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Freud believed that a gratification degraded to a substitute is a symptom (19). This formula may be modified to state that in neurosis a meaning is presented by the ego in a disguised form. The present paper speculates about a factor additional to the familiar conflict and fixations that contribute to the formation of neurosis. This factor is the 'faulty thinking' referred to by Freud in describing the psychic processes in wit, comedy, and humor (20). Such faulty thinking also operates in neurosis; it does so by means of a state of the ego which I call the 'as if' ego state.
Vaihinger found that 'appearance, the consciously false, plays an enormous part in science, in world philosophies, and in life' (28), (33). By his 'as if' Vaihinger means a conscious state whereas I mean an unconscious 'as if' attitude. Otto Sperling refers to Vaihinger when he writes that 'an illusion is naïve if the deception either of the senses of the mind is complete and not contradicted. If, however, the illusion is entertained only to a limited degree and for a limited time, and the ability to recognize that it is an illusion is retained, the illusion … is a controlled illusion' (31). Both Sperling and Vaihinger refer to a conscious 'as if' attitude. Helene Deutsch used the term 'as if' in a way different from both Vaihinger's and mine to describe the personality of patients who lack genuine feeling in object relations (5). In 1951 I pointed out that orgasm may occur at the peak of anxiety dreams, dreams of drudgery, masochistic punishment dreams, examination dreams, masochistic masturbatory fantasies,