Post-Autism: A Psychoanalytical Narrative, with Supervisions by Donald Meltzer

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Post-Autism recounts in close and vivid detail the story of the author's struggle to analyse and communicate with a pubertal boy who presented with a diagnosis of untreated infantile autism. Marisa Melega, who was at that time a young and relatively inexperienced analyst, worked with Mario in Sao Paulo, Brazil, from 1978 to 1982 and during most of that period the case was supervised by Donald Meltzer, who had recently published his pioneering work Explorations in Autism, based on ten years of collaborative endeavour with a group of therapists. At that period the condition of autism was relatively little understood, and psychological therapies undeveloped.This book is therefore of particular interest from several viewpoints: as a detailed record of autistic features and their manifestations in a teenage child; as an example of the potentialities of distance supervision (for communication was mainly by post, though there were some meetings); historically, as a basis for comparison with our current understanding of the condition and the efficacy of psychoanalytic treatment; and perhaps above all, as an intimate record of the making of a psychoanalyst, by means of a particularly difficult yet highly emotionally stressful relationship with a patient. As Melega writes in her introduction: "I received brilliant lessons from Donald Meltzer that have enlarged my general psychoanalytical capacity to investigate the transference and countertransference ... to avoid sticking exclusively to verbalizations, and to search for my own oneiric images during the sessions in order to make analysing Mario possible."

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CHAPTER ONE Mário and his stories

PDF

CHAPTER ONE

Mário and his stories

M

ário was referred to me aged eleven years and nine months, and his treatment lasted around seven years, monitored over most of that time by Donald

Meltzer, with a review of the case eighteen years later. The following narrative will demonstrate the steps taken toward building an analytical relationship with the boy, and testify to the analyst’s emotions in the face of the difficulty of establishing a link that could evolve into a growth relationship. When

Mário came to me for analysis, I knew that he had severe difficulties in getting in touch with reality and a strong learning disorder and, when he was almost two years old, presented with autistic behaviour, according to a clinical assessment made by a neurologist at the time.

Mário’s developmental history

From the very beginning of his life Mário’s fragility in his object relations was clear: he had difficulty in taking his mother’s nipple, took too long to suck; his mother had the impression that he didn’t like feeding until at two years of age, he started to

1

 

CHAPTER TWO Applying the post-Kleinian understanding of autistic states

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CHAPTER TWO

Applying the post-Kleinian understanding of autistic states

D

uring the analysis’ fourth semester I started to get acquainted with the picture of autistic mental structure arrived at by Meltzer in Explorations in Autism

(1975). I began to see things going on in the consulting room that I had never seen before. Although Meltzer stated that the analytical technique to analyse children like Mário was the same as with other children, in the beginning I found it difficult to situate myself within the very deep comprehension of the ongoing analytical process that this entailed. My difficulties I believe resulted from a training still insufficiently equipped to make use in the clinic of the concepts introduced by Melanie Klein and extensively taught and often improved by Meltzer himself.

The clinical work with autistic children undertaken by the group of Kleinian psychoanalysts under the supervision of

Donald Meltzer in Explorations resulted in proposing the following modalities of mental functioning in autistic children: a special kind of dissociation that Meltzer called “dismantling”, a notable difficulty with the categories of space and time, an archaic use of

21

 

1 - Mário and his Stories

ePub

Mário was referred to me aged eleven years and nine months, and his treatment lasted around seven years, monitored over most of that time by Donald Meltzer, with a review of the case eighteen years later. The following narrative will demonstrate the steps taken toward building an analytical relationship with the boy, and testify to the analyst's emotions in the face of the difficulty of establishing a link that could evolve into a growth relationship. When Mário came to me for analysis, I knew that he had severe difficulties in getting in touch with reality and a strong learning disorder and, when he was almost two years old, presented with autistic behaviour, according to a clinical assessment made by a neurologist at the time.

Mário's developmental history

From the very beginning of his life Mário's fragility in his object relations was clear: he had difficulty in taking his mother's nipple, took too long to suck; his mother had the impression that he didn't like feeding until at two years of age, he started to be fed with a bottle. During the first three months, he cried his eyes out, day and night, apparently due to colic. Then he would calm down and wherever his mother placed him he stayed calm, provided she was close to him. His mother reports that she didn't hold him on her lap except at feeding time, so that he wouldn't get in the habit of expecting her to carry him around. At ten months, he started speaking some words: “dada”, “mummy”, “pooh”; imitated his father saying “get out”, and tried to say a girl's name, “Heia”. He was never a happy child. He started walking at thirteen months. At eighteen months, playing hide-and-seek with his uncle, he was startled by his uncle appearing suddenly, and began to cry and laugh. From that moment his behaviour changed; he stopped speaking and wouldn't look at his mother or other people. He was very restless and kept walking all day long, moving his arms a lot, sometimes so he hit his ears. He was not interested in any toy, and looked like a puppet that walked and ate.

