It is very difficult for the mothering object of the infant with Asperger's syndrome (AS) to be, in D.W. Winnicott's words, good enough. This is not, however, due to the mothering object's own psychological obstructions to sharing her devotion and unbridled wish to fill her child's belly and mind with the contents of herself. Rather the Asperger's infant's maternal environment fails to fulfill its role of encouraging psychic development because of the infant's neurological deficits.
The infant with AS is born with perceptual, sensory, and communication difficulties that impede his capacity to decode his mother's messages of nurturance, containment, and her eagerness to fill him with herself. The mother cannot sate his physical hunger and bridge the psycho-physiological rupture that takes place at birth, and surround him with the psychological sac of her own symbiotic wishes. Thus an Asperger's baby perceives the maternal holding environment his mother has created—even when she is doing her job well enough—as if it is filled with holes or gaps.
Winnicott famously said, “There is no such thing as an infant.” He elaborated on this statement in a footnote in 1965 by writing, “Whenever one finds an infant one finds maternal care and without maternal care there would be no infant.” Although Winnicott focused an analytic eye on the “real” qualities of the mother, it is also necessary to look at the infant's “real” contribution. One can expect individual differences among infants in two main variables: the infant's capacity to communicate his inner states and his capacity to receive his mother's communications.
In the case of AS, research suggests that the young Asberger child—and perhaps even the infant with AS—is neurologically impaired in his capacity to read faces, to detect subtlety in the timbre of the human voice, to be able to derive pleasure from prolonged skin-to-skin caressing, to be focused, above all other facial features, upon the other's eyes, and to be able to manage fluctuations of arousal triggered by stimulation from without and within. From this, we can assume that the infant with AS is hampered in his ability to take in the emotional nurturance and containment his mother gives to him.
Understanding AS through the lens of Winnicottian theories of psychic development has implications for the treatment of patients with AS. For example, with regard to the transference, it should be expected that the patient with AS might perceive the analyst as never being good enough, as being a part of the persecutory environment rather than as helping to protect from and to mediate it. This could take one of two forms with such patients: hostile and devaluing attack of the analyst or erasure of the analyst by creating around themselves a protective shell (to use Frances Tustin's phrase) of obsessive ruminations and perseverations.
I have found in my work with patients with AS a pattern of feeling oneself having been killed off and then fighting, with some degree of concerted force, to come back to life for oneself and, thus, for the patient. Along the lines Winnicott described in the infant's progression from relating to an object to using the object, the analyst may need to become dead (whether destroyed or deadened) and then, as Winnicott says, somewhat paradoxically, to survive having been killed off. To not tolerate this deadening transference is to spit it back at the patient, to resist the patient's attempt to bring the analyst into the patient's self and object world and thus to prevent the kind of regression necessary for analytic work to take place.
On the other hand, to never challenge this type of Aspergian transference is to perpetuate the AS patient's belief in the persecutory, malevolent, preoccupied, passive, withholding, and selfish coldness of his environment as well as of the highly destructive nature of his aggression. This perpetuation of the patient's perception of his environment as being chronically not good enough is likely to prevent the building or the breaking down of rigid defenses against the sensoria necessary for more realistically distinguishing helpful from hurtful aspects of his environment. Following along the same lines as those put forth by Anne Alvarez, the analyst must, after allowing herself to be made unreal and dead, make herself real and alive for the patient with AS. Otherwise, there is the risk of being turned into something like an inanimate figure, something that is useless yet poses no danger of impingement.
Many more patients who have been identified as having AS are coming into our offices. It is possible that many analysts are seeing some now who have yet to be correctly diagnosed. An appreciation for the intricate interplay of neurological and psychic development is necessary to provide analytic treatment that is attuned to the particular needs and conflicts that the patient with AS is likely to present. The theories of Winnicott are particularly well suited to understand this interplay and to provide a basis for working with patients with AS within a psychoanalytic framework.
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Michael L. Krass, Ph.D., is a member of the Contemporary Freudian Society, is in private practice in Falls Church, Virginia, and is a clinical assistant professor at the George Washington University. He presents regularly on Asperger's syndrome from a Winnicottian perspective.