Tha elf nd eto ‘This is a rich, thought-provoking, scholarly book, Ite good bibliography gives acces to the growing literature on indi iduation ia small children in a way that wil, T hope, eagage the interest ofall analytical peychologist Note: ‘The review of The sf and te objet world, by Edith Jaccbson, ‘was originally publithed inthe International Journal af Psycho. analysis 46,4, 19855 that of Oe fama ymblae andthe itd ef indistaton, Vl. I, Ifo rehass, by Margaret S. Mahler, in the Journal of Analytical Prychology, 7, 2, 7972 6 CHAPTER SEVEN Infantile autism: a disorder of the self” ‘An outline theory ofthe self and its relation to individuation ‘nas been developed and the ground has now been lad for considering theoretically particular disorder of childhood, ‘oneering work has been done in defining the syndromes of| infantile autinm by Kanner, rsdley, Bender, Heller, De Sanets, Weygands, Despert, Creak and others, while the psychoanalyst Mabier, Klein, Tacs, Rodrigué,Betelheim and ‘Turin have made significant contributions to its poychologial steuetnre and is origins tis apparent, when reviewing the Fiterature, thatthe eases decribed, analysed, and weated by differing. therapeutic ‘methods, with varying erly are dificult to evaluate because diagnoses are meatly inuficienly specie and the prognosis consequently uncertain. Creak wed to resolve the problem by iolating nine characterises and specifying that to make @ diagnosis of autism a child must show a specified mumber of them. Hee method aimed at defining objecive criteria, bt the way in which they were interpreted by clinicians showed that ‘hey were unrdiable so, ifthe characteraes ean be interpreted so ciferently, its doubtfal whether her own achievement can be asened at objective either. Definition of Infantile Autism Tn 1958 Antony organized esiental data and succeeded ia spewing the varius fyadroms na wef and workable way + Presoay pubind ws “Une thle de Pie i La pti {Fon 8g, Canes sherri onde ”Toe sf and eiom see ri (eiood fay Influenced by peychoanalytic theory and Piaget’ formu lationt as well, be telated. primary end secondary autem 10 primary and secondary narcas, ‘The clasification i helpful ax it places the disorders in. 1 ‘context; on the one hand the pathological forms are related 10 formal states, and on the other to neurosis sod organi brain disease, Antony manages the varity of syndromes observed ia linia practice by elasming that each entity can combine with another, so thatthe cases presenta continuous spectrura Father than a numberof discrete dseareentitc. “The distinction between primary and secondary astm has heen accepted by both Mahler and Tustin who have each developed i rut, and they confirm Antony’ view, a8 I do fako, that chere are many eases tint do not ft ealy to either ‘ype of disorder "The eifferental diagncees of idiopathic primary autima are Decween brain damage and mental defoct, ‘The less serious secondary autism is to be differentiated from the obyestional inorders though thie idea ar recently been contested by Meluer: following Bion he hat explored the pasty that ‘bsesional states are more lke autem than other donde, and thatthe two may be genetically related, 8 Inflated of th elf Progao: ‘Mutism is the best indication of « poor prognecis, ‘Those children who never speak or use only’ a few words are les Tiely to recover chan these wo start to speak and then regres in response to a specific external event, ch as the birth of Sbling, which acts traumatcally (compare cases Jamen and Anthony infra), The symptom suggest that the core of the lisorder stems from the early Life of the infint. Influence of Mother As tothe influence of the mother, Antony finds, in agreement ‘with ethers such sa Mabler (196g), that in the primary group Shei les significant than in the secondary group and that, in rast cases, the influence of the mother, though always signi ficant, isnot decisive. Ieison thie ground that Use designation of idiopathic infantile autism can be justified. ‘Neither Winnicott nor Betelaeim (1967), who has unique experience in this fel are at all of thin opinion: Winnicot ‘considers that there has been an environmental defect, while Bettetheim goes so far as to contend that antistic children are autistic because they came into the world and were confronted ‘with mothers who wished for their deat, Scope and method of Present Thesis In this paper T shall define che characteristic features of iiopathic autism and, to do hig structural models relevant to analytic procedures will he wed to organize observations fom fase on which T have reported in Part Three infra, Experience has also been gained through observations on other children seen fr conmiltation and who were edacable. "For present purpose it js fst propased to consider the children alone, as if the parents or other persons