Editorial

The first half of this issue is focused on work with children in psychotic and autistic states. We have four papers, each with a different focus, which when read together, really do make a significant, and in some cases, original contribution to our thinking about psychotic and autistic states of mind that might inform our work with non-autistic children too.

Ruth Weinberg explores psychosis in autism through a detailed case study. A review of the literature on autism and psychosis is offered, and useful distinctions are made between psychotic symbiosis and other autistic presentations, including a brief vignette from another case as a point of comparison. The particular presentation under discussion is clearly specified and helpful notes on technique are put forward through the main case study. We join the therapist as she picks a path between the autistic and the psychotic aspects of her patient. Her attempts to engage him interpersonally carry the risk of pushing him into psychotic hallucinatory wish fulfilment. She speaks movingly of having to negate her personhood, at times, in order to get close to him, without pushing him over the edge. This paper demonstrates how arduous and delicate the work is, to make hugely important but very limited gains:

To this day, Matan shows limited willingness for me to do anything that demonstrates I am not part of him and have a mind of my own. Fortunately, there is a slow and gradual development of abilities, and the most frequent feeling is that his slow progression occurs because he can now stay closer to reality and disintegrate less.

Yaakov Roitman offers some thoughts on why the autistic child is so vulnerable to psychotic states and has such difficulties with separating and separateness. Using Bion’s thoughts around perception and internal representation, he explores how the autistic mind, functioning under the dominance of the pleasure principle, rather than the reality principle, fails to create accurate enough internal