HOW DO MAKE-BELIEVE AND PSYCHOPATHOLOGY INTERSECT?
As we already documented, it is difficult to label specific forms of illusion construction as less mature or more pathological than others. Our own inclination is to assume that normal pretending flows imperceptibly into what is regarded as psychopathological distortion. Indeed, we would say, as have others (e.g., Sarbin & Mancuso, 1980; Szasz, 1961), that the difference between "normal illusion" and "crazy" elaboration is often embarrassingly hazy.
To explore the intersection of make-believe and serious "reality distortion," we set several goals in this chapter. First, we analyze cogent observations bearing on the matter of differences between normal modes of illusory fabrication and those typifying persons who are considered psychopathological. How well can we distinguish psychologically "normal" from "pathological" modes? Second, we examine the relationship between the ability to conjure up illusory images and the likelihood of developing clinical levels of psychopathology. Does facility in constructing the illusory render one more or, to the contrary, less susceptible to extreme forms of personal disorganization? Last, we are interested in the possibility that various types of psychotherapeutic treatments represent systems for providing alternative, substitute forms of supportive illusion.
Anyone who has, in the real world, attended clinical case conferences concerned with diagnosing psychiatric patients knows the uncertainty attending such decisions. It is an unusual occasion when easy agreement concerning diagnosis occurs. There are often disagreements about whether patients be-