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Despite Freud's remarks and a striking outer similarity, dreams and psychoses arise from quite different ego configurations. The psychotic process consists of two phases: the first, due to a breakdown of the ego, results in withdrawal from reality and regression to an undifferentiated state; the second leads to attempts at restitution and it is then that psychotic symptoms appear. The similarity to the dream occurs in this second phase, and not all parts of the ego are involved.
In the dream, the ego has to keep its level of cathexis as low as possible to protect sleep; a hallucinatory wish fulfilment is the ego's offering to the impulse to secure this cathexis. The psychotic symptom occurs in waking life and does not stem from the ego's need to lower cathexis. Dangers arising from conflict force the ego to regress, sever its ties to reality, and prevent a return. Primary process, hallucinations, and delusions are used in the ego's attempt to undo the undifferentiated state to which it has regressed. The undifferentiated state does not contain cathected memories but rather is the ego's attempt at restitution which recathects the infantile memories. Thus the memory of the infantile trauma makes its influence felt both in the content of the psychotic symptom and in the normal dream. In the psychotic symptom this is due to the attempt of the psychotic ego to regain touch with reality whereas in the normal dream the infantile memory serves to gratify the instinctual need.