Chapter V: Disturbed Geography of the Life-Space in Autism - Barry

The process of establishing an internal world, with internal good objects, through introjective identification, as revealed in the psycho-analytic treatment of an adolescent boy, with a severe psychotic character structure, subsequent to an autistic state.

An object to be available for helpful projective identification of a part in distress, relieving that part and returning it to the self for integration (Bion) has to be an object with sufficient strength and resilience to withstand invasive projective identification (Bick) and the parasitic ensconcement of that part within the object (Meltzer). The material that illustrates this thesis, is taken from the analysis of an adolescent, who at the age of twelve was referred for treatment as he was ineducable, incapable of going to school and totally unsociable. When disturbed he was virtually unmanageable at home. As a young child he had been autistic, but this appeared to have been relieved at the age of six following treatment at the Hampstead Clinic. Subsequently a grossly psychotic character structure seemed to have become manifest. Barry's analysis was interrupted after nine years, when he was aged 21, at his own decision. It is material from the early stages of the analysis that will, I hope, illustrate how this child became able to establish an internal world that contained objects having functions and roles which allowed for the development of phantasy. This foundation allowed him ultimately to become healthier through introjective identification.

The phases of analysis to be described can be summarized as follows:

The Clinic, the treatment room, the analyst, were the focus of aggression, and Barry presented himself as an unbearable monster. The phase ended when Barry seemed to recognize the analyst as an object, that could be firm but was vulnerable, that had a skin which could be damaged, but could heal (Bick).