TOSCHI, Piera (Neuropsychiatrist)
Italy
Introduction
In the autistic world we sometimes find ourselves confronted with subjects who, even as adults, continue having infantile behaviours and serious difficulties in socializing, even though individually considered, seem to be geniuses. There is, for example, the case study we are presenting, who, when asked to tell us the exact day of the week corresponding to any given date of this century, can tell us the exact answer in just a few seconds. This same subject is also extraordinary in other areas, such as three-dimensional designs (even as a child), memorization of popular songs, meteorology and even in knitting.
Developmental psychology has not yet been able to explain the coexistence of infantilism and social confinement on the one hand, and unusual or curious talents, on the other hand. In autistics, it has been ascertained that the right hemisphere (the optical hemisphere) of the brain dominates over the left hemisphere (the one specialized in language): which could explain the mnemonic and eidetic capacities of some autistics, even in severe cases.
In our case, we prefer asking to
what purpose an autistic develops such talents, concluding that
since autistics can learn - without external help - mostly due
to there being no rapport with their social behaviour, it must
be due to motives of internal self confidence: mental patterns
settled in themselves (it is known that scientific models are
the antithesis of chaos) and constantly summarized, something
we know we find in the autistic condition, or rather, that they
are in a desperate search for order and regularity.
Introduction to the case study of 'Andrea'
We have followed A. since he was 3 years and 10 months of age (born 23.12.68). He was a handsome child, blond, light eyes, but with an absent gaze, fixed in space, indifferent to stimuli and calls. He hadn't spoken for a year. The first words spoken in the observation room were "Don't throw the balls", " Don't spit on the floor, you bad boy." These were internal admonitions, repetitive and singsong. Feeding him was difficult. He ate only what he liked and only when he wanted it. He wouldn't get undressed to go to bed, or even take off his shoes. He wouldn't look in his mother's face or into those of his three older sisters. Sometimes he would turn to his father if he wanted something. He inflicted injury to himself by hitting his head against windows until they broke and by hitting his own hands. He screamed and had uncontrollable crying fits.
Therapeutic intervention and intensive education, arranged just for him, led to a slow, but continuous improvement. A rapport was established, he'd look at us in the eyes and even a rare smile. We'd be included in his games and he'd say a few words. One of A's habits was to invent new short words; MAMPA= mamma and papa, PUMPI= his parents in the car, PEME= his therapist who substitutes his parents, GINGI= a record with the fairy tale of the Ugly Duckling on it.....
In June of 1980 (around the age of 11 or 12) A. finished the fifth grade of elementary school. He could speak, write, read, communicate and interact with his schoolmates. This very positive evolution had been possible since all along he had been learning many things of the world around him, and he could feel the care with which his parents, his sisters, his aunts and uncles and other relatives had been surrounding him. Such familiar favourable atmosphere was never lacking, even though during adolescence, the most vulnerable phase, many obsessive manifestations burst out which coincided with several unfavourable changes.
In fact, in less than 10 years, from 1982 on, his family moved three times and A. also went from one school to another and experienced different educational centers. We, however, remained in contact with him because we had an agreement with A'S family that he would continue meeting with his Psychotherapist and his Psychologist every Saturday, something which continues even today.
At that time the therapist suggested that A. write to his Psychologist about his problems. Thus started the vast collection of letters along with other writings and drawings.
Until now, between letters and other writings, in less than 10 years, we have reached over 225 pieces, without counting the hundred or so drawings which also reflect his various emotions, along with an inexact number letters to various other persons. These were mostly provoked by the fear of the ending of a friendship which he considered very important. At other times, they deal with venting against people (family or helpers) who, in his opinion, treated him authoritatively or with anger. In that case, we can define his reactions as auto or hetero-aggressive behaviour. In other moments of denial, he no longer speaks to or looks at a person, in the hope that the person will realize his mistake and change his ways.
Rarer are the happy moments, either remembered or programmed. At these times, A. always finishes with the expected celebration, a great dinner with trimmings.
His sensibility to atmospheric conditions is astonishing. He memorizes the minimum and maximum temperatures in various places for many years and reads the weather forecasts everyday in the newspaper. He doesn't want to talk about certain seasons, thus trying to control even changeable things like the weather.
