Cognitive Deficit, Mindlessness and Psychotic Depression: Observations of a “Born Loser”

The referral of this case for assessment for psychotherapy was, in part, an attempt to seek clarification of the diagnosis of one child's deeply disturbed and bizarre behaviour. It was also stimulated, and this has importance, by the interest, curiosity and bewilderment which the child herself was able to arouse in those caring for her.

Kate was eight years old and attending a school for the educationally subnormal when she was referred to the clinic by her school. Her teachers were convinced that Kate was of good intelligence and that she was wrongly placed in an E.S.N. school. There was a strongly held feeling that she had potential for development and her teachers were unhappy for her to remain in a setting where, it was believed, this potential would not be reached. Autism was suspected since Kate manifested many of the characteristics of the Kanner syndrome and the expectation was that she would benefit from more specialised schooling. So it was that Kate began to attend the clinic three times per week for the exploration of her strangeness and to consider whether she would qualify for special education. In addition, the function and fitness of psychotherapy in such an undertaking would also be kept in review.

What has resulted is that Kate has remained in psychotherapy for three years, and this has allowed close observation and study of her very primitive levels of experiencing and her consequent failures to achieve that degree of integration necessary for mentation. During this period, Kate's behaviour has been considered by both her parents and her teachers to be showing slow but steady improvements: in her responsiveness to and co-operation with others, in her use of language and in all the social and learning activities of school. This being so, it could at least be fairly said that psychotherapy was not contra-indicated. Any claim to there being a positive correlation between her “progress” and the therapy will have to wait on examination of the