Freud distinguished between neurosis and psychosis by arguing that while the former is psychically localized, the latter is relatively global. In neurosis, individuals break with a portion of reality that they find intolerable. As a result, their overall relation to reality remains more or less intact, but becomes impaired in one aspect of their personality.
In contrast, because psychotic individuals tend to find reality as a whole too painful to bear, they break with it globally, and construct an alternative, delusional, “magical” reality of their own. This alternate relation to reality, manifesting itself in the initial meetings with the patient, is at the root of the clinician’s confusion.
Now many of us throughout American society at large, after an interminable electoral campaign and transitional phase into the presidency of Donald J. Trump, have experienced a form of disorientation and anxiety that bears a striking resemblance to the clinical situation I have described. And recent events indicate that this feeling is not going to abate any time soon.
What we’re all experiencing now is somewhat like the confusion an analyst encounters with a psychotic patient.