Nevertheless, trying not to have a partial or tinted description of A., one has to remember that in any of the mentioned letters, A. communicates mostly about that which causes him pain or worry. In reality, A. has a life full of positive interests, be they his manual working of wood and leather, or the other unusual things which we have already mentioned.
But here are some direct evidences
that his horizons are more limited and agitated than peaceful.
Selected direct speech
The most insistent and intense emotions are provoked in A. when confronted with the fear of losing the support of people, be they his parents, relatives, the Psychologist, the Psychotherapist or helpers. It seems he has always connected the meaning of his existence to them. Thus, in almost all the letters, even in those where he complains about or criticizes the addressee, telling him how he should act so as not to cause A. pain, the beginning is always the same, "I care about you." Sometimes A. uses a more emphasized form, "I love you a lot" or "I'll never leave you" or "Never leave me" or "Friends for life" or "Friends as long as we're both alive". These variations are signs of a personality which was injured very early, since as an autistic child, but very intuitive like most children, he no longer felt loveable. He felt guilty for existing, since no one had tried to help him understand that he wasn't a "bad boy", but was wonderful and capable of doing good and beautiful things.
The autistic solitude of early infancy has gradually lessened since he has had targeted help organized with the collaboration of the Family at the Center, where he has stayed such a long time since the age of three and a half.
Few of the letters we have, refer
to his parents, and when they do, it is with very sober expressions.
The difficulties of maintaining a positive relationship with
both his mother and father at the same time emerge very clearly.
He writes, "Andrea treated his Mama badly, because he loves
Papa better." (letter #195). 'Treating badly' here means
attacking his mother, making her fall and forcing her to lock
herself in the kitchen. He didn't speak to her again for over
two years (from 1991 to 1993). In '92 he wrote, "You'll
see, I'll make up with Mama", but it took another year before
he did. The motives for such behaviour are apparently very fragile.
A. wanted to take a walk under the arches beneath his house,
but didn't want Mama to interfere. "Mama had better not
bother me (about the walk). Papa and my sisters will take care
of me." (L.# 240).
Those were two difficult years when A. didn't communicate with his mother, years of autistic regression in which it was like his mother didn't even exist. They were substituted with an obsession for keeping his mother under his control. A. is terrorized when something isn't under his tyrannical control. He was afraid of his mother and didn't want to see her, because she gave him admonitions, which he remembered very well.
A few years earlier he had acted in the same way with his father. "I attacked Papa. I gave him such punches and slaps and I yelled out the window, 'Doorman, come and calm him down.' I told him I wanted him to buy a "Giulietta" (a make of car), because when he had that kind of car, Papa was nicer." (L.#86) Actually, after having made peace with Mama, A. again had problems with Papa. He wouldn't look at him and wouldn't listen to him. A. would drive with him in the car and if he needed something, he would ask for it, but if invited to shake his hand, he'd do it turning his back on him.
The reasons? This is how A. vents with the Psychologist. "Help Papa to give Andrea kisses, since it's been four days that he hasn't seen him. Teach him to stop saying, 'That's enough' and 'What a pest you are'.... A. doesn't feel the need to speak to Papa for seven months." (L.#295)
"Convince Papa to calm down and to speak to Andrea calmly, because he's nervous and wants to watch TV" (L.#265) "Tell him that A. will always for his whole life, go down to the archway under the house whenever he wants, even after dinner for an hour, without asking permission from anyone, if his sisters aren't around."(L.#274) In other words, his self-sufficiency is pathologic, because it blocks the space necessary for communication. The fact that he speaks or writes about it, doesn't liberate him from autistic behaviour. On the contrary, it depresses him even more since he sadly declared to the psychotherapist, "Nothing ever goes right for me!" In this complaint, he seems to have pessimistically answered the question that he asked his mother in 1987, "Why are we born? Why are we alive?" His mother, overcome with emotion, didn't know what to answer.
