The Loss of Reality in Neurosis and Psychosis (Freud, 1924)
I have recently indicated as one of the features which differentiate a neurosis from a psychosis the fact that in a neurosis the ego, in its dependence on reality, suppresses a piece of the id (of instinctual life), whereas in a psychosis, this same ego, in the service of the id, withdraws from a piece of reality. Thus for a neurosis the decisive factor would be the predominance of the influence of reality, whereas for a psychosis it would be the predominance of the id. In a psychosis, a loss of reality would necessarily be present, whereas in a neurosis, it would seem, this loss would be avoided.
But this does not at all agree with the observation which all of us can make that every neurosis disturbs the patient’s relation to reality in some way, that it serves him as a means of withdrawing from reality, and that, in its severe forms, it actually signifies a flight from real life. This contradiction seems a serious one; but it is easily resolved, and the explanation of it will in fact help us to understand neuroses.
For the contradiction exists only as long as we keep our eyes fixed on the situation at the beginning of the neurosis, in which the ego, in the service of reality, sets about the repression of an instinctual impulse. This, however, is not yet the neurosis itself. The neurosis consists rather in the processes which provide a compensation for the portion of the id that has been damaged – that is to say, in the reaction against the repression and in the failure of the repression. The loosening of the relation to reality is a consequence of this second step in the formation of a neurosis, and it ought not to surprise us if a detailed examination shows that the loss of reality affects precisely that piece of reality as a result of whose demands the instinctual repression ensued.
There is nothing new in our characterization of neurosis as the result of a repression that has failed. We have said this all along, and it is only because of the new context in which we are viewing the subject that it has been necessary to repeat it.
Incidentally, the same objection arises in a specially marked manner when we are dealing with a neurosis in which the exciting cause (the ‘traumatic scene’) is known, and in which one can see how the person concerned turns away from the experience and consigns it to amnesia. Let me go back by way of example to a case analysed a great many years ago, in which the patient, a young woman, was in love with her brother-in-law. Standing beside her sister’s death-bed, she was horrified at having the thought: ‘Now he is free and can marry me.’ This scene was instantly forgotten, and thus the process of regression, which led to her hysterical pains, was set in motion. It is instructive precisely in this case, moreover, to learn along what path the neurosis attempted to solve the conflict. It took away from the value of the change that had occurred in reality, by repressing the instinctual demand which had emerged – that is, her love for her brother-in-law. The psychotic reaction would have been a disavowal of the fact of her sister’s death.
We might expect that when a psychosis comes into being, something analogous to the process in a neurosis occurs, though, of course, between different agencies of the mind; thus we might expect that in a psychosis, too, two steps could be discerned, of which the first would drag the ego away, this time from reality, while the second would try to make good the damage done and re-establish the subject’s relations to reality at the expense of the id. And, in fact, some analogy of the sort can be observed in a psychosis. Here, too, there are two steps, the second of which has the character of a reparation. But beyond that the analogy gives way to a far more extensive similarity between the two processes. The second step of the psychosis is indeed intended to make good the loss of reality, not, however, at the expense of a restriction of the id – as happens in neurosis at the expense of the relation to reality – but in another, more autocratic manner, by the creation of a new reality which no longer raises the same objections as the old one that has been given up. The second step, therefore, both in neurosis and psychosis, is supported by the same trends. In both cases it serves the desire for power of the id, which will not allow itself to be dictated to by reality. Both neurosis and psychosis are thus the expression of a rebellion on the part of the id against the external world, of its unwillingness – or, if one prefers, its incapacity – to adapt itself to the exigencies of reality, to ’Αυάγχη [Necessity]. Neurosis and psychosis differ from each other far more in their first, introductory, reaction than in the attempt at reparation which follows it.
