This article examines the etiological role of incest as unconscious fantasy and incest as social fact in producing psychopathology. It reevaluates the importance of the Freudian theory of fantasy for an understanding of father-daughter incest, with particular attention to the relationship between fantasy and memory and between conscious and unconscious fantasy. Although the importance of acknowledging the social fact of incest is affirmed, I maintain that an analysis of the mental representation of the incest experience in fantasy is as crucial to the treatment of incest victims as is an acknowledgment of the primary etiological role of real victimization in producing pathological states. Case material is presented to illustrate the ways in which the reality of incest may combine with stage-specific fantasies to determine the nature and extent of the incest victim' pathology.