in the enviton= iment were nonexistent. Justification for this procedure is cevidendly called for, expecially as environmental factor were ‘withoat doubt also important in both the genesis and main- tenance of their disorders. The fist justiication is empirical: nterating observations can be made using analytic pro- cedures, hich show how influence ean be exerted and changes 7”Ti sof ond ation observed in the child hime The second justification is theoretical tress on the theory ofthe ef at T have elaborated itn the earlier chapters of this book and elsewhere, Genetic Theories ‘There are two groups of genetic hypotheses available: 1. Those that postulate a barier that i et up between the child and the external world and thae protects his inner world (Antony, 1958) This hypothesis preeuppores that the child it Dom. with a constitutional stimulus barrier, which is sttong er extra seasiive and becomes pathological as a defence ‘gaint excessive, inmuficiently reliable, or gras defective miatemal care, '2. Those that donot pretuppose a barzier fom the beginning, ‘though it ean and does become etablihed later ‘Mahler (1960) holds Use the disorder stem from two stages ofinfnt development that have not been outgrown, In one the infant shows primary autism and has no awareness of is self 8 distin from the inanimate environment. She next distinguishes f stage in which there is a "mother-child tunity, which i characterized by delusional, omnipotent symbiotic faion with the needing object’ (bid, p- 938). This formulation presupposes that thare are two separate pertona, mother and infant, who fase. The two stages aze conceived to ie a the root fof wo nds of prychosiss primary autistic peychosis and ‘symbiotic psychosis: The laticr shows the characteristic “rage Panic reactions’ to minimal fstrations. Here a rudimentary and insecure boundary between the mother and infant must be assured. These two syndromes are not incompatible, nor ned they be rigidly separated; indeed, in any cae under testment, she in line with others, holds that characteristics ofeach may be found and so the concept of a barsir ean be wed to explain some of the behaviour inthe whole group and even in those children whose disorder must have erysalized in he fest weeks of extraterne Ke. ‘Aa how the barrier comes into being: there are chose who ‘think that itis wholly due w environmental flare (Winnicott), for to a death wish on the part of the mother (Betelaeim); those who contend that it develops out af aa infantile poyehote Aepresion (Tustin); those who look for organic flare of the & ther | Infantile ato disorder ofthe self arousal mechanisms in the centrencephalic stem (Rimland); finally, the origin is placed in sme daorder of intrauterine Hie Gender} Relation to the ‘External? Object Ie is clear thatthe child’ relation to the “external” objoct must bbe the main focis of attention Ifthe views of Mahler (and ‘others at well) are correct there cannot be any firm distinction between what is interuel and external wnt the child has reached a Hage at which the ego strong enough to make such Aistinesons; that is, until primary autism and the state of fusion have been ved through and superseded. "The idea that ee relation to the ‘eteraal” objects the most fementary ofall the characteristics of autism so fax considered {s supported by some mothers who can look back and detect that the disorder originated from soon after birth when ‘breastfoding had been established. Ifthe hypothesis of such an carly otjgin be established then ie most ulltely cha the ore fof the disorder cam be undertood in terms f the child’ retreat {nto an inner worl (Here a dificuty in terminology arises in that what looks to the adult ke interna? and ‘eternal’ expesience ofthe infant or {child is not so experienced by him, wo Tpropose to put the to Swords in quotation marks unles the data provided by the ebild early indicates that the experience is related to @ known boundary between the child's ianer and outer object.) "The autei chil’s relation to objects has been extensively seudied, Te has been observed that any object that engages the cies interest must comply with what he wants to do with i the object can be anything rom a toy toa part of a person-—bis hhand or arm, for instance which the child will manipulate to his own end TF the object does not comply with the chile’ neds, he wil either cease to he intersted and treat i as iit {oes ot exist or he will ly into a rage or panic. The objects that are used and that comply with the child's needs are called autistic on, at ¥ would prefer, selF- object. "There iy however, another kind of relation to object that has not received the same ettenton, the child's clase Inspection of fealty. ‘That this is posible for autistic children came as furprse to me. When I fit made the observation many years Br