Epilogue

Our contributors seem to vary with regard to their ideas about the etiology of autism, some regarding it principally as a constitutional or neurocognitive disorder and others suggesting that it is an early developmental deviation in the service of dealing with unmitigated terror where there is an intense fusion with mother and a lack of preparation for separation. The latter point of view does not exclude primary neurobiological considerations. The picture that seems to emerge is that autism is probably a biological disorder (genotype) intermixed with a psychological disorder (phenotype) in which there is a failure on the part of the infant to countenance separation, resulting in its entering into a default position whereby it regressively reinstitutes a primary autistic withdrawal and, at the same time, needing the environmental objects to be all the more “holding” and “containing,” but to such a degree that apparently a pathological relationship with the caretaking mother results, which can be characterized as “addictive.”

What is remarkable about the discussions is that each contributor found something in the report that corresponded with his or her own clinical experience. It might be necessary to put the etiology of autism on hold for a while, but the report itself throws considerable light on what lies behind the symptoms confronting the clinician.

If we have brought this elusive disorder closer to being understood, we can perhaps consider this issue of Psychoanalytic Inquiry to have advanced our knowledge to some degree.