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Given the nebulous subject of the book I am reviewing, I wish to start with a disclaimer. And how better than to follow the editor, Howard Levine (p. 15), in quoting that great theorist, Wilfred Bion:
when we are at a loss we invent something to fill the gap of our ignorance—this vast area of ignorance, of non-knowledge, in which we have to move ….
… we could argue that the whole of psychoanalysis fills a long-felt want by being a vast Dionysiac system; since we don't know what is there, we invent these theories and build this glorious structure that has not foundation in fact—or the only fact in which it has any foundation is our complete ignorance, our lack of capacity. (2005, p. 2)
This rich and thought-full book has interesting but abstract and necessarily speculative descriptions of highly complex concepts, drawing on the work of Freud, Melanie Klein, Bion, and Donald Winnicott, amongst other pioneers, and applying them to the aetiology and experience of autism. The ten chapter authors—all renowned psychoanalytic specialists from England, Europe, Israel, Mexico, and the USA—have inferred from their clinical experience, both movingly and persuasively, the emotional and psychic impact on the developing infant of overwhelming sensations and experiences in utero.
Earlier intuitive thinking about autism by Frances Tustin, Donald Meltzer, and Anne Alvarez, amongst others, is acknowledged and reflected throughout the book. All the chapter authors have helpfully included substantial case material to illustrate the often very abstract theories underpinning their work. Most of the clinical work described has been with children, who have been in psychoanalytic treatment for four to six times a week over periods of between four and thirteen years, reminding us that this is an expensive and therefore exclusive service, available mainly to the privileged few who can afford it.
In his introductory chapter, “Making the unthinkable thinkable: vitalisation, reclamation, containment,