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At this point in its history, psychoanalysis has a rather ambivalent relationship with the idea of reality. On the one hand, many theories stress its purely subjective or interpersonal nature. On the other, even as these views have gained ascendancy, quite a number of analysts have been very interested in a group of patients—those with perversions, especially fetishists—who have a marked problem accepting reality.
Alan Bass's book is in this tradition of studying fetishism as a way of gaining a deeper understanding of defences against reality—a tradition that stretches back to Freud's work on disavowal (1927) and splitting of the ego (1938). The title of Bass's book expresses his basic theory in a very condensed form. He begins with certain characteristics of fetishistic patients who resist the process of interpretation as such, reacting to it as a trauma. He notes that such patients give evidence of having registered the reality of the analyst and the interpretation unconsciously, but defend against this registration by calling upon primary process functioning, involving the equivalence of fantasy, memory, and perception. As an example, Bass describes a session in which he had helped a patient see his fear of contact and had begun to be able, almost for the first time, to observe himself in the transference. Near the end of the session, the patient said that he knew for certain that Bass was sleeping, and became very angry. Here the patient used a perceptual certainty, based on a conflation of fantasy and perception, to negate the full registration and internalization of the reality of a session where he and Bass were actually connecting well.
In Freud's (1938) account of this process, a little boy, upon seeing the female genitals, disavows what he has seen, continuing to think of the woman as having a penis (thus conflating fantasy with reality) and at the same time registering what Freud called the reality of castration. Bass thinks that both of these ideas—that th