Meetings of the New York Psychoanalytic Society

March 15, 1966. TRUTH OR CONSEQUENCES: RECONSTRUCTIVE DISTINCTIONS BETWEEN FANTASY AND REALITY. Oscar Sachs, M.D.

Dr. Sachs considers the importance of interpreting reality that has become admixed with fantasy, and the role of the superego in reality testing. Difficulties are frequently encountered in distinguishing between fantasy and reality in the 'memories' of traumatic events described by patients. In the early years of psychoanalysis there seems to have developed a pragmatic attitude that it made little difference whether a remembered traumatic event was real or fantasied: subjective drive-dependent experience was accorded the primary ideological significance. More recent emphasis has been on 'conflict patterns' and tends to approximate Freud's view that unconscious fantasies are roughly equivalent to actual traumatic events. In certain cases, the necessity to uncover or reconstruct specific traumatic events may be limited to a vital, repressed detail that alters the meaning, or to the truth or falsity of the event. It is especially important to delineate actuality when this has been denied prior to repression; when the denial comes from an authoritative source—such as a parent—later superego function may interfere with reality testing. Dr. Sachs presents a case report to demonstrate this problem as well as that of the effect of parental prohibition and denial of reality.

There appears to be more masochism and guilt created from acts of reality than fantasy if these occur when superego formation is already well developed. In Dr. Sachs' patient there was frequent confusion between self and object and an interference with certain aspects of reality testing as well as guilt feelings. The reality distortion related more to superego demand than to ego distortion. For this patient the distinction in reality between who was lying and who was guilty was vital to the resolution of her obsessional symptoms and her anxiety. Greenacre, in Re-evaluation of Work