Meetings of the New York Psychoanalytic Society

March 31, 1964. DELUSIONAL FIXITY, SENSE OF CONVICTION, AND THE PSYCHOTIC CONFLICT. John Frosch, M.D.

Referring to Freud's paper, Constructions in Analysis, Dr. Frosch points to the element of the historic kernel of truth as being the essential factor which lends a sense of conviction to both a delusion and to an analytic reconstruction. The question is raised as to the role of historic truth in the persistence of a neurotic symptom, and whether the fixity of the latter is to some extent derived from the fact that it contains kernels of historic truth. The author then contrasts the neurotic with the delusional psychotic: in the neurotic the consistent belief in the reality of the symptom is missing; in the psychotic there is belief in the reality of the idea, and the historical truth is a current reality. There seems to be a more direct relationship between actual traumatic experiences and the content of the delusional system in the psychotic than there is in the neurotic. In some delusions what is striking is the rather overt, relatively undistorted or poorly disguised real aspect traceable to childhood. Dr. Frosch warns us that not only the content of the actual experience as such but certain intrapsychic reactions may be the crucial historical factors. The delusional state may be accompanied by alterations in the ego state, bringing about feelings which, having been experienced at one time in the past, lend a feeling of reality to what the individual is currently experiencing. Fragmented ego states are regressively re-experienced in the psychotic. Primitive introjective and extrojective mechanisms may be utilized in relating to present surroundings as they have been utilized previously. In the paranoid certain early experiences may contribute to disruption in the development of adequate ego boundaries and other experiences necessary to maturation. The accompanying ego states may be regressively re-experienced in the psychotic patient and lend a qualit