XII. Psychotic Illness in Early Childhood Ten years on from Explorations in Autism1

The clinical work and seminars of the research group (John Bremner, Shirley Hoxter, Doreen Weddell, Isca Wittenberg and Donald Meltzer) which eventuated in Explorations in Autism, took place between 1965 and 1974 in an atmosphere of enthusiasm about the illumination shed by the conceptual tools made explicit in Melanie Klein's paper, ‘Notes on some Schizoid Mechanisms’. It was largely by the extrapolation of her implicit model of the mind that we developed such concepts as dimensionality, dismantling of the senses, and primitive obsessional mechanisms. Bion's ideas, which had stunned us but had as yet not been assimilated, played a very little part in our conscious conceptualising but were already at work, underground as it were, as was Esther Bick's idea of skin containment.

In the last ten years no such formal research study has been carried on, but a different type of experience has given rise to new ideas which now seem ‘ripe’ to be shared. But I wish to make it clear that they do not have the same status scientifically as the earlier work and will require clinical confirmation to assess their usefulness. They derive from the conscious use of Bion's Theory of Thinking as a clinical tool and have proved, in my opinion, to be astonishingly clarifying and therapeutically effective. The experience of which I speak, which I have shared with my wife, Martha Harris, has been one of teaching analytical child psycho-therapy at various centres in Europe, North and South America and India, following cases over periods as long as ten years at a frequency ranging from one to five times a year. The main centres have been in Oslo, Paris, Novara, Rome and Pisa. I would estimate that we have followed about twenty cases fairly closely and seen another thirty cases in a more diagnostic way. This experience, of course, has taken place on a background of regular supervisory work once a week or fortnightly with young colleagues in