What To Do If the Mind Does Not Develop: A Psychoanalytic Study of Pervasive Developmental Disorders

Views: 80
Ratings: (0)

The result of three decades of psychoanalytic work with children and adolescents, this book takes a fresh and empathic look on the pervasive developmental disorders in childhood and adolescence, describing their many manifestations through the presentation of particularly representative clinical cases, in pages of high scientific rigour but also of simple and poetic language. What To Do if the Mind Does Not Develop speaks both to the specialist and researcher and to the reader who is simply interested in the topic, thanks also to a glossary of the more difficult technical terms. The text offers valuable psychoanalytic observations on the cognitive and emotional difficulties of these patients that may help physicians, teachers, and parents to develop a better and deeper understanding of their true psychology.

List price: $28.99

Your Price: $23.19

You Save: 20%

 

11 Slices

Format Buy Remix

Chapter One - The Mind Model of Child Psychoanalysis in Clinical Work with Children

ePub

In this chapter I would like to talk about my psychotherapeutic work with children in general, in order to clarify, as much as possible, what is the therapeutic method of psychoanalysis and what are its main purposes. My hope is that this may facilitate and make it more interesting to read the clinical stories of some of my patients who suffered from pervasive developmental disorder, which can be found in the second and third part of this book. I will clarify this issue in the second chapter with the help of the written notes from a consultation with Carlotta, a five-year-old girl with a few phobic symptoms.

I would like to start with a question: What are the unconscious aspects of the infantile mind that the psychoanalytic method makes accessible to a scientific exploration?

It is well known that the work of a psychoanalytic psychotherapist and of a child psychoanalyst is mainly based on the careful observation of the unconscious aspects of the internal world of the child and of his most intimate emotional experiences, as they manifest themselves in the transference within the therapeutic relationship in a well-structured space-time context. In the past—I am referring to the early Freud and his Studies on Hysteria (1895d)—it was thought that the main purpose of therapy was for the patients to be able to re-experience or communicate, within the therapeutic relationship, the many painful derivatives of childhood, of a mainly sexual nature (seductions, threats of castration), which in the course of the development had been repressed since they were intolerable or unacceptable. These experiences, in their repressed state, were the basis of the inhibitions, perversions, neuroses, and peculiarities of character of the patients themselves; thus, the main purpose of the analytic work was to reconstruct their traumatic past and bring it back to light, so that the related negative affects could be explored in a situation of safety and trust. It was thought that this reconstructive work ought to be done by the analyst with a neutral attitude, without any moral judgement.

 

Chapter Two - An Example of Psychoanalytic Consultation with Children: The Clinical Case of Carlotta (C)

ePub

At this point I would like to illustrate what I said earlier with the help of the notes of the first consultation session with C, a five-year-old girl. My purpose in discussing this piece of clinical work here is to show how a particular receptive and listening attitude adopted by an experienced, sensitive adult, in the context of a setting that is well structured and sufficiently free from external interferences, allows, in just a few sequences, the child to reveal some deep aspects of her relations and emotional life. This, in turn, facilitates the therapist's understanding, and my own as a supervisor, of the main characteristics of the little girl's personality structure so to formulate a few interpretative hypotheses about her symptoms, which will be investigated later in the following sessions and finally shared with her parents.

C is a five-year-old girl attending a private nursery. She has a sister who is two years her senior. Her parents want a consultation because for a few months, before going to kindergarten, C has started vomiting (despite having an empty stomach, since she never eats her breakfast), or panicking as a consequence of a simple reprimand, saying that she has heartache and that she cannot breathe. C never shows her anger or rebellion, and she often shows—both at home and at the kindergarten—an excessively complacent attitude, despite being often in the grip of feelings of anxiety when faced with something that was not programmed by her, or anything unpredictable.

 

Chapter Three - The Eyes and the Mind (1): On the Observational Processes in Clinical Work with Children

ePub

In this chapter I would like to develop a few very personal ideas on the relationship between the eyes and the mind in psychoanalytic psychotherapeutic work with children and adolescents. To do so, I will make use of material from different sources: clinical material from the initial assessment meetings with a seven-year-old boy, not particularly ill and therefore quite ready to get to know his emotions and his deepest thoughts; and from a psychotherapy session with a young adolescent, with Asperger's syndrome, who was still stuck on his beliefs and unable to enter into a world of shared meanings. My two clinical cases will be preceded by observational material from one of my colleagues, which she gathered within the ward of neonatal intensive therapy where she worked; and literary material from The Blue Bear (2002), a novel by the American writer Lynn Schooler, which clearly illustrates the impact of artistic creation on symbolic development. Finally, I will discuss two poems by Tagore, one on the birth and the other on the death of a child, to exemplify how a poet can observe and give shape to certain fundamental human experiences.

