A Discussion of the Paper by Donald Meltzer on 'Mutism in Infantile Autism, Schizophrenia and Manic-Depressive States: The Correlation of Clinical Psychopathology and Linguistics'

Dr Meltzer has presented us with a difficult communication about difficult communication. I for one am not certain that I have grasped anywhere near all that Dr Meltzer has intended to communicate. Part of the difficulty is, of course, that his paper consists of condensations and fragments from not just one, but two, books. I fear that I have difficulty discerning how a full-scale theory of language emerges from the clinical vignettes presented and the inferences drawn from them.

These clinical data and inferences do, nonetheless, illuminate several pivotal interrelations between language function and object relationships in schizophrenia. A core difficulty for the schizophrenic person is his simultaneous inordinate need for, and fear of, an intensely close personal relationship (Burnham et al., 1969). Both separation and fusion are powerful threats to him. Concurrently, he needs, yet dreads, influence and control from other persons. This need–fear dilemma permeates his entire functioning and is particularly manifest in his use of language. He uses language both to invite closeness and to interpose distance. He uses it both to confront and to avoid dangerous affects and thoughts. He uses it both to reveal and to conceal his wishes and fears. He uses it both to advance towards and to retreat from participation in shared reality (Burnham, 1955).

Dr Meltzer's patients abundantly illustrate these conflicts in their use of speech and silence. As he has pointed out, the two women seemed predominantly, though not entirely, to be regressing from interpersonal closeness and participation in shared reality. The young man, Jonathan, seemed haltingly to be moving towards restitution of object relationships and the use of language to communicate rather than to isolate and insulate himself.

All of the patients were enormously preoccupied with issues of influence and control. They showed dread and resentment of external influences. Sylvia said, 'Let us alone'. Philipp