Some Considerations about Personality Structure in Child Psychosis

Some of the literature connected with child psychosis and autism (Freud, Klein, Kanner, Segal, Stern, Tustin) is examined, together with different hypotheses about its psychological aetiology. Special attention is given to the problem of fixation/regression, which is quite controversial. An example is provided of a child, basically autistic, who can be seen as being in an intermediate state between a psychotic and an obsessional disorder. With this, another controversial problem arises: is there any similarity between the rituals of autism and those of obsessional neurosis? And what about the withdrawal of affects we find in both? A psychotherapy case is then presented, describing a child with significant autistic features, 9 years old at the beginning of the treatment. He has a twin brother, who presents with a rather confusional psychosis, in therapy with another therapist. My patient showed erratic contact, stereotypical behaviour, very little language and confused accounts of stories from television, film and cartoons. In the course of treatment a quasi-delusional state also appeared. Even though he was mute in the main, sometimes his attachment to me shown in the transference gave me the feeling of a baby in his first phases of emotional development. Surprisingly he showed some capacity to play with toys in a constructive way — a sign of limited improvement.

Further considerations are given in conclusion, dealing with the structure of childhood psychosis. Autism and confusional psychosis are considered as being basically one structure, with different pictures, easily interchangeable. Sometimes my patient's expressions, through either some elementary play or his rituals, seemed halfway between pre-symbolic and symbolic. Some features typical of the paranoid-schizoid position can be recognized: feelings of persecution, massive projective identification and fragmentation.