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Asperger's syndrome (AS) was defined in 1944 by the German psychiatrist Hans Asperger, one year after Leo Kanner's description of autism. However, it has only recently received wider attention. The main diagnostic systems in use in the USA and Europe, DSM-IV (APA 2000) and ICD 10 (WHO 1992) respectively, have defined the syndrome as being distinct from autism. However, as the two syndromes share certain features, the distinctions between them are considered by some to be matters of degree (cf. Trevarthen 1998).
The patient – whom I shall call Johnny – was diagnosed after one year of therapy as suffering from Asperger's syndrome by the consultant child psychiatrist in the clinic where I work, a diagnosis having been requested by the patient's school. The consultant child psychiatrist made her diagnosis by looking at the file notes, talking to the educational psychologist, meeting the mother and seeing the boy herself. She noticed Johnny's difficulty in understanding social cues and the effect of his behaviour on others, his inappropriate behaviour in social situations and his low self-esteem and incapacity to maintain peer relationships. At the beginning of treatment, I considered my patient to have been in a ‘post-autistic state’. Meltzer et al. define this state as the outcome of a process of dismantling typical of autism, i.e. a passive process ‘akin to allowing a brick wall to fall to pieces by the action of weather, moss, fungi and insects’ (1975: 12–14). The process occurs by allowing the senses to wander and to attach themselves to the most stimulating, most colourful, warmest, softest objects available at a given moment, and by the suspension of attention. Both Meltzer et al.’s and Tustin's frameworks have been of value in understanding the state of mind of patients like mine, which at the outset of treatment I was only able to intuit. I experimented during the therapy with a particular technique designed to reach and ‘to reclaim’ the patient (Alva