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For many years I have been working with an extremely ill and passive autistic boy named Bobbie whose inner world appeared to be perpetually empty. Where objects did exist, they were generally lifeless, useless and terribly fleeting; his sense of self was virtually non-existent. I found him exceptionally difficult to reach, partly because of inadequate treatment conditions, but largely because his withdrawal was so deep and chronic. When I began seeing him at the age of 7 he was far away and he had been so for a long time.
He is now 20. His development in treatment has been extremely slow and the developmental steps, though often initially dramatic, have been widely spaced, lingered over and dwelt upon in a way I shall describe later. However, this sluggishness itself has made it relatively easy to note the steps and the conditions which seemed to promote them. With less ill patients, or with normal infants, the pace of development is a great deal more rapid: thoughts, feelings, ambitions, achievements, checks, all flow together and across each other, often all at once. The complex eddies and currents move with such speed that it is not always easy to separate what is really new, or at least a renewal in a patient's development, from what may simply have gone unseen before.
Unfortunately for Bobbie, but fortunately for my ease in observing him, the repetitive pull and the pressure toward sameness means that real moves stand out in a striking way. It is also a fact that the facility with which he slipped away from contact and his excessive dependence on my contribution and efforts to contact him have led to a situation where I have had to examine much more closely than is usual the effect of my interpretations on his capacity for attention.
I shall describe two rather different situations in treatment which I think helped to bring him to life. I shall go on to suggest that these two situations may be closely related to certain maternal functions and to the ac