 

2 - Applying the Post-Kleinian Understanding of Autistic States

ePub

During the analysis’ fourth semester I started to get acquainted with the picture of autistic mental structure arrived at by Meltzer in Explorations in Autism (1975). I began to see things going on in the consulting room that I had never seen before. Although Meltzer stated that the analytical technique to analyse children like Mário was the same as with other children, in the beginning I found it difficult to situate myself within the very deep comprehension of the ongoing analytical process that this entailed. My difficulties I believe resulted from a training still insufficiently equipped to make use in the clinic of the concepts introduced by Melanie Klein and extensively taught and often improved by Meltzer himself.

The clinical work with autistic children undertaken by the group of Kleinian psychoanalysts under the supervision of Donald Meltzer in Explorations resulted in proposing the following modalities of mental functioning in autistic children: a special kind of dissociation that Meltzer called “dismantling”, a notable difficulty with the categories of space and time, an archaic use of the obsessive mechanisms, and the phenomenon of mindlessness that can be viewed as an extreme case of dismantling.

 

CHAPTER THREE Technical problems of the analysis

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CHAPTER THREE

Technical problems of the analysis

I

n this chapter, we can see the deeper focus on some of the technical problems of this analysis, discussed with Dr

Meltzer, as these became especially apparent during the next semester of the analysis, from January 1980 onwards.

Session of January 29th, 1980

Mário enters and immediately starts shouting at me:

Mário: Shut up! Otherwise I’ll cut your mouth or I’ll tie your mouth or I’ll cut your hand! What would you rather have done to you?

And he carries on with the business of filling up a page with numbers in decreasing order, then shows me the CIAM student list (his special school). I ask him if he is still going to study at CIAM this year (a decision to be made before he goes on holiday). He nods and tells me to shut up.

Analyst: You feel I am a threat every time I say something.

What do you expect me to do? Am I supposed only to listen to you?

43

44

POST-AUTISM

 

CHAPTER FOUR Fighting the use of autistic objects

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CHAPTER FOUR

Fighting the use of autistic objects

T

his chapter covers a period (1981–1982) in which I focussed on the problem of dealing with Mário’s use of autistic objects, and made some experimental explorations. From April 1981, I decided to make my presence more emphatic in order to tackle this problem. It seemed it was not enough to simply speak aloud, to ponder, to show that I am present; this approach still tolerated the use of autistic objects.

So from this time, when he came in and started telling his stories or enumerating his lists, I tried standing up myself, in a more confrontational way.

When I saw, for example, that he was listing a numerical sequence with an interval of four figures, I spoke the next number in the sequence, showing him that I had solved the riddle. He became furious, hitting me and trying to wrestle back control by forcing me to go back to “my place”. On other occasions he would threaten me, assaulting me with the cushion, the footstool, the box, kicking out and climbing onto the table so that he felt more powerful than me.

 

3 - Technical Problems of the Analysis

ePub

In this chapter, we can see the deeper focus on some of the technical problems of this analysis, discussed with Dr Meltzer, as these became especially apparent during the next semester of the analysis, from January 1980 onwards.

Session of January 29th, 1980

Mário enters and immediately starts shouting at me:

Mário: Shut up! Otherwise I’ll cut your mouth or I’ll tie your mouth or I’ll cut your hand! What would you rather have done to you?

And he carries on with the business of filling up a page with numbers in decreasing order, then shows me the CIAM student list (his special school). I ask him if he is still going to study at CIAM this year (a decision to be made before he goes on holiday). He nods and tells me to shut up.

Analyst: You feel I am a threat every time I say something. What do you expect me to do? Am I supposed only to listen to you?

Mário: Right.

Analyst: Like a bucket? I just take in everything you say?

 Mário: Right. If you don't shut your mouth within ten minutes, I’ll cut out your tongue.

 

4 - Fighting the use of Autistic Objects

ePub

This chapter covers a period (1981–1982) in which I focussed on the problem of dealing with Mário's use of autistic objects, and made some experimental explorations. From April 1981, I decided to make my presence more emphatic in order to tackle this problem. It seemed it was not enough to simply speak aloud, to ponder, to show that I am present; this approach still tolerated the use of autistic objects. So from this time, when he came in and started telling his stories or enumerating his lists, I tried standing up myself, in a more confrontational way.

