Chapter IV: Primal Depression in Autism - John

I should like to portray some of the experiences I had with John in the course of his first year of analytic treatment with me. Much of the time, these experiences were so painful for one or both of us, that it requires considerable effort to face the task of reliving them again in one's mind. I shall describe in detail some of the sequences of play and behaviour in the hope that it will allow the reader to draw his own conclusions about the nature of John's relationships. I have in most instances not quoted the interpretations I gave, but indicated in my comments on the session how I understood what was going on. I shall want to pose many questions and only tentatively suggest some causes for John's liability to lose himself in a state of mindlessness or alternatively to collapse into a particular kind of catastrophic depression. While the unrelenting projection of despair made this child at times difficult to bear, John's passionate nature, his capacity for tenderness, his vulnerability to depressive pain, and his appeal for help evoked great affection and concern in me.

It will be seen that the material is understood against a background of theory derived from Melanie Klein's work. The need for the mother to hold the projected pain of the infantile psyche, as stressed by W. R. Bion, views the mother as container, and thus links with E. Bick's work on the containing function of the skin. But I shall present the sessions and my reflections about them as free from technical terms as possible and aim to convey the impact of this child and the feelings he was able to engender in me.

A Brief Developmental History

John was born after a difficult and prolonged labour. His mother was unwell for about two months following the birth and John was therefore bottle-fed and partially cared for by his father. He was a strong sucker, an easy and lively baby, reaching his milestones rather late. But he was a jolly infant