflicts that grow out of them are worked over defensively by the ego and incorporated into a scheme of memories and patterns of fantasy. In one part of the mind the inner eye, as it were, remains focused on an inner stream of fantasy thought in which the traumatic memories are retained in a disguised form. Freud conjectured that the delusion owes its convincing power to the element of historical truth which it contains and which it inserts in place of the rejected reality. It would follow, he added, that what pertains to hysteria would also apply to delusions; namely, that those who are subject to them are suffering from their own recollections. What I have tried to demonstrate in this paper is that this is a general principle of mental life. The traumatic events of the past become part of fantasy thinking and as such exert a never-ending dynamic effect, occasionally striking, sometimes less so, on our responses to and appreciation of reality.
     One of the measures of the involvement of a person in the neurotic process and his traumatic past can be taken from the extent to which his mental functioning is pulled toward concentrating on the inner stream of fantasy thinking in competition with realistic daytime preoccupations. This can be clearly seen in fetishists and in some former fetishists who develop unusual responses to the perception of reality. The fetishist suffers from the memory of a traumatic perception, a confrontation with the sight of the penisless female genital at a time when he was particularly vulnerable to castration anxiety. He seems unable to get over it. Around the traumatic events he weaves a wish-fulfilling, reality-denying fantasy, the illusion of the woman with a phallus. But it does not seem to help. Before his mind's eye, even through the compensating fantasy, he continues to see, however dimly, the original perceptions of the female genital proclaiming the danger of castration. Looking at reality becomes a hazard, for at any moment he fears he may encounter a set of perceptions identical with those that precipitated the original panic.
     In some individuals this leads to a peculiar relationship to reality in general (7) because they make an unconscious equation of reality with the female genital (25) and they treat the former the way the fetishist treats the latter. They refuse to face it. They cannot take a really good look at anything. This tendency influences them in the direction of impracticality and propels them into unrealistic behavior in many areas of their lives. During analytic sessions it is hard for them to look at their productions or at the analyst's interpretations. At best they give them only a fleeting glance. In presenting a problem such patients tend to seize upon some insignificant, minor detail, tangential and peripheral to the heart of the matter. Although at one level they clearly perceive the true nature, the real nature of the problem, at another level they persist in 'beating around the bush'. During the analysis they have a set of mannerisms involving their eyes. Either they keep them closed, shield them with their hands, rub them, or blink continually throughout the session. In speaking, they express themselves in the conditional voice, for example--It seems, I suppose, Perhaps, Maybe, Could it be that?, etc. Nothing is definitely asserted. The central reality has to be obscured and denied, but in the manner of the fetishist, these patients have to fasten their attention on some distracting, peripheral, reassuring perception that corresponds to the female phallus as envisaged in their inner fantasy. A variation of these trends may be seen in individuals who are petty liars, who have a compulsive need to embellish, adorn, and obscure reality.
     From a study of these unusual character traits one can see how painful events are woven into fantasy thinking and how persistent focusing on these elements in the stream of fantasy thought leads the individual to scan the data of perception of reality to discover reassuring evidence of the validity of the solution which he arrived at in fantasy. Under the pressure of unconscious wishes and in keeping with the need to fend off anxiety, the perceptual apparatus of the ego is oriented and alerted to incorporate, integrate, correlate, deny, or misinterpret the data of perception.

     The interplay between unconscious wishes, defense, and perception may serve as a transition to the next point concerning the psychology of moods. Growing as they do out of the vicissitudes of individual experience, the memory schemata of each person are typical and idiosyncratic. The memory patterns which are important in psychoanalytic treatment are grouped together according to the pleasure-unpleasure principle and are reactivated in the context of emerging conflicts over instinctual wishes. I referred earlier to the capacity of external perceptions to intensify the cathectic pressure of fantasy. Thus it is easy to see how moods may be evoked by perceptions of reality in the sense that real experience stimulates the emergence of specific memories and systems of fantasy.
Most often, but not always, the patient is aware of which event it was that precipitated or provoked his mood. For the duration of the mood the thoughts that come to mind are in consonance with the fantasy that gave rise to it. No other thoughts seem to present themselves to awareness. Opposing thoughts are brushed aside and the perceptions of the external world are selectively attended to and interpreted in terms of the mood.
     During analytic treatment, we are in a position to correlate the mood with the fantasy whose content is appropriate to the affects, thoughts, and perceptions characteristic of that specific mood. It is the pervasive quality of the fantasy which establishes the nature of the mood and its cathectic potential perpetuates its existence. I have illustrated this point with the material from a patient who was in a depressed mood (5). His realistic perceptions--breakfast, birthday, and oranges--intensified the cathexis of a latent cannibalistic fantasy. The mood, thoughts, and activities and the response to reality were in keeping with the contents of the stream of fantasy thoughts.
     But what can we say about moods whose appearance cannot be traced to any specific event or external perception? The evocation of such moods I would suggest might still be related to some perception of external reality, to some sensory stimulus which found registration outside of consciousness. Clinical experience and experimental studies offer abundant proof of Freud's idea that while the perceptual system is functioning it is completely pervious to external stimuli. Potzl (30), Fisher (10, 11), and others have demonstrated conclusively that even stimuli which are subliminal in intensity may find registration outside of consciousness. It seems highly plausible that, like the day residue of a dream, percepts registered outside of awareness may dynamically affect fantasy thinking to the end that a fantasy is cathected, stimulating emergence of the mood.

