Medium 9781855753143

Arctic Spring: Potential for Growth in Adults with Psychosis and Autism

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The title of this book takes us on an imaginary voyage to a distant land where people live in extremely difficult and uncomfortable climatic and environmental conditions. In the same way, psychotic and autistic patients seem to experience an emotional inner world characterized by loneliness and coldness. This frozen world of emotions is also reflected in the transference and prevents the formation of the therapeutic alliance, which is indispensable for the therapy to develop. The author compares the characteristics of autistic child psychotherapies and those of the adult cases illustrated.

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1: Autistic capsules in adults

ePub

Ne pas pouvoir joindre la vie antérieure à la vie présente, ne pas pouvoir la raconter en entier à quelqu’un, pas même à soi, telle est la solitude. Elle en étouffait plus d’un. Je savais que moi-même je faisais partie du lot.

[“Being unable to link one’s past life to the present one, being unable to narrate all this life to someone, not even oneself, this is loneliness. And this loneliness has stifled more than one life. I knew that I myself belonged to this group.]

F. Cheng, Le dit de Tianyi

Autism

I n 1911, Bleurer introduced the psychiatric term of autism, later taken up by Minkowsky, in 1954, to indicate a fundamental symptom in schizophrenic adult patients. “Autism” signified losing contact with reality, introversion, and loss of initiative. It was accompanied by other symptoms such as bizarre behaviour and hostility to the outside world. These patients had abolished all social relationships and lived in a strange, impenetrable world.

This term was subsequently taken up by Kanner (1943) and Asperger (1944) to indicate a psychiatric syndrome characteristic of childhood, and it was later widely adopted to define a certain type of personality. In psychoanalytic terminology, it was adopted to describe a state, position, or defence.

 

2: Vicissitudes of the transference in work with autistic adults and children

ePub

“I have always been distracted and ‘absent’. Now I understand the reason for this distraction: I wanted to run away from a relationship and reality. Even now, when I’m listening to the answer I’ve asked, I sometimes find it hard to listen because I feel so far away from the other person as soon as I have asked it.” Irene

This chapter describes similarities and differences in the course of psychotherapy as well as typical characteristics both of adult patients with autistic capsules and of autistic children. If we start from the premise that autistic mechanisms are created to avoid pain and because of the fear of disintegration, during therapeutic analysis it will emerge that the patients with autistic cores have experiences that are analogous to their infantile traumatic situations. Just as in infantile autism it is impossible to establish a real relationship because of a lack of awareness of differentiation between “me” and “not-me”, in adults we can see how the relationship with the analyst is either superficial or partially rejected.

 

3: Countertransference: an overview

ePub

“Once I didn’t speak at all … then I spoke without thinking … now speaking for me means getting tired, because it’s difficult to transform a thought into words and understandable sentences.” Renzo

During the last fifty years the development of psychoanalytic studies has focused increasingly on the concept of counter-transference. The initial interpretation of the countertransfer-ence as an obstacle to treatment was transformed into a useful and indispensable tool in understanding the patient. Since then, the countertransference has made the analyst more responsible for her verbal interactions with the patient, because she can no longer consider herself a detached observer but is involved in a complex relationship in which both actively participate in realizing their own self. In particular, the extension of psychoanalytic psychotherapy to also include autistic and psychotic patients has led to theoretical and technical modifications and consequently has determined additional changes in the concept of countertransference, which has taken on fundamental importance in psychoanalytic treatment.

 

4: Use of countertransference in patients with autistic capsules

ePub

“Once I looked at myself in the mirror and saw the external shape of my body but I did not feel I existed. I was like a shadow. I remember the anguish of being unable to distinguish the mannequins in shop windows from real people. I felt I found myself in a terrifying unknown world.” Irene

The use of countertransference in work with adults with autistic capsules is of fundamental importance, since these people tend to avoid emotional relationships. Due to the absence of emotional messages from the patient, the analyst will have to pay constant attention to her own inner world in order to recognize the patient’s different emotional positions through her own feelings, especially when the patient re-experiences early anxieties. The analyst will have to be in contact with her own regressive cores and connect her inner processes to those of the patient.

Because the transference relationship in cases such as these occurs on two different levels, the countertransference will also undergo similar oscillations. By analysing the countertransference, the analyst will be able to distinguish between the patient’s different projections and intervene in an appropriate way where are signs of a primitive catastrophic anxiety.

 

5: Working with adult patients with autistic capsules: obstacles to treatment

ePub

“When I was a child I learned to write in a mechanical way, just copying words. Only now, however, do I understand that my writing is like a sign that I exist. I used to read words without understanding the real meaning of the sentences. It made it so difficult for me to study.” Irene

The duration of the psychotherapeutic treatments of the patients I describe was frequently extended due to many external factors (interruptions, illness, etc.) and to difficulties in the analytic work because of a certain deadness in the emotional communication between therapist and patient.

Sidney Klein (1980) points out that in these cases, since it is impossible to contact one part of the patient, which is unknown to both patient and analyst, the analysis fails to bring about any significant change. The social situation and the intellectual activities of the patients made it difficult for the analyst to imagine that such regressive parts existed. However, in the cases described here, the request for analysis was motivated by acute symptoms such as depression, crises of depersonalization or derealization, psychosomatic diseases, or psychotic episodes. The main topic of discussion was the patient’s description of her or his symptoms.

