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The central thesis of Anne Alvarez's outstanding book is that autistic, psychotic, and severely disturbed children are occupied with minimal or ‘pre-’ objects. This kind of object is not adequately included in traditional psychoanalytic models of development and, hence, in analytic technique. Her main example is autism, the profoundest and most difficult to reach of the childhood psychoses. It is illustrated through the narrative of the twenty-year treatment of an autistic boy, which runs through the whole of the book. Unlike the ‘shell-type’ autistic children described by Tustin, Robbie was a floppy, amoeboid, skeletonless boy. Having no structure in his personality, he was unable to use primitive mechanisms like projection and projective identification. These mechanisms are basic to Kleinian thought and technique, in which the author trained and which to a degree failed her in the task of understanding Robbie. Being at a loss spurred Alvarez on to make the discoveries she describes in her book.
Robbie's history and treatment with Mrs Alvarez, beginning when he was 7, are laid out in the first three chapters. The second chapter begins with the lines from Andrew Marvell: ‘My vegetative life should grow/Vaster than Empires, and more