The Psychology of Neurogenic Communication Disorders:

Fantasy Fantasy is a symbolic way of meeting needs. It can be a form of escape through daydreaming which protects and supports the ego (Carson et al., 1988). Sometimes called autistic fantasy, the individual deals with emotional conflicts by excessive daydreaming as a substitute for a more appropriate action (Burgess and Clements, 1998). There are a variety of fantasies including occupational, athletic, financial, sexual, and social. During fantasy escapes, the person can retreat and withdraw into an imaginary world and bridge the gap between desire and reality (Carson et al., 1988). During this time, the person can act out emotionally significant roles in well organized and often elaborate daydreams. Fantasy also can be unconscious. These are fantasies embedded in the unconscious mind. Unconscious fantasy can influence a person's consciousness. This is particularly true of unconscious role scripts. For example, a person can act out an unconscious fantasy that he or she is impervious to danger, a rough and tough chance-taker. A patient with this type of script may take chances unnecessarily and have a cavalier attitude about rehabilitation. Fantasy, as a coping style and psychological defense, is desirable, mature, and adaptive for some patients with neurogenic communication disorders. Unobtainable wishes can be obtained, albeit symbolically, during fantasy escapes. Patients can withdraw and retreat into imaginary worlds during fantasy escapes. They can provide needed relief from the realities of the situation. Certainly, like all coping styles and psychological defenses, fantasy can be maladaptive when it becomes a frequent and unnecessary substitute for reality. Language is not necessary to use fantasy as an escape from unpleasantness. Patients with severe neurogenic communication disorders can use pure visual imagery during fantasy. Although patients with intact language can narrate elaborate fantasies, purely nonverbal fantasies can be created by patients without language. Fetch Another session of therapy. Sometimes, you feel that you are on a "fast track" to rehabilitation that gives you very little time to appreciate your successes. Today, your mission is to compute numbers correctly. You find the right number of quarters in a dollar, count ten pennies to make a dime, add one column of numbers, and subtract this, that and the other thing. You are not doing well with these numbers. Once, they were so easily computed and now they seem monumental problems. A sense of failure overwhelms you. Whew! You stare at a door knob. For a few precious seconds, you see yourself in your back yard. Your golden retriever jumps to retrieve a well-thrown Frisbee. The freshly mown grass is green, flowers are blooming, and the white picket fence clearly marks the boundary of that wonderful place. You are once again normal. Again, you throw the Frisbee and the dog grasps it in her teeth. But the words, ". . . would the loaf of bread cost?" brings you back to reality. As you, the dog, Frisbee, flowers and grass dissolve in your mind, you now find yourself struggling to remember how many dimes in a dollar. At the end of the session, the clinician will write in the chart that you have difficulty tracking and attending to tasks.