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Explorations in Autism

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'Explorations in Autism is a turning-point in both the understanding of and the clinical approach to autism. The clinical material gradually unveils the geography of the internal mother (which proved crucial for the development of Meltzer's 'claustrum' theory) and allowed him to draft, for the first time in psychoanalysis, a theory of the dimensionality of mental life.'- CARMO DI SOUSA LIMA, Portuguese Psychoanalytical Society'The rigorous exploration reported in this book has shed a totally new light on the subjective experience of autistic children and hence on the primitive developmental phases of every human mind. A new metapsychological model of the psyche stems from the description here of fundamental concepts like primal depression, dismantling, adhesive identity, dimensionality as a parameter of mental functioning.'- DIDIER HOUZEL, French Psychoanalytical Association and Professor of Child and Adolescent Psychiatry, University of Caen'Donald Meltzer's brilliant "lessons" supervising my analysis of a post-autistic boy have increased my psychoanalytical instruments for investigating the transference and countertransference: how to observe emotional and behavioural facts during the session (not only verbalizations), and how to seek out my own dream images in order to carry on with the analysis.'- MARISA PELELLA MELEGA, Brazilian Psychoanalytical Society, Sao Paulo'These modalities observed in autistic children have a more general scope than in psychopathology and even lead us to rethink certain basic concepts in psychoanalysis. The research recorded in this book allowed Meltzer to come into contact with children who were unable to form an object containing a space to be used in their mental development. Later, using conclusions drawn from this work,Meltzer went on to formulate the "aesthetic conflict" in a book which pairs with this one: The Apprehension of Beauty (1988).'- VIRGINIA UNGAR, Buenos Aires Psychoanalytical Association, Chair, IPA'Meltzer's understanding of sense perception and language development is inspiring. He was so far ahead of his time that we are only beginning to realise how he anticipated recent developmental research. In this book, by way of clinical work, he extended the scope of psychoanalysis to wide new fields of thought.'- MARIA RHODE, Emeritus Professor of Child Psychotherapy, Tavistock Clinic/University of East London

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Section A: Theory

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SECTION A

THEORY

CHAPTER ONE

Aims, scope and methods of the investigation

Donald Meltzer

This small book is not intended as an exhaustive study of a particular pathological syndrome. It is perhaps more like a traveller's tale than a report of scientific inquiry. We can give the compass bearings we followed, the equipment we took and the experience of past travels which served as the basis of our judgments. The rest is all description of the terrain and in habitants, flora and fauna, and the adventures along the way. Furthermore it is all hindsight, for we planned nothing of the sort in advance and only thought to organize ourselves as a group for the purpose of review, and later for the writing up and publication of our experiences.

In fact the children being described in later chapters were among the most interesting of a somewhat larger group of children treated by the psychoanalytical method in private or in clinics over a period from 1960 to 1970. The two items which the various cases had in common were (a) the therapists had all been trained in the psychoanalytical method of child therapy as developed by Melanie Klein; and (b) they all came into supervision from time to time with one of us (D. M.) because he was known to have a special interest in autistic children and to have had some experience of their treatment by the psychoanalytical method. As the clinical work progressed at its own pace and new realizations made their appearance in one child's treatment after another, it began to become apparent that a definitive view of autism was taking shape which differed greatly from anything previously suggested in the literature of psychoanalysis or child psychiatry. The Melanie Klein Trust then gave us a grant to review the experience as a research group in 1967, which injunction we carried out for three years in bi-weekly seminars. The fruits of this work trickled into print in several papers, to a congress of paediatric psychiatry at Rome (D. M.), to the British Psychological Association (D. M.), to the Association of Child Psychotherapists (S. H.), to an international congress of psychoanalysis (D. M.). But the bulk has been fairly laboriously gathered together to form a book which we believe has a very compelling internal logic and sequence.

 

Section B: Clinical Findings

ePub

SECTION B

CLINICAL FINDINGS

Introduction to clinical findings

The main body of the book now follows, and is composed of the individual clinical reports by the various therapists of the research group. In addition there is a chapter by the editor (D.M.) relevant to the mutism of autistic children but drawing its clinical material from the psychoanalytical treatment of schizophrenic and manic-depressive patients in late adolescence. No effort has been made to restrict the individual authors within an overall framework of exposition, and for this reason a certain amount of overlap will appear in the descriptions of the children and their analytic material. But in a way this is all to the good, for it not only enriches the concepts by multiplying the illustrations with small variations, but also serves to bind together the group of children being described. It will be seen that we have been at no pains to establish the diagnosis of Early Infantile Autism by the usual psychiatric nosological canons, but have rather left this issue to sort itself out descriptively. In the long run we ourselves found the homogeneity of the material, the evolution of the transference and the revelation of central conflicts, to be both surprising and convincing in relation to our earlier doubts and debates.

 

Section C: Implications

ePub

SECTION C

IMPLICATIONS

CHAPTER EIGHT

The relation of autism to obsessional mechanisms in general

Donald Meltzer

The experiences recorded and discussed in this book, deriving as they do from the combination of detailed observation and the panoramic backdrop of years of analytic process, have contributed to our grasp of mental mechanisms in no area so richly as in the field of the obsessional ones. The problem of ‘choice of neurosis’ with which Freud struggled, by virtue of being formulated at all (one of those wrong questions to which there can be only wrong answers), gave rise to a whole spectrum of speculative theories of one or two factor or even multiple factor type. Stage of development of the libido, fixation points, traumatic factors, mechanisms of defence, mother-baby relationship, sociological factors, heredity of constitution – these and many more have been sorted through in this quest. It might easily be misconstrued that a mechanismspecific theory of autism was being promulgated in this volume, but it would be a mistake which this present chapter should make clear. I intend to show the light thrown on the essential workings of obsessional mechanism by the way in which they are employed in this surely most primitive of all obsessional disorders. Of course, the moment one calls autism an obsessional disorder it sounds like a nosological statement with etiological implications, but it is not so intended. The experience with Piffie has been selected as the locus for this discussion as he presented obsessional mechanisms of a particularly ‘pure’ sort, as well as in near ‘pure culture’.

 

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