To aggravate the danger of his frequent moments of crisis, there was even the death of his uncle Arturo two years. Mourned immensely by A., because more than anyone, he knew how to say the magic phrase, "Come to me, calm down, I love you." A. is hoping that his uncle, even from afar, will tell him those magic words, "Come to me, calm down," as if he were still alive. He asks the Psychologist to say his uncle's magic formula to him. He is looking for a successor to his uncle even in other family members, but the growing dissatisfaction leads him to long for "his uncle to come back from the dead in three or four days, exactly the 16.12.94, and as he will reappear walking towards the mountain and he'll say 'come to me, calm down.' " This he tells to the other people at the Center (where A. is now living). "When he comes back," he continues to write, "he'll come down from Heaven and sit on the right hand of his father Moreno." (Letters #296 and 276) A. also dares to write to his uncle at the cemetery where he is buried, and at the same time, to the Mayor of Florence who he invites to be present for the resuscitation of his uncle, giving the exact date and time established by A. (L. #283)
To us these initiatives and talk seem paradoxical and hallucinogenic, but in A. they spring from his profound hunger and thirst -for friendship and security. In this and in other similar situations, -A. repeats his pet phrase "If God wishes..... and God will want", because according to A's emotional logic, how could God not want something that is as urgent and necessary to A. as the air he breathes? In this claim, there is obviously a lot of egocentricity, infantilism, omnipotence and confusion. In one letter he even affirmed, "I promise to do always exactly what I want." But even in this claim, there is the push to search for help to not remain blocked and desperate inside the terror of the autistic solitude.
In almost all the messages directed to the Psychologist (more than 200), A. proclaims to be in perfect harmony with him, so much as to call him several times 'a second father' (Letters 121 & 147). "A. wants to see you as and considers you a second papa and wants to be your friend his whole life." Thus, when this second father runs the risk of disappearing from his horizons, because of transfer or illness, A. has no peace. He wants to do something about it. To this purpose he writes about 70 letters, makes phone calls day and night, advises treatments and proposes other persons who could be chosen for certain assignments in place of his Psychologist, who has to always remain available for Andrea.
It wouldn't be significant to quote these writings in length, because the same words are almost always used. Here is his quaint echo, "Dear Psychologist, I love you. Don't abandon us. If God wishes, and there's no doubt of it. I give you ten days time. Andrea is happy because God wishes it." (L.#317) Regarding his health, he writes, "If it is very cold, put on your hat that covers your ears, with your scarf around your neck and that way you'll be warm to come to us." (L#198) Finally, an unusual suggestion "Every evening and every morning you must place your face above a pot of hot water, almost boiling, and do lots of facial gymnastics in October and November" (it was about treating a facial paralysis due to cold).
Evidently such a strong attachment is accompanied by A's incredible needs. Each time the Psychologist disappoints him, for example because he says, "That's enough", instead of "Quit it" or "Stop it", he is more or less traumatized.
In less serious moments, but all incredibly memorized, he writes to advise changing styles. In a letter from the '80's (L.#140), between various events, recalled even pleasantly, but generally, he remembers the place and day between 1973 and 1983 when their rapport was a little tense. Since A. continually relives the past, especially the negative incidents, ¡t is no wonder that his touchy sensibility to just a certain word can trigger a sense of change with the ensuing fear of abandonment. He has no peace until an accord is again established. Again, with his usual style he concludes, "We'll stay friends forever, if God wishes, and God does .
In other more serious instances, when, his vulnerability is provoked by disorienting circumstances, (angry voices, authoritarian words...) A. reacts with shocking attacks of panic and self-destructive behaviour. When the crisis is over, he sends a lot of messages, one after another, to retrieve the hope that the friendship will continue (L.#14).
When such incidents have shaken him up, we note expressions in this tone, "I promise to reach an agreement with you... I don't want to see you angry. I send you lots of smacking kisses". (L.#145) "I promise not to cry for silly reasons, but dear Psychologist, be patient with A. who will be good" (L.#154). "Y want to make peace.... but don't get angry anymore... don't yell at A It won't help Please, put up with .... (Letters # 158-243-137).
