Say hello to the scream extractor: working with an autistic child with psychotic mechanisms

Abstract

This paper describes the first two years of intensive psychotherapy with a six-year-old boy diagnosed with autism. I explore the many ways in which he retreated from reality, most frequently by taking refuge inside the maternal body or flying off into an imaginary space world. He fragmented his identity and that of his objects by using the discourse of fictional characters. Everything was externalised; there was little transmutation of material available for thought. I consider his dilemma – the wish to fuse with the object and the fear of being engulfed; the omnipotent denial of the need for an object and of the parental relationship, leading to an inability to make links. The paper discusses working with a child who experienced any ‘paternal’ firmness as persecuting and destructive. The softer, receptive maternal mind of the therapist was more easily tolerated. He gradually began to internalise a more benign combined object, as he became more able to bear separateness from the other.

Keywords:

• Psychic retreat
• fragmentation
• fusion
• omnipotence
• psychic bisexuality
• attacks on linking

Acknowledgement

I should like to thank Edna O'Shaughnessy for her invaluable help in the supervision of this case.