 

Chapter Four - What can be Done if the Mind does not Develop? Encountering Bi-Dimensionality and Absence of Meaning While Working with Child and Adolescent Psychotics

ePub

Introduction

In the course of our work as psychoanalysts of children and adolescents, we have found that in recent years there has been a steady increase in the number of psychotic patients suffering from serious delay in the structuring of their personality, with peculiar character traits and social and intellectual limitations mainly due to a failure to enter a three-dimensional world in their mental life rather than with a state of confusion in their sense of identity. Their internal world was flat, populated with few fragmented and degraded objects with no emotional light. Their relationship with others and with the emotions they give rise to was based mainly on automatic mechanisms of consent or dissent, or on mechanisms of avoidance and closure of an autistic type.

By automatic consent we mean all adhesive ways of relating to others (adhesive identification, adhesive behaviour, adhesive learning); by automatic dissent we mean all negativistic ways of relating to others (negative identification, behaving in the opposite way to that expected such as by laughing when crying or being frightened is expected, or spitting out when drinking is in order, or by saying words with their syllables reversed).

 

Chapter Five - Is it Possible to Interpret Autistic Material in the Way we Interpret Dreams?

ePub

Autism is a variant of thought and its development, which is based on alpha function reversal and on projective identification on the level of the part-object. By applying these two principles in an imaginative way, it could therefore be possible to interpret autistic material in the same way that we interpret dreams (Meltzer, in: Associazione Culturale Racker Venezia, 2002).

In the previous chapters on observation and the psychoanalytic method, I have shown how difficult it is, even in a specific context, such as the analytical one, to understand the behaviours of children or adolescents who suffer from pervasive developmental disorder. We saw, in my meeting with the autistic child in the ward at the Gemelli General Hospital (in the prologue), how everything that in normal personal and social relationships creates contiguity, reciprocity, arouses interest, or courtship, at first glance appears in these patients extraneous to communicative intentionality, enclosed within an unfathomable solipsism. I showed above all, with the help of Alessio's clinical data, how our difficulty in getting in contact with their way of being is not simply linked to their personal isolation, to their inability to form relations (an objective solipsism), but also to a fairly high degree of alienation from objective reality (in a pseudo-scientific manner).

 

Chapter Six - Thomas (T), the Child trapped in a “Deaf and Dumb” Pinocchio-Like Body: In between a Disembodied Mind and a Dehumanised Body

ePub

With the help of clinical data of Vincenzo and Antonio we saw in Chapter Four how the bodily experiences associated with an emotion do not have a right to citizenship in the mind of children and adolescents with pervasive developmental disorder, and how everything that could make them aware of an emotional experience (the observations “of sensorial impressions” as Bion would say, or the “lived body” as Maurice Merleau Ponty would say), instead of being transformed into elements apt to become dream thoughts that can then be used for thinking and for memory, is immediately dismantled, hidden, fragmented. Therefore, in the end, these patients are prisoners within a mechanical and unresponsive body, which is no longer a figment of imagination but only expression of repeated, excited or opaque “scripts”, and they live in a world of bizarre, concrete, and idiosyncratic objects, not suitable for thought.

In this chapter I will talk about how motor behaviours of a child can distort and obstruct the development of its Ego and the processes of emotional and social learning, when “its actual body”, its corporeality, becomes part of autistic defences and is transformed into something mute and deaf, like a piece of wood, unavailable to any commonality, unsuitable for intersubjective communication.

 

Chapter Seven - Suzanne (S), a Goldilocks-Like Spiteful Little Girl: The Growth of a New Concept of Self through the Birth of Imagination

ePub

Introduction

In this chapter, I will tell the story of Suzanne, a young girl who was about five and a half years old when she was referred to me for psychotherapy by the teacher of a special needs school in London specialised in the treatment of autistic children, which she had been attending for a few years. She suffered from spasticity and was severely delayed both verbally and non-verbally—according to the Reynell language test scale, her comprehension level was considered to be around the age of two years and seven months, whereas according to the Symbolic Play Test, her mental age was under twelve months. She showed several autistic features, such as lack of interest in interaction or communication with other people, immediate and delayed echolalia, and the tendency to become absorbed in simple and repetitive behaviours rather than playing with toys in a constructive way. In the special needs school, where she has recently passed from the last year of maternal school to the first year of primary school, she had always been considered as a difficult child, especially for the almost total lack of interest in what happened around her and what she was taught. S refused to talk to her teachers, to play with them or with the other children. Instead, she spent most of her time by herself and spoke a strange, completely incomprehensible jargon, a mixture of her native language—Spanish and English, but without any grammatical structure. Sometimes she asked to go to the toilet, where she would spend hours mumbling and looking inside the toilet bowl, fascinated by the flushing water.

