The Loss of Reality*

Among the most important as well as most perplexing psychiatric phenomena is the one which is often called the loss of reality. The patient who is becoming psychotic no longer experiences certain aspects of the external world as his fellow human beings do, but in private, bizarre ways, difficult to understand and even more difficult to share.

The patient may all of a sudden see himself as a great inventor, his wife as a plotter who poisons his food, the neighbors as a gang of conspirators. Certain signs, heretofore deemed harmless, become clues of obscure machinations or of gigantic, secret intrigues. That such fantasies can occur to human beings is not at all surprising. The imaginations of many more people than is generally known follow these strange paths, but these imaginations are generally recognized as such and are easily discarded.

The peculiarity of the psychotic mind consists of the inability to dismiss these fantasies; moreover, of the willingness to accept them as reality, in fact as overbearing aspects of reality, which leave little room for the rest of life.

The acceptance of these absurd beliefs occurs in spite of what seems to the non-psychotic a complete lack of corroborating evidence.

How is such acceptance possible? To explain the phenomenon exclusively in psychodynamic terms—for instance, by considering the delusional system as a denial of the unpleasant reality, or a wish-fulfillment, or an attempt to relive and solve conflicts—is to miss the focal point of the problem. There is no doubt that these psychodynamic