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Three pieces of clinical material have now been presented to illustrate five factors which are necessary for speech development and use but are, one or more, found defective in severe mental illness where the tendency to mutism exists. To recapitulate, they are: (a) the capacity to form dream thoughts suitable for transformation into language, impaired in Jonathan and fairly crumbling in Sylvia; (b) the ability to accomplish this transformation, through identification with speaking objects, into the music of deep grammar, disintegrating in Sylvia and slowly being reconstituted in Jonathan; (c) the lalling process of play with words, requisite to the construction of a vocabulary suitable for communication about the external world and the virtuosity in superimposing this lexical structure of superficial speech on the musical base of deep speech, recovering in Jonathan; (d) apprehension of external objects with qualities of psychic reality which render them suitable as an audience, altered by Philippa's delusion; and finally (e), a desire to communicate states of mind and information to other people, waning in Sylvia.
In relating these factors to infantile autism, I have described our findings regarding the states of autism proper and the impaired personality development in such children outside this realm of self-induced mindlessness. I have outlined the mode of functioning of the central manoeuvre in autism proper, the primitive and gentle dismantling of the ego, and traced its consequences, also showing how the disposition which favours such a method of dealing with an environmental failure can lead on to less primitive methods of omnipotent control and thus of obsessionality. This latter, combined with the impaired introjection and preference for an adhesive(Bick, 1968) form of narcissistic identification, interferes with the differentiation of the various areas of the geography of phantasy(Meltzer, 1967) and thus with the formation of internal objects. This latter difficulty is further complicated in the realm of speaking, by the tendency in later development for the pregenital Oedipus complex to manifest itself as an attack on the verbal coition of the internal parents. These ideas about autism, which could only be outlined here, will be presented more fully in book form, Explorations in Autism, by the author and his co-workers J. Bremner, S. Hoxter, D. Weddell and I. Wittenberg.