Meetings of the New York Psychoanalytic Society

April 12, 1960. DREAM AND PSYCHOSIS: THEIR RELATIONSHIP TO HALLUCINATORY PROCESSES. Maurits Katan, M.D.

Superficially the dream and psychosis resemble each other, and the similarity was utilized by Freud in an effort to unravel psychotic symptoms by comparison to phenomena in normal life—the dream being one. It was regarded as a psychosis of short duration in a normal person. Other normal examples useful because of similarity to psychosis are early stages of child development and hysterical hallucinations. The author believes, however, that the normal examples differ in varying degree from psychosis, in function, mechanism, and structure. In the dream, instinctual desires are fulfilled by use of visual images, characteristic of preverbal thinking and derived from the day-residues—and thus, if successful, preserve sleep. Here the ego grants fulfilment by a push back to hallucinations in order that it may avert the drive's push to reality, which would mean waking. In psychosis the process is different. The psychotic process consists of two stages—a prepsychotic stage and psychosis proper. In the former, the wish, having become conscious as a result of beginning ego defect, is at first defended against; but as the process progresses reality itself has to be surrendered to prevent fulfilment, and secondary introjections and projections are utilized. This is a retreat from reality, and return is prevented by the same conflicts that forced the break. This is the work of the still-functioning ego. As the process advances, cathexis is withdrawn from the ego as well, and the attempt at restitution ensues—this time making use of the same primary introjection-projection mechanisms which established reality contact in the early stages of development. There is again, however, a decisive difference: in the early stages an id-ego conflict is not possible, and hence there is progress toward reality testing; in psychosis, such progress is rendered dangerous by conflic