Panel Report - Psychic Reality: Theoretical Concepts: Chaired by CHARLES BRENNER, New York

The Chairman opened the panel by introducing the panellists and their background pre-published papers. Britton proposed that ‘belief is to psychic reality what perception is to material reality’, so that belief confers the force of reality to that which is psychic in the sense that ‘seeing is believing’. Like perceiving, believing is active and is influenced by desire, fear and expectation. Therefore, perceptions can be denied in the same way that beliefs can. He then distinguished between belief and knowledge, describing the latter as based on objective evaluation. To become knowledge, in this sense, belief requires sensory confirmation (reality testing). In the absence of objective confirmation, belief may confer the status of reality on mental products, including fantasies, with the important consequences that led Freud to introduce the concept of psychic reality in the first place. As an alternative to denial, defences such as counter-belief, the annihilation of belief and the suspension of belief may be used. Counter-belief lies at the heart of defensive organisations and defends the patient from believing existing fantasies.

Britton described a female patient who it seemed firmly believed she had a special relationship with her analyst/father, a belief that she used to counter fantasies of exclusion. Another female patient maintained a counter-belief that she would go blind if she lost sight of her mother. Britton suggested that the annihilation of belief is a drastic schizoid defence against feelings of impending catastrophe and can yield a sense of futility and emptiness, often accompanied by de-realisation. Suspension of belief, found in extreme form in the as-if personality, is relatively common in analysis. An example was given of a male patient who suspended a belief in the apparent coldness and sadism of his analyst by idealising him and by somatising affective pain. Revelation of the patient's belief in his unconscious fantasies was a prerequisite to hi