Psychoanalyzing a Vulcan: The Importance of Mental Organization in Treating Asperger's Patients

Abstract

The opinion that psychoanalysis is of little value in treating patients suffering from Asperger's syndrome is a relatively common one, even among fellow psychoanalysts. Several reasons have been suggested to account for this including the discrediting of psychoanalytic treatment for patients in the autistic spectrum because of Bettelheim's (1967) mistaken blaming of the condition on poor parenting or the assumption that a biochemically based disorder cannot benefit from a psychologically oriented treatment. This article suggests that a third reason has to do with the underlying model of mutative action used by many current day psychoanalysts. Implicit in most modern day Freudian work is a model of mutative action that prioritizes verbal interpretation and emphasizes the gaining of insight into unconscious mental content. Viewing the psychoanalytic task as deciphering the unconscious meaning of the patient's verbalizations ignores the problem that Asperger's patients have with mentalizing or developing a theory of mind. This article suggests that psychoanalysts shift their emphasis to promoting a process of insightfulness defined as the equivalent of mentalization as it occurs in the psychoanalytic situation. Insightfulness is similar to the Kleinian emphasis on promoting higher order symbolic thinking. The psychoanalytic treatment of a patient suffering from Asperger's syndrome is described to illustrate how the psychoanalyst works to promote insightfulness and how this approach differs from trying to uncover the hidden, unconscious content presumed to lie at the depths of the psyche. The patient described also illustrates the higher end of the Asperger's spectrum and the need not to let the character defenses that develop to cope with such a debilitating disorder not obscure the essential constitutional basis of the patient's difficulties even though, of course such limitations will become components of compromise formations.

Notes

Alan Sugarman is a Training and Supervising Psychoanalyst, Supervising Child and Adolescent Psychoanalyst, San Diego Psychoanalytic Society and Institute; Clinical Professor of Psychiatry, University of California, San Diego.