Fear of Fusion and Projective Identification in Autistic Children

I should like to present the case of pauline, who suffered from a symbiotic psychosis, and compare her with the remarkable presentation made by Ellen Stockdale. In my discussion I compare the stage of symbiotic psychosis, as demonstrated by Pauline, crossed by primitively encapsulated autistic children in the course of their evolution.

I shall try to elucidate the paradox between the constant search for the confusion of identities through massive destructive projective identification in the symbiotic psychosis, and through adhesive identity into autism with the fear of normal fusion. I approach this contradiction specifically through the vicissitudes of the formation of spatial relationships. I present some of my own hypotheses with regard to the formation of the body ego (body image) as it emerges with increasing precision in children afflicted by primary and secondary autism who are in analysis.

Since the beginning of her treatment at the age of three, Pauline had presented the principal signs of symbiotic psychosis described by Mahler & Furer (1968), a syndrome also called secondary autism in the United States and regressive secondary autism by Tustin in England. (Tustin [1990] actually prefers the term confusional entangled children.)