As so often happens, the poet sees things in the mind's eye that
science cannot see with the human eye. I believe that Jorge Luis
Borges, the Argentinean poet and writer is describing the world
of autism in these lines:
No habrá nunca una puerta.
Estás adentro y el alcazar abarca el universo
y no tiene anverso ni reverso
ni externo muro ni secreto centro.
Laberinto. Jorge Luis Borges.
The main purpose of my presentation today is to communicate an
experience. This took place in the context of a special atmosphere,
which was essential to the full realisation of the experience.
In order to describe it to you I have divided my exposition into three parts:
a) The context in which the experience took place, which I call the structure.
b) A brief descńpbon of previous psychotherapeutic experience with autistic children.
c) My own experience as a psychotherapist with children with autistic features, especially
with the post-autistic state of mind.
a) The structure:
I am going to start with the structure, because that is really
the framework where the experience took place. By structure I
mean: the process of diagnosis, the organization of the educational
units, the different therapies and in particular, the collaboration
of the parents.
Children in Touch is a charity aiming to support the therapeutic
education of autistic children. The work started in the Chinnor
Unit in 1973 in response to the needs of one moderately autistic
young boy. Now, in 1996, a total of 60 children attend the three
teaching Units based in Southern England (Oxford, Thame and Chinnor).
As the demand and the response grew, the Units continued to focus
primarily on educational needs, but gradually began to introduce
a variety of therapeuttic techniques. These methods now include:
holding therapy, the Woldon method, music, speech and art therapy,
drama therapy and psychotherapy.
b) Previous psychotherapeutic experiences:
The psychoanalytic view of autism, originally calied Early Infantile
Autism, was first described around 1946, and was thought to be
a very rare affliction. Gradually it came to be
recognised more and more as being something that any child could
go through as a phase of autism quite early on and recover from
- wholly or partially.
From now on I am going to talk about autism with
nongenetic or organic cause as Francis Tustin described in her
book "Autistic States in Children". Here, the term
autism tends to have three different references: first of all
to autism itself, as a full blown mental state; post autism which
is the children who have recovered from autism partially but enter
into a confusional state; and the children that have what are
called "autistic features" in their personality.
My own work has developped out of the work of my
teachers in this field, the work on autism by Francis Tustin and
Donald Meltzer, whose book Explorations on Autism has inspired
my work.
I'd like to describe briefly the psychotherapeutic
method.
Children in Touch has a long history or tradition
of incorporating the additional support of different psychotherapists.
These therapists work in constant interaction with the central
or care activities; the result is a sort of multidisciplinary
group af work. All of the psychotherapist have been using a variety
of play techniques and working in a similar kind of setting.
The setting and the context could be described briefly as:
- Psychotherapy if a method that allows the child to externalize his/her internal world, feelings, states of mind, conflicts, etc... using toys, action, verbal and no verbal communication.
- The role of the therapist is to facilitate this
work and break through especially at the moment of change and
crisis, trying to be in contact with the child in the area of
feeling, imagination ant thinking.
In terms of the outcome, our experience has been
that some children have reacted very quickly to psychotherapy
while for others the process has been much slower.
In the majority of cases after coming out of the
autistic state of mind, a process of development was established
which facilitated a clarification of different areas of the life
of the child promoting learning processes. The collaboration
and participation of all the famifies involved deserves a special
mention.
c) My own experience.
I am going to talk briefly about the psychotherapy
of 4 children with different features, that reveal autism but
with a large part of the personality living in a post autistic
state.
I am going to concentrate especially in one of the
specific moments of catastrophic change as it was called by Bion.
Sometimes I think that it would be more properly described by
the paradoxical term claustrophobic change.
I am going to talk in general because of the restrictions of time but also because of confidentiality. I am going to try to describe mainly what seems to happen when the child
is coming out of the autistic features. But first 1 have lo focus
attention on the feature itseif.
The essential characteristic is one of dismantling the mind and using obsessional devices.
I have to explain a little bit the meaning of the obsessional devices. For most children in the period of frantic ambition the development - between 6 months and 4 years - the disappointments and the frustrations are modulated by the availability of the parents to recover temporarily its sense of omnipotence: that they are willing to pick the child up, confort him or baby her.
But some children adopt a device of their own which leads them to an entirely different orientation to the world, and that is a device of manipulating their attention, and enables them not onty to obliterate the parents, but to obliterate the world as a world of interest where frustration and disappointment can occur.
