The transition ‘from planned to market economy’ in the former Soviet Union and in several countries in post-communist Europe is one of the most sweeping social transformations of the second half of the 20th century. It is widely accepted that this transformation was driven by a shared belief in the market’s superior ability to deliver economic growth, to create wealth and contribute to the well-being of the populations after the demise of the defunct socialist ideology. However, the element of utopian fantasy undergirding the grand projects of socialism and the market is usually ignored, often with detrimental results. The study draws on Freudian and Lacanian psychoanalysis to propose an alternative reading of the process of transition, as an exchange of one powerful fantasy for another. My key contention is that as long as the common utopian dream of social harmony underlying both projects will not be recognised for what it is, which is in itself an unattainable desire of the human psyche, the illusory dreamlands will continue to exist and so will their violent political consequences. The study uses the example of public health policy development in the Soviet Union and post-Soviet Russia to illustrate how unacknowledged fantasy leads to violent utilitarianism as it was manifested in socialism, and is now repeated differently but no less tyrannically in the market. In conclusion, I argue for integrating fantasy as a constitutive element of political projects and explore the possibility of the autonomous (self-determined) mode of governance that Cornelius Castoriadis (1987/2005) theorised on and juxtaposed to the heteronomous ways of organising ruled by master signifiers present in various ideologies.