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The split in the ego between consciousness and unconsciousness which sometimes eventuates in fetishism can also be clinically manifested in sleep disturbances, depersonalization, déjà vu and a variety of alterations in the sense of reality. It is suggested that this same split comprises the central dynamic mechanism in enuresis. The sleep disturbance which accompanies enuresis involves a confusion between waking and sleeping, sometimes taking the form of a dream that one is awake.
Three patients (adult males) revealed in the course of their analyses that they suffered from childhood enuresis accompanied by a sleep disturbance. Milder forms of sleep disturbances persisted into adult life. In these analyses, certain perceptual distortions, difficulties in the sense of reality, confusions between fantasy and reality and between waking and sleeping, could all be linked to the functional split between consciousness and unconsciousness and eventually to disavowal of the female genitals. The enuresis represented a functional equivalent of the fetish (and it may be that the urinary stream itself actually served as a fetish).