When I saw, for example, that he was listing a numerical sequence with an interval of four figures, I spoke the next number in the sequence, showing him that I had solved the riddle. He became furious, hitting me and trying to wrestle back control by forcing me to go back to “my place”. On other occasions he would threaten me, assaulting me with the cushion, the footstool, the box, kicking out and climbing onto the table so that he felt more powerful than me.

 

CHAPTER FIVE Mário reaches adolescence

PDF

CHAPTER FIVE

Mário reaches adolescence

I

t is now February, 1983. Our sessions continue after a six weeks’ holiday. At the beginning of the year he continues with his list of candidates, which takes about two months to complete and runs to around 58 pages. The sense I make of this “great invention” is that of a manoeuvre that will infallibly maintain neutrality in the face of the threat of my attempts at

“anti-neutrality”. I believe this is the only way he can be with me. If I threaten to get up and leave (fighting against his mental customs), he gets up and leads me from the door back to my seat, asking me to stay. However his use of autistic manoeuvres has somewhat decreased. It seems we have reached a modus vivendi in which he feels bonded to me, does not dismiss me, and is more often able to listen to me.

Session of February 10th, 1983

As soon as he enters, Mário starts to draw up a calendar for

1983.

Analyst: Strange child. Now we’re getting a 1983 calendar.

 

CHAPTER SIX Review

PDF

CHAPTER SIX

Review

I

n July 1997, eighteen years after the end of Mário’s analysis,

I reviewed the case with Meltzer in a supervision group at

Oxford, which also included José Americo Junqueira, João

Carlos Braga, and Marli Braga. After reading out the introductory sections, the first meetings, and the session of August 15th,

1979 [page 23, above], Dr Meltzer commented:

Meltzer: It certainly reminds me (and probably at that time reminded me) of a boy we had in Oxford who was in the process of progressing from being autistic and mute to gradually becoming more and more schizophrenic. He also had these very elaborate, quasi-historical stories that he made up, which were really confabulated but had their roots in history and Bible stories and things of this sort. This boy was more particularly rooted in the

Old Testament and the story of Abraham and Isaac, and the old man and the old woman were Abraham and Sarah. He was very preoccupied with this.

 

5 - Mário Reaches Adolescence

ePub

It is now February, 1983. Our sessions continue after a six weeks’ holiday. At the beginning of the year he continues with his list of candidates, which takes about two months to complete and runs to around 58 pages. The sense I make of this “great invention” is that of a manoeuvre that will infallibly maintain neutrality in the face of the threat of my attempts at “anti-neutrality”. I believe this is the only way he can be with me. If I threaten to get up and leave (fighting against his mental customs), he gets up and leads me from the door back to my seat, asking me to stay. However his use of autistic manoeuvres has somewhat decreased. It seems we have reached a modus vivendi in which he feels bonded to me, does not dismiss me, and is more often able to listen to me.

Session of February 10th, 1983

As soon as he enters, Mário starts to draw up a calendar for 1983.

Analyst: Strange child. Now we're getting a 1983 calendar. This is too much!

Mário continues as if nothing had happened.

Analyst: This is impossible! I shall have to leave. (I get up.)

 

6 - Review

ePub

In July 1997, eighteen years after the end of Mário's analysis, I reviewed the case with Meltzer in a supervision group at Oxford, which also included José Americo Junqueira, Joao Carlos Braga, and Marli Braga. After reading out the introductory sections, the first meetings, and the session of August 15th, 1979 [page 23, above], Dr Meltzer commented:

Meltzer: It certainly reminds me (and probably at that time reminded me) of a boy we had in Oxford who was in the process of progressing from being autistic and mute to gradually becoming more and more schizophrenic. He also had these very elaborate, quasi-historical stories that he made up, which were really confabulated but had their roots in history and Bible stories and things of this sort. This boy was more particularly rooted in the Old Testament and the story of Abraham and Isaac, and the old man and the old woman were Abraham and Sarah. He was very preoccupied with this.

I then read out the session of August 16th, 1979 [page 24].

Meltzer: You certainly had a very therapeutic impact in the first session, which he announces to you immediately, that the werewolf has been captured and the gold recovered and so on. He really settles down to some sort of communication with you in which you are working almost purely with your intuition, because the content of what he says isn't really intelligible. But the mood and the flavours are what you pick up and what you talk to him about, and he seems very gratified by this – that you are not bound to language, to the verbal level. You are willing to take language in its wider, communicative aspects and so get at his feelings about things. This is very promising really.

 

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