Accordingly, the initial difference is expressed thus in the final outcome: in neurosis a piece of reality is avoided by a sort of flight, whereas in psychosis it is remodelled. Or we might say: in psychosis, the initial flight is succeeded by an active phase of remodelling; in neurosis, the initial obedience is succeeded by a deferred attempt at flight. Or again, expressed in yet another way: neurosis does not disavow the reality, it only ignores it; psychosis disavows it and tries to replace it. We call behaviour ‘normal’ or ‘healthy’, if it combines certain features of both reactions – if it disavows the reality as little as does a neurosis, but if it then exerts itself, as does a psychosis, to effect an alteration of that reality. Of course, this expedient, normal, behaviour leads to work being carried out on the external world; it does not stop, as in psychosis, at effecting internal changes. It is no longer autoplastic but alloplastic.
In a psychosis, the transforming of reality is carried out upon the psychical precipitates of former relations to it – that is, upon the memory-traces, ideas and judgements which have been previously derived from reality and by which reality was represented in the mind. But this relation was never a closed one; it was continually being enriched and altered by fresh perceptions. Thus the psychosis is also faced with the task of procuring for itself perceptions of a kind which shall correspond to the new reality; and this is most radically effected by means of hallucination. The fact that, in so many forms and cases of psychosis, the paramnesias, the delusions and the hallucinations that occur are of a most distressing character and are bound up with a generation of anxiety – this fact is without doubt a sign that the whole process of remodelling is carried through against forces which oppose it violently. We may construct the process on the model of a neurosis, with which we are more familiar. There we see that a reaction of anxiety sets in whenever the repressed instinct makes a thrust forward, and that the outcome of the conflict is only a compromise and does not provide complete satisfaction. Probably in a psychosis the rejected piece of reality constantly forces itself upon the mind, just as the repressed instinct does in a neurosis, and that is why in both cases the consequences too are the same. The elucidation of the various mechanisms which are designed, in the psychoses, to turn the subject away from reality and to reconstruct reality – this is a task for specialized psychiatric study which has not yet been taken in hand.
There is, therefore, a further analogy between a neurosis and a psychosis, in that in both of them the task which is undertaken in the second step is partly unsuccessful. For the repressed instinct is unable to procure a full substitute (in neurosis); and the representation of reality cannot be remoulded into satisfying forms (not, at least, in every species of mental illness). But the emphasis is different in the two cases. In a psychosis it falls entirely on the first step, which is pathological in itself and cannot but lead to illness. In a neurosis, on the other hand, it falls on the second step, on the failure of the repression, whereas the first step may succeed, and does succeed in innumerable instances without overstepping the bounds of health – even though it does so at a certain price and not without leaving behind traces of the psychical expenditure it has called for. These distinctions, and perhaps many others as well, are a result of the topographical difference in the initial situation of the pathogenic conflict – namely whether in it the ego yielded to its allegiance to the real world or to its dependence on the id.
A neurosis usually contents itself with avoiding the piece of reality in question and protecting itself against coming into contact with it. The sharp distinction between neurosis and psychosis, however, is weakened by the circumstance that in neurosis, too, there is no lack of attempts to replace a disagreeable reality by one which is more in keeping with the subject’s wishes. This is made possible by the existence of a world of phantasy, of a domain which became separated from the real external world at the time of the introduction of the reality principle. This domain has since been kept free from the demands of the exigencies of life, like a kind of ‘reservation’; it is not inaccessible to the ego, but is only loosely attached to it. It is from this world of phantasy that the neurosis draws the material for its new wishful constructions, and it usually finds that material along the path of regression to a more satisfying real past.
It can hardly be doubted that the world of phantasy plays the same part in psychosis and that there, too, it is the storehouse from which the materials or the pattern for building the new reality are derived. But whereas the new, imaginary external world of a psychosis attempts to put itself in the place of external reality, that of a neurosis, on the contrary, is apt, like the play of children, to attach itself to a piece of reality – a different piece from the one against which it has to defend itself – and to lend that piece a special importance and a secret meaning which we (not always quite appropriately) call a symbolic one. Thus we see that both in neurosis and psychosis there comes into consideration the question not only of a loss of reality but also of a substitute for reality.