Psychosis in autism

ABSTRACT

This article discusses a unique form of withdrawal observed in children with ASD, using a detailed case study. This withdrawal can be understood as linked to a psychotic organisation, in addition to the autistic aspects and early developmental difficulties in the sense of self. A child on the spectrum with psychosis makes for a unique case, because the psychosis rests on an early developmental impairment. In such cases, a fragile self uses disintegration of the mind as a mechanism that enables blurring of the self. This defence mechanism is different from Tustin’s ideas about the autistic sensory blurring of the self through autistic objects and shapes. If this psychotic mechanism becomes fixed, it creates unique anxieties regarding the lack of self-nuclei. The constant projection of large parts of the self into outside figures creates a fear of rapid form transformation and poses unique challenges in analysis. A clinical example is given to illustrate these momentary states.

KEYWORDS:

• psychosis
• autism

Acknowledgements

I wish to thank Joshua Durban, Michal Zelinger Hanan Heller and Orna Ophir for their helpful comments on earlier drafts of this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. The issues raised in the article were discussed with Matan’s parents and I suggested they let me know once they had read the paper if they wanted to discuss it further. On receiving the article, they chose to sign the informed consent without reading it. Although I understood the necessity of this process, on discussing this with them I was put in touch with the fact that I was imposing my needs on them. Perhaps they were not ready to read about their son as a case study, and were relieved with choosing not to read the paper.

Jan’s analysis ended about a year ago. I telephoned the parents and sent them the article to read. They read the part about Jan, and sent me their agreement. The mother found it touching. No further discussion of the clinical vignette ensued. In Jan’s case, I felt quite comfortable to ask the parents for informed consent. The treatment has ended with a successful outcome, and the paragraph about Jan was short, indicating that he managed to overcome many of his difficulties. This I think also made it easier for the parents reading it.

Additional information

Notes on contributors

Ruth Weinberg

Ruth Weinberg is a clinical psychologist and a training and supervising psychoanalyst at the IPS, Israel. She works in a private clinic and teaches in the psychotherapy programme at the academic centre of Tel Aviv University.