 

Chapter Eight - Rebecca (Re), the Child Kissed by the Snow Queen: Lifeline and Perspective as Symbolic Forms

ePub

Introduction

In the previous two chapters I have tried to illustrate the ways in which two children, Thomas and Suzanne, suffering from pervasive developmental disorder, related to the “life experiences” in which they were immersed and which pressed on their physiological and psychic apparatus in order to be taken in and organised with some sense or meaning. Applying the notions of part object and reversed alpha function to the clinical material, I reached the conclusion that there was something wrong in the anatomy and physiology (Caccia, 2012) of their early internal object relations which, in the course of their development, had prevented their “body” from becoming the metaphor of a human link, and their “mind” from becoming incarnate in their “living body”.

To this regard, I have pointed out how both children, the first because of the trauma of his neonatal asphyxia and the second because of her premature birth, have entered life in a painful way and in an emotionally deprived context. I have also shown how their developmental delay and their states of isolation within the analytic relationship, although roughly comparable to those of a normal baby in his last months of foetal life and the first months of neonatal life, never appear as preparatory for a new phase of development and expression of those unconscious conflicts and persecutory anxiety and confusional states which can be observed in early infancy.

 

Chapter Nine - The Eyes and the Mind (2): The Exercise of Knowing the Self and the Other

ePub

“Now I would use as a model the diamond cutter's method of cutting a stone so that a ray of light entering the stone is reflected back by the same path in such a way that the light is augmented-the same ‘free association’ is reflected back by the same path, but with augmented ‘brilliance’. So the patient is able to see his ‘reflection’, only more clearly than he can see his personality as expressed by himself alone (i.e. without an analyst).” (A note by W. R. Bion to D. Meltzer, quoted in 1986b, p. 121)

I

At this point in the research, after a long and arduous thinking on the written notes of the therapeutic experiences of Thomas, Suzanne, and Rebecca, we are faced with a considerable number of clinical phenomena that need to be organised within a unitary design: a few of them are well-known, others less familiar with uncertain meanings. Brought to light in the first instance by the dynamic forces of the analytic process, they have then been freed by what kept them hidden and that prevented us from understanding their nature. Now they lie on our workbench like precious minerals ready to tell us their story and the story of the ground that has preserved them for so long.

 

Chapter Ten - In the Clearing of Being: The Difficult Discovery of Shared Meanings in the Process of Weaning from Therapy in a Patient Suffering from Pervasive Developmental Disorder

ePub

Foreword

In this final chapter of the book I would like to consider the concepts of “treatment” and “cure” in psychotherapeutic and psychoanalytic work with children and adolescents suffering from pervasive developmental disorders. I shall do this by focusing my attention mainly on those aspects of their personality, stemming from their mental functioning, when they recover from being autistic or psychotic.

The importance of this study is linked to the fact that even after years of therapy, we must acknowledge that there is something irreducibly peculiar about their mode of being. We find above all in their character a mixture of immaturity and obsessional traits (Hoxter, 1975), which is difficult to interpret on a developmental basis. As such, we are eager to learn how much of it represents an overcoming of the initial condition or simply a sophisticated transformation.

As a basis for my discussion, I have selected the written notes of five sessions of the last year of Al's therapy, the adolescent patient suffering from Asperger's, whom we have already met in Chapter Three, when I talked about the countertransference phenomenon of the “negative contagion”, which occurred during our discussion of the immortality of the soul.

 

Appendices A to K - Areas of Conceptual and Methodological Development

ePub

In the following section I will try to offer a clearer definition of the conceptual tools, which I applied to the clinical notes in the book while interpreting the behaviour of my patients. In doing so I hope to help people who are not familiar with the observational method of child psychoanalysis to share my way of looking at the developing mind in children and at the same time to allow those colleagues or other professionals who are already accustomed to it to test its usefulness in future research and therapeutic work.

Appendix A: the alpha-function

The alpha-function is a fundamental concept in W. R. Bion's “theory of thinking”, according to which, in order to “learn from experience”, the individual must transform the sense impressions of early emotional experiences (beta elements) into psychic elements (alpha elements). The notion of alpha-function was first introduced in Learning from Experience (1962) on the notion that any knowledge of the human mind, even the most abstract one, is largely metaphorical, and that the earliest metaphors used are those that can date back to sensorial experience and to the perceptions of our sensory-motor apparatus. In this sense, any theory on the birth and development of the mind must be seen as a hypothesis, whose validity lies in its capacity to enhance the quality of our observations of clinical phenomena; therefore it has the significance of a model that, when no longer useful to its purpose, must be abandoned.

 

Details

Print Book
E-Books
Slices

Format name
ePub (DRM)
Encrypted
true
Sku
9781781817148
Isbn
9781781817148
File size
0 Bytes
Printing
Disabled
Copying
Disabled
Read aloud
No
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata