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Interpersonal Determinants of Reality-Testing Capacity

Arch Gen Psychiatry. 1960;3(4):368-372. doi:10.1001/archpsyc.1960.01710040038006.
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Although the capacity to test reality is variable in any person, it appears to be critically diminished in those who are labeled "borderline" or "psychotic." The classical scientific literature examines this process mainly as an intrapsychic phenomenon. Freud1 wrote that in both neurosis and psychosis there is a withdrawal of the ego from reality. In economic terms, there is a withdrawal of preconscious cathexis. He said, ". . . . neurosis does not deny the existence of reality, it merely tries to ignore it ; psychosis denies it and tries to substitute something else for it." Freud called the normal or healthy reaction a combination of these two: "It denies reality as little as neurosis, but then, like a psychosis, is concerned with effecting a change in it. This expedient normal attitude leads naturally to some active achievement in the outer world and is not content like psychosis, with establishing the alteration


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