 

6: Therapeutic factors in the treatment of patients with autistic cores

ePub

“Once, when I acted in a play, I re-experienced my past feelings of being lost in the world like a tiny grain of sand. Now, however, when I experience the depth and fullness of living, I become dizzy with excitement.” Irene

Despite the common denominator represented by autistic defences, each patient must be considered as an individual, just as each autistic child has his own particular personality (Alvarez & Reid, 1999).

How much is the autistic part of each individual related to the rest of the personality? We deal with the most archaic part of mental functioning, which does not use a symbolic language to come into contact with others, in addition to another, more structured, part that seems to relate to others in a more normal way. The analyst has accordingly to adopt a flexible approach so that she can adapt to the different levels of the personality structure as they are alternately presented.

For her part, the analyst has her own mental organization, which comes into play in countertransference responses where the experiences and projections of the two participants intermingle. Although the analyst has undergone a good analysis and is interested in doing

 

7: Elisa

ePub

History

Elisa came to my attention when she was 24 years old and finish ing medical school. She was a beautiful, fair-haired girl, dressed in an elegantly understated way, and interested in sports. A previous psychotherapy had ended in failure, so she started the therapy with serious misgivings about the therapist’s ability to help her. Because of the high level of depression and anxiety as well as the failure of the previous therapy, Elisa’s mother accompanied her to the first interview with me. Although Elisa would have to make a rather long journey each time she came to the three or four sessions a week, she agreed to begin psychotherapy.

Her evident symptoms included serious depression, ritual behaviour, obsessive thinking about perfection, and foreboding about the future, as well as her tendency to repeat actions and to being overwhelmed by parasitic thoughts. She suffered from crises of derealiza-tion, when she would be overcome by an uncontrollable, psychotic anxiety. When walking down the street, the environment would appear unfamiliar, lifeless, and cold, devoid of any human presence, and filled with foreboding of imminent death. I discovered over the course of the therapy that all these symptoms were intensely felt and did not

 

8: Irene

ePub

History

I first met this girl, whom I shall call Irene, when she was 17 years old. She had been brought by her mother to the children’s neu ropsychiatric outpatient clinic because of a serious crisis characterized by fainting spells and uncontrollable anxiety due to episodes of derealization. Once it was ascertained that there was no physical damage (temporal epilepsy), she was put under diagnostic observation, and psychotherapy was suggested. The main psychic symptoms were the following: crises of derealization and depersonalization; and a phobia of public places, especially crowded department stores, where she would become paralysed with fear due to her inability to distinguish between the living people around her and the mannequins in the window displays. She could not tell which bodies were real and alive and which were fake or “dead”. She did not understand whether she lived in the real world or in some other kind of world.

She had her first anxiety attack when she was an adolescent, during a party given by some friends. It was held in the basement of a house, and the confusion, the music, the smoke, and the voices gave her the impression of being in hell. Irene ran out of the building, utterly terrified, not knowing where she was and feeling as if she no longer existed. Subsequently, she would experience analogous sensations,

 

9: Ambra

ePub

History

I first met Ambra when she was 20 years old: she was a tall, stout girl with a mass of long, golden hair. She had a pale, rather strange face, with a questioning look and expressionless eyes. She looked as if she came from Mars. Both the tone and inflection of her voice, the way she moved, and what she said all expressed violence and were intimidating. Her questions required immediate responses. Her body wanted to impose itself on others in spite of her neglected and scruffy appearance. Her arrogance and desire to prevail over others were constant.

At that time, Ambra was prey to an acute dissociative crisis with erotomaniac delirium and ideas of being influenced and persecuted or envied by others. The acute phase, during which psychotic symptoms prevailed (delusional ideation, and a dissociative state) lasted several months and was accompanied by impulsive behaviour that was difficult to avoid, complications in her social relations, and the tendency wilfully to put herself in dangerous situations. The psychotic crisis exploded during her university studies.

 

10: Renzo

ePub

This case of a therapy started in childhood and continued into adulthood is included here to demonstrate how the emergence of the patient, Renzo, from autistic isolation was followed many years later by additional developments in his cognitive and emotional capacities after the therapy had resumed.

I was able to follow this patient for about twenty-five years, and this allowed me to make some interesting considerations regarding his autism. I shall not describe in detail the various phases of this therapy but only give an idea of Renzo’s development by summing up the various phases and providing some significant fragments. The recognition of the autistic capsules made it possible to recover his vital energy that had been frozen and abandoned for a long time. Certain details and specific problems have been left out since they involved separate issues from those under discussion.

During the first phases of the therapy from 9 until 16 years of age, some changes took place in Renzo’s relationship with me (Tremelloni, 1987), supported by an improvement in his behaviour and learning capacity. Already this seemed to represent a good result compared to his previous autistic closure. However, many years later, when therapy resumed because of the appearance of behavioural disorders, another part of the personality, which up to that time had remained

 

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