A Question of Autism

A boy of three was presented to the Clinic for a diagnostic assessment because he was showing signs of autism. I, as diagnostician, was of the opinion that while David was not yet autistic, there were possibilities that he might end as if he were. I will try to indicate the vulnerable aspects of his personality as described by his parents and by colleagues who referred him for assessment. I shall give my metapsychological understanding of the case based on the diagnostic material, making use of the format of Anna Freud's Profile. I shall then attempt to show from his ongoing analytic treatment how far my opinion was validated and to what, if any, extent David was in danger of being seen as a child with secondary autism. I shall attempt to pin-point those areas of his personality which seem at risk.

Kanner first drew attention to the condition he called autism. He defined it as an inate inability to perform the usual biologically provided, affective contact with people. He noted that most of the children whom he diagnosed had intellectual parents who failed to understand what babies need. (Kanner 1943). Winnicott considered that childhood psychosis, in which he included autism, was an environmental deficiency disease (Winnicott 1976). Francis Tustin implied that psychotic states are developmental phenomena arising through interference with normal processes (Tustin 1966). Margaret Mahler (1975) described infantile autism (and symbiotic psychosis) as an extreme disturbance of identity, of awareness of a sense of being, a feeling that includes a cathexis of the body with libidinal energy—not ‘who I am’, but ‘that I am’. She considered that, “the psychotic child never attains a feeling of wholeness, of individual entity, let alone a sense of human identity. In autism and symbiotic infantile psychosis, something has gone basically astray at the very root, that is in the earliest interactions within the mother/infant unit”. In primary autism a de-animated frozen wall exists