The essence of the device is to enable the child to destroy temporarily
the level of relationships that percibes persons, and the self
capable to relate to these people the level of meaning and the
level of objects sometimes called the consensual level of perception,
where all the senses are joined together in consortium to percibe
persons and their qualites. The way that it is done is by reducing
all perceptions to the level of sensations, which can then be
easily separated one from another, so that, with any particular
object that is encountered, it is encountered with only one sense
organ, so that the world became a world of diverse objects each
one with sensual quality.
In the case of one child, the relic of the autistic feature became
mysteriously concentrated in a collection of coins. In another
case, the obsession was directed at broken things. In a third
case the child had an image of being frozen with a hammer trying
to break the ice. In the fourth case, the obsession was with
faeces. When these children move out of using these obsessive
mechanisms, they become very vulnerable as if they had no skin
and generally react in a violent way to frustration and change.
It is important in the first three to four years of the psychatherapeutic
process to establish the conditions which allow for the possibiiity
of the child to come out of the autistic state of mind and to
enter into a post autistic stage and later set in place a process
of development.
Its worth mentioning too the importance of slowing down the obsessive
devices because they are blocking the process of leaming. The
use of characteristic primitive obsessional mechanisms and the
separation of the senses is the central obstacle which stops the
learning processes for these children.
I want to emphasise the importance and the significance of the
moment of tremendous change in the child, what I would like to
call claustrophobic change. At this point, and in my experience
of the process of coming out of an autistic state of mind, it
is essential to maintain continuity in the working team with the
school, parents and teachers. It is at this moment where the consistency
of the structure is tested, and definitively the desire and capacity
of the analyst to carry on with the work.
This moment is of tremendous importance because the child is coming
out of a world where he or she knows what is happening and is
comfortable to one where the uncertainty is great and representing
a kind of second birth - a mental birth. The child seems to live
in a sort of cave world in which they are very sensitive to
light, sounds, sensations, surfaces, etc.
On leaving the autistic state, it is worth mentioning that there
are some children who enter a kind of confusional state which
takes sometime to work though: in some cases it is very difficult.
The urgency to have some kind of therapeutic attention is based
on the fact that children are wasting or losing emotional and
mental development time which is difficult to recover - and sometimes
impossible. Early diagnosis is seen to be crucial. This state
of holding the sensations and the management of the senses through
the claustrophobic change can turn into the possibility of beginning
to develop other exeperiences which permit the child to grow emotionally.
This includes receiving and understanding symbols as well as
to begin learning processes and to develop other types of interests.
The child that was collecting coins, whom I referred to earlier,
started to make jewellery and develop other interests and was
able to attend classes in a mainstream school. The child that
was obsessed with broken things was able to work through his aggression
and destructiveness; he was also more able to attend mainstream
classes. At the moment, his main preoccupation is with exams
in the school. The child that used to see himself as frozen now
is a lively child. There are still some difficulties in the area
of speech that we are still working on. And finally, the child
who was concerned with faeces is responding very positively to
psychotherapy, but it is still early days in his treatment.
The work is a kind of constant maintaining of work groups with
specific tasks appropriate to keep the structure - without being
so rigid that it breaks down nor so flexible or loose that it
disintegrates.
This concept and implementation of the structure has been very
useful and successful not only for the children but also, and
especially, for the parents.
I believe that the autistic and confused state of mind in a child
without brain damage, is not irreversible, however difficult.
Important possibilities for these children can be opened, nothing
spectacular but possible.
The moment of coming out of the autistic state of mind is also
very important not only in relation to change but also in considering
the timing between the catastrophic change and the moment when
the child starts to play using differents toys and develops an
interest in another object as part of a thought process. As a
result, the children have a greater possibility of experiencing
a normal school life and the ability to cope with more stressful
situations.
The answer to the situation posed by Jorge Luis Borges: I think
there is a door for these children so they can come out of their
prison. This door is illustrated by the South American song sung
by the Uruguayan Cemir Cemaya:
Otra voz canta.
Por detras de mi voz,
escucha,escucha,
otra voz canta.
Viene de atras, de lejos,
viene de sepultadas bocas y canta.
Dice que no están muertos
escuchalos, escucha
mientras se alza la voz
que los recuerda y canta
escucha escucha
otra voz canta
Dice que ahora viven en tu mirada
sosténlos con tus ojos, con tus palabras
sosténlo con tu vida
que no se pierda
que no se caiga
escucha, escucha otra voz canta
No son solo memoria
son vida abierta, continua y ancha
son camino que empieza y que nos llama
cantan conmigo
conmigo cantan.
BIBLIOGRAPHY
Wilfred Bion. "Catastrophic change" Bulletin 5. British Psychoanalytical Society 1966
Donald Meltzer. Explorations on autism.
Francis Tustin. Autistic States in Children. Autism and childhood psychosis.