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In many cases of mental perturbation one of the major aims of psychiatric and psychoanalytic therapy is to “adapt the patient to reality”. Some of the most important as well as the most frequent psychiatric disease pictures, such as schizophrenia, depressions, neuroses, are considered to be a flight from, a distortion of, or a compromise with, reality. Notwithstanding the free and loose use in psychiatric therapeutics of terms, such as “making the patient face reality” a definition of reality is rarely attempted. Generally, by “adaptation to reality” is meant an adjustment to, or acceptance by the patient, of current values and concepts. A great latitude has been permissible in the estimate of the norm both as to time and changing values. The therapist is always aware that the patient's reality and his own need not, nay cannot, be the same. Ideally he should not, and theoretically at least, he seldom attempts to force his particular reality values upon the patient.
Differences in reality appreciation exist necessarily because the reality sense is dependent upon the degree of feeling which at a given time invests occurrences or thought. Thus one finds that in patients where the sense of reality is very markedly diminished, an inability exists currently to invest either isolated or general situations with feeling. One finds, also, that with reality appreciation disturbed, a person's attitude toward time and toward purposes is distorted—for without an active sense of reality, life has little meaning.
In this paper the origin of the sense of reality (also depersonalization, estrangement, feeling of unreality) and its relationship to time and purpose will be considered. The observations cited are entirely clinical and based largely on long psychoanalyses of three patients, suffering from varying degrees of depersonalization and derealization.