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This is a companion paper to “A Significant Element in the Development of Autism” (1966). It would seem preferable that these two papers should be read in conjunction with each other. The previous paper dealt with the “hole” type of depression. The present one brings further insight into this type of depression and discusses primitive processes which become excessive in order to protect against its catastrophic effects. The processes constitute a system of delusion and seem to play an important part in the pathological state of autism. Therapeutic material will now be presented to demonstrate these autistic processes in action.
David was referred for child psychotherapy at age ten years ten months with the diagnosis of child psychosis. The significant facts in the early history were that David was the youngest of two boys. Mother had wanted a girl and when David was born with a slightly twisted spine, she felt that she had a flawed child. The father had the same defect which made one shoulder higher than the other but it had not greatly incommoded him. This was long before the work on the effect of early separation from the mother had become a subject for the popular press. When David’s mother read of a masseuse in London who could cure his physical abnormality, she decided that he should have treatment even though it meant being separated from her baby. With great feelings of unhappiness, she strong-mindedly began weaning him from the breast at five months, so that at six months he could go to London to have treatment. David stayed in what she called a Baby Hotel from whence he went for daily massage. The parents lived some distance from London and so could only visit very rarely. At thirteen months, the masseuse decided that he needed his mother more than he needed treatment, so he returned home with his spine straightened but with the stage set for atypical development.
When he went to the village school