Further Thoughts on Miriam Voran’s Response: Containment, Origin of the Self, and Pathways to Autism

Abstract

Miriam Voran’s original article, “Containment, Origin of the Self, and Pathways to Autism,” and her responses to the commentaries by Allen Schore and myself highlight the issue of how we align clinical evidence with psychoanalytic perceptions in very young infants at risk for autism. I consider that it is perhaps premature to pathologize defensive behaviors and use psychoanalytic theory to interpret a 6-month-old infant’s experiences of their own vitality, doubting if they are capable of distinguishing between “self” and “other,” as they do not yet possess language or “theory of mind.” However, as long as we do not have clear biomarkers to diagnose autism, we shall have to rely on our clinical observations. Similarly, psychoanalytic and psychodynamic concepts may play a valuable role in opening insights into aspects of the inadequate development of the self in infants at risk for autism, which presumably is the core of autism. Children with autism are extremely sensitive to the environment as a result of their lack of sensory regulation and are also easily fraught with anxieties. One of the major questions presented in this article is whether existential anxiety appears as part of the development of the self or does the self fail to develop, because it is inhibited by anxiety. However, I would like to suggest that this crucial phase is a significant window of opportunity for therapy.

ACKNOWLEDGMENTS

I would like to express my gratitude to the Mifne clinical team for their helpful input, and to Dr. Susan Warshaw for her invitation to further discuss this challenging subject of infant development.

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Notes on contributors

Hanna A. Alonim

Hanna A. Alonim is an expert in the Autism Spectrum in Infancy, Founder and head of the Mifne Center for Infants and Families since 1987. She has been Head of the Therapy Training School for Autism at the Bar Ilan University since 2001. She developed the Early Signs of Pre-Autism Scale for Infants (ESPASI) in 2005. Alonim is the founder and counselor of the Infants at Risk Detection Unit, the Tel Aviv Sourasky Medical Center, and a member of the Helsinki research committee at the Ziv Medical Center, Galilee.