The Loss of Reality in Neurosis and Psychosis (Freud, 1924)

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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.

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