Letter

Dear Sir,

I am grateful to Dr Plaut for his careful reading of my paper. He makes a number of important points, to which I would like to respond:

1. When the analyst confronts the patient with ‘the’ reality, the implication is that the standards of reality ‘should be … the same as the analyst's’. He infers that I assume that the testimony of our senses is an infallible guide to what is real, and that I claim a ‘certitude as to reality and its normalistic or even moralistic aspects’.

I believe neither that perception is infallible, nor that the analyst is the arbiter of what is real and what is not. As I said on the first page (509), perception is an actively interpretive act, rather than a passively receptive one. On the other hand, I do believe that we always assume that we have at least an approximate consensus about certain things being real and certain things being unreal; the assumption that we share a universe of discourse is basic for any communication to be possible. That does not mean that we are right, but it does mean that we are stuck with those judgments. In any case, in the analysis of perverse patients (and most other analytic patients), the issue is rarely that the analyst and patient disagree about what is real. Every fetishist I ever worked with could tell me that a woman does not ‘really’ have a penis. The man in my case example could tell me, when he turned his attention to it (i.e. ‘tested reality’), that he ‘really’ had a mole that ‘really’ had changed—even though he wanted desperately to believe otherwise. Most of us would not call a patient who argued that women have penises, or that the mole was not there, ‘perverse’; we would call such a patient psychotic. The issue with patients who use perverse defenses is not that they disagree with the analyst about what is real, but that they ignore the implications of their own assessment of what is real. When I refer to the analyst as being a spokesperson for reality, I do not advocate arguing with the