Epilogue

THE MYSTERY THAT IS AUTISM INSPIRES INQUIRY, attempts to understand and to explain. Its intractable nature can inspire desperation or the desire to conquer and defeat—or both. This combination of human responses to autism has led to an exceptional amount of hypothesizing about etiology and treatment. Some of that drive has led to the development of important advances and some to the pursuit of “fringe” theories and treatments supported only by anecdotal evidence and the desire to believe.

The historical efforts to explain and cure autism were not the psychoanalytic tradition's finest hour. The seductive pull to force a fit of phenomenology to theory is one that most of us have experienced at some time in our careers. It is, obviously, something that must be zealously guarded against in the name, not only of those we aim to help, but the field of psychoanalysis as well.

Does the assumption, on my part and those of the authors in this issue, that disorders of the autistic spectrum are neurobiological in origin justify a rejection of any application of psychodynamic thinking to the problem? Part of the answer lies in a question that cannot be adequately explored in this issue, although it was touched on by Greenspan in his article. Autism is not a singular entity. Individuals are affected not only in level of severity, but in a variety of presentations as well. Individual development both acts on and is acted upon by autism. Intervention must be geared to the complex matrix of each individual.

The clinical interventions described in this issue will, to this writer's mind, be effective only for those on the higher end of the autistic spectrum and should not be seen as evidence of their value all along the spectrum. Modified dynamic formulations for patients with sufficient expressive and receptive language, cognitive abilities, and capacity for relationship may lead to helpful intervention for some higher functioning individuals. For those who could benefit,