Some of these humble supplications can be compared to those of one of his contemporaries (Birger Sellin), recently published with the help of 'communication assistance'
"Again I am doing many more silly things than usual, and I don't even know why an implacable willpower fails", "I can't control myself. Really, everyone at the Center has it in for me and only shout at me. I'm a catastrophe...." , "I can't stand it that they say stupid things about me .... that I'm bad... This anger makes me furious. I would rather be dead, a life with this suffering is intolerable. I hate all men" (pag.42 & 44) "I want to return and be welcomed into the lovely human society in a way that everyone can accept me...", "It's my wish to help autistics to understand their own world better ... and that they be treated differently in institutions." (pag.71)
We see similar behaviours in A. with the helpers at the community which he presently attends. Here, however, A. doesn't only say that he hit his head against the wall because a helper told him, "Hurry up" instead of "Walk!" , but he seems to almost enjoy telling about certain conversations where he protests that they didn't explain to him the reasons for doing certain things. He consoles, or avenges himself, with a drawing of six nasty helpers side by side, and underneath five friendly helpers. (L.#251)
We can't go beyond the limits imposed by this paper, but we want to at least point out that according to us, as well as other scholars like Jung, Bion, Benedette, and Scarles, communication through images permits us to work with the profound creative core of the Self which remains unscathed by the schizophrenic process.
The drawings (hundreds) by A. contain not only an unconscious communication intent, but permit even an unconscious therapeutic projection, present in the patient as well as in the therapist. (Notebook ASP - Dec. 95 Pag. 63/86)
Andrea remembers, in writing, even
happy moments of his relation with the Psychologist and with the
Psychotherapist (picnics, suppers, those which he calls 'therapeutic
outings', trips ... ) But these memories are only a frame for
the tale of his more difficult occasions.
Conclusion
The most practically interesting
and important aspect of A's world seems to be his total hope for
harmony and peace.
Everyone hopes that scientific research will soon work miracles in its knowledge of the autistic syndrome, and that it will also propose early and effective intervention to bring relief from this dreadfully oppressing anguish for this segment of humanity, which cannot be ignored (an average of 4 autistic children for every 10,000 births). Meanwhile, humanity itself, when confronted with anyone suffering mental illness or handicaps who hasn't been emarginated for the sake of consumerism and progress, can benefit from this, because mankind is rediscovering really human values towards one another and authenticity in the practice of equality and brotherhood.
For our part, we are convinced that by having helped A. start writing about and illustrating his difficulties, we have helped him not only to communicate his moods along with the suffering caused by his sensitivity and vulnerability, but also to liberate himself from them in a relatively short time. This is shown by the fact that when confronted with bigger problems, A. immediately and repeatedly turns to these means of communication.
Furthermore, the reading and analyzing
of his writings and drawings, has been, and is, very useful to
understand, to contain and to console those autistic subjects
who don't have the means of speech, and since finding it impossible
to communicate their suffering, often resort to desperate screaming
to attract our attention.
Finally, after this and other similar
experiences with autistics through the past 30 years, it seems
right and natural to us to close by accelerating our voluntary
services so that those like Andrea, who voyage daily in a stormy
sea of insurmountable anguish can have someone to cling to. Also
so they may sense that their lives are significant, individually,
or as a part of a more humane society.
SUMMARY
Andrea T., who is now 26 years old, has been followed by us since he was 3 years and 10 months of age. At the beginning his speech was sing song and repetitive, but not communicable. Intensive therapeutic intervention and an individual learning program facilitated his increasingly positive development. A. learned to read, to write and to communicate. He revealed a surprisingly precocious talent for drawing. At the age of 5-7, he could draw three dimensional pictures of his father's car, a crane and houses. At the onset of adolescence, at his therapist's suggestion, A. started writing about his emotional problems caused by unfulfilled desires and difficult situations. This rich documentation which we possess seems particularly interesting, not as much for the stereotyped framework which is always the same, but more for the emotional tension which prevails in his message. The messages are usually directed, but not always, to the Psychologist and always begin with these words, "Dear XY, I love you..." The emotional tension of this message at times is such that A. repeats these words five or six times in the same letter.
A. is endowed with an intelligence
which in some areas exceeds the norm, like being able to give
the exact day of the week for any given date for the past 50 years,
but his relationship with adults is disturbed by the fear of rejection.
His written messages very often signal the shadow of these nightmares.
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