Finally, another question must be raised. What is the form of fantasy thinking? How highly structured is it? Some authors, for example, have rejected the suggestion that unconscious fantasies may have a complicated organization or contain elements of imagery that are visually representable. My own experience and thinking have led me to the conclusion that for the most part fantasy thinking has a quasi-visual nature. It is easily transformed and transformable into visual representations. At first I thought of this relationship in terms that were uncomfortably static. In connection with an attempt to demonstrate how reality is experienced in terms of inner fantasy needs, I wrote:

There is a hierarchy in the fantasy life of each individual, a hierarchy which reflects the vicissitudes of individual experience as well as the influence of psychic differentiation and ego development? To use a very static analogy for a highly dynamic state of affairs, we may say that unconscious fantasies have a systematic relation to each other. Fantasies are grouped around certain basic instinctual wishes, and such a group is composed of different versions or different editions of attempts to resolve the intrapsychic conflict over these wishes. Each version corresponds to a different 'psychic moment' in the history of the individual's development. It expresses the forces at play at a particular time in the person's life when the ego integrated the demands of the instinctual wishes in keeping with its growing adaptive and defensive responsibilities. To continue with a static analogy, we may conceive of the interrelationship between unconscious fantasies in terms of a series of superimposed photographic transparencies in which at different times and under different psychic conditions one or more of these organized images may be projected and brought into focus (3, p. 377)

The expression 'hierarchy of fantasies' is meant to convey the idea that instinctual derivations operate throughout life in the form of fantasies, usually unconscious. The organization of these fantasies takes shape early in life and persists in this form with only minor variations throughout life. To borrow in analogy from literature, one could say the plot line of the fantasy remains the same although the characters and the situation may vary.
      A few years later it occurred to me that the interaction between fantasy thinking and reality could be expressed illustra tively through the use of a visual model. I compared this aspect of the operation of the mind to the effect that could be obtained if two motion picture projectors were to flash a continuous series of images simultaneously but from opposite sides onto a translucent screen. Here I have altered the analogy in order to carry it further. There are two centers of perceptual input, introspection and exterospection, supplying data from the inner eye and data from the outer eye. It is the function of a third agency of the ego, however, to integrate, correlate, judge, and discard the competing data of perceptual experience. All of these factors influence the final judgment as to what is real and what is unreal. In addition I have tried to make room in my conceptualization for the infinite complexity of the relationship between the outer world of perception and the inner world of thought.
     The predominant role of vision in the totality of human perception can hardly be overstressed. Supposedly eighty percent of learning is affected through vision. There is a vast literature of psychological studies of visual perception. In those areas which are of particular interest to psychoanalysts, namely, the development and alteration of mental functions under the impact of intrapsychic conflict, the study of visual experience has always been considered to be of special importance. Many, perhaps most, of the models of the psychic apparatus which Freud devised to illustrate his concepts of the functioning of the mind were either visually representable or based on analogies either to optical instruments or to contraptions which could somehow record experience in visual form. In most of these models he discussed perception in terms that were primarily, if not exclusively, applicable to visual perception, although it is always clear that he had no intention of treating the two as if they were identical. It is possible that this resulted from the fact that his earlier models were devised to integrate the data derived mostly from the study of the psychology of dreams and of the neuroses. In the case of the former, he was concerned with the problem of why the sleep-time hallucinations which we call dreams are almost exclusively visual in nature. In the case of the neuroses, he was impressed by the etiological significance of memories and fantasies and of the vivid visual form in which they are recalled. According to Freud, the closer a thought or fantasy is to the pleasure-dominated unconscious instinctual tendencies, the greater the possibility that
it will be represented mentally in a visual form (15).
     The element of visual representability of fantasy thinking has an important bearing on psychoanalytic technique. In his 1966 Nunberg lecture (27), and in a number of as yet unpublished works which I have been privileged to read, Lewin refers to the pictorial nature of the individual's store of memories. In connection with the patient's response to a construction he says: 'It is as if the analysand was trying to match the construction with a picture of his own'. Each analyst has a different capacity for visual memory or fantasy representation. But following Lewin, I think it is correct to say that some form of visual thinking occurs in the analyst's mind as he thinks along with his patient's free associations. The joint search by patient and analyst for the picture of the patent's past is a reciprocal process. In a sense, we dream along with our patients, supplying at first data from our own store of images in order to objectify the patient's memory into some sort of picture. We then furnish this picture to the analysand who responds with further memories, associations, and fantasies; that is, we stimulate him to respond with a picture of his own. In this way the analyst's reconstruction comes to be composed more and more out of the materials presented by the patient until we finally get a picture that is trustworthy and in all essentials complete.
     The successfully analyzed patient stands in contrast to the hero of Antonioni's poetic motion picture, Blow Up. The photographer hero has witnessed and recorded a traumatic event, a sadistic conceptualization of the primal scene. His life has been altered thereby but out of the vast storehouse of his (memory) pictures he can no longer retrieve the one that contains the record of the trauma. Not being able to produce the photograph is the analogue of being unable to recall the traumatic event. Thus the hero in Blow Up becomes a kind of twentieth century Everyman traumatized in childhood. He has lost his connection with his past and has, in his hand; only the fragment of the experience, a fragment out of context, enlarged to the point of unreality. Is it memory or fantasy? Without confirmatory evidence he begins to doubt his own reality. Only through psychoanalysis can the picture be restored and the individual be reintegrated with his past. In this way he comes to appreciate the connection between fantasy, memory, and reality.


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