The Perpetuation of an Error1

This paper is an attempt to sort out my ideas about autism before my professional life comes to an end. It is fitting that I should do this with the Association of Child Psychotherapists because, as you will see, I have been very helped in my thinking by child psychotherapy colleagues of various theoretical persuasions.

I should like to think about an error made by many psychoanalytic therapists (including myself), to which I drew attention in a paper published in the International Journal of Psycho-Analysis as recently as 1991. In that paper I pointed out that observational studies of babies by workers from many countries - such as Colwyn Trevarthen (1979) in Scotland; Daniel Stern (1983, 1985) in the United States; Miller, Rustin, Rustin, and Shuttleworth in England (1989); Piontelli (1992) in Italy; Perez-Sanchez (1990) in Spain - had shown conclusively that there is not a normal infantile stage of primary autism to which the pathology of childhood autism could be a regression. This has been the mainstream hypothesis concerning the aetiology of childhood autism to which many psychoanalytic therapists have subscribed, especially in the United States and in Europe. This flawed hypothesis, based on faulty premises, has been like an invasive virus in that it has permeated and distorted clinical and theoretical formulations. It has perpetuated these distortions and obstructed communication between psychodynamic workers with autistic children. It has also obstructed communication with our Jungian colleagues, for example with Dr Michael Fordham, whose model is of a ‘primary self’ that innately unfolds (or not, as in autism) to reach out and take in the environment. In this paper, I want to think about why so many of us have made this mistake, and also to discuss the theoretical and clinical adjustments necessitated by its modification.

The question may be asked why such an issue is important. I would suggest that it is important because it affects our basic assumptions ab