A case study in psychoanalytic treatment bettelheim on autism


Psychotherapy Can Offer Young Autists What Behavioral Therapies Cannot

These historical changes have influenced the form and function of later research into autism and related conditions. The concept of autism was coined in by the German psychiatrist Eugen Bleuler to describe a symptom of the most severe cases of schizophrenia, a concept he had also created. According to Bleuler, autistic thinking was characterized by infantile wishes to avoid unsatisfying realities and replace them with fantasies and hallucinations. Psychologists, psychoanalysts and psychiatrists in Britain used the word autism with this meaning throughout the s and up until to the s e.

Piaget, However, in the s, many British child psychologists challenged the contentions about infantile thought assumed by Bleuler and created new methods to validate child psychology as a science, in particular epidemiological studies.


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The meaning of the word autism was then radically reformulated from a description of someone who fantasized excessively to one who did not fantasize at all. This article traces this radical transformation of the concept of autism in Britain, exploring the reasons behind the shift and the impact that it has had on psychological sciences relating to infants and children. It argues that the change in the meaning of autism was part of a more general shift in Anglo-American psychiatric reasoning which sought to understand psychological problems through epidemiological studies rather than individual cases.

However, few people have explored this in relation to child psychology and psychiatry. This article examines the way that epidemiological methods shifted and morphed central concepts in these fields, in particular the concept of autism. It argues that the diagnostic practices required of psychiatric epidemiology in the s continue to influence contemporary theories and descriptions of autism in Britain.


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    London worked hard to ensure that new treatment methods were developed to enable their children to adjust to the new social roles that they were being forced to adopt. This led to a growth in new behavioural treatment methods as well as a massive backlash against psychoanalytic styles of reasoning. However, it is important to position these changes in relation to broader shifts in the disciplines of child psychiatry, psychology and psychoanalysis.

    Epidemiological studies in child psychiatry experienced a period of expansion in s Britain in the wake of the Mental Health Act. Autism had always been central to the study of childhood psychopathology in Britain and the introduction of epidemiological studies provided the concept with a new framework in which it has since flourished.

    As Gillian Sutherland, Deborah Thom, Nikolas Rose and others have documented, the s and s in Britain witnessed a vast expansion of charitable and governmental services to cater for the psychological problems of children Rose, ; Sutherland and Sharp, ; Thom, In that same year, Cyril Burt was appointed as the first official government psychologist in the UK and tasked with assessing the levels of psychological disturbance in the child population.

    He worked with infant welfare centres, school medical inspection officers and reformatory and industrial schools in order to do this Evans et al. In the late s, the Commonwealth Fund, an American philanthropic body, began to provide funds for the purposes of improving child guidance services in Britain Thom, Early child guidance clinics were used to direct child-rearing practices and to guide the behaviour of problem children Jones, The expansion of psychological services offered growing opportunities for child psychological professionals to observe and assess infants and children.

    These were associated with a burgeoning discourse relating to the developing subjectivity of infants and children. The early 20th century had witnessed growing speculation about the nature of infantile and unconscious thought processes and their role in causing mental illness. Bleuler, Sigmund Freud, Carl Jung and Pierre Janet were all significant thinkers in this period who sought to unearth the forces that underlay psychological illness in the thoughts, experiences and traumas of childhood Ellenberger, A lot of this work was taken up readily by a new generation of child psychological professionals in Britain, such as Susan Isaacs, Melanie Klein and Mildred Creak.

    In , Janet had explained the function of reality as a synthesis of all psychological functions ranging from automatic functions at the level of the nervous system up to complex thoughts and actions. If the nervous system was weak, psychological tension would drop and an individual would lose the ability to synthesize these complex functions and also lose the sense of reality Janet and Raymond, According to Bleuler, when schizophrenics tried to conduct logical operations in thought, they were unable to draw upon all appropriate associations in the mind, thus leading to an unsatisfactory sense of reality.

    They therefore substituted this unsatisfactory reality with fantasies that more readily satisfied their affective needs. By blocking off the perceptive-sensory stimulations of the outside world, autistic thinking then came to obey its own special laws, which were no longer bound by the rules of logic Bleuler, [] : Freud would later expand on the way in which autoerotic thinking and, what he termed, primary narcissism were transformed via the onset of the Oedipus complex. However British researchers such as Creak, Klein and Isaacs followed Freud and Bleuler in linking autistic and autoerotic thought with hallucinatory thinking.

    They also drew substantially from the work of Jean Piaget in making these claims. During this stage of thinking, children could not follow logical rules and did not think conceptually and there was a predominance of visual imagery in their minds Piaget, : — These thought processes subsided as the infant became more aware of the concrete objects and reality surrounding him or her. Piaget drew direct analogies between infantile thinking and unconscious symbolism as described in psychoanalytic theory Vidal, : — In Britain, child psychological professionals introduced these theories in the s and s.

    In , she argued that schizophrenia and psychosis should be diagnosed more often in children as this would help child psychologists to understand infantile thought and its extreme pathologies Klein, In addition, she had been greatly influential in guiding government policy on childcare and education; for example, giving evidence to the Hadow Committee on Infant and Nursery Schools in and later the Home Office Care of Children Committee in ibid. Mildred Creak was another important British child psychological professional who sought to develop ideas on severe psychopathology and hallucination in infancy.

    She had trained in medicine at University College Hospital, London, and was appointed as head of child psychiatry at the Maudsley Hospital in Along with Klein and Isaacs, she paved the way for more detailed discussions on the way that severe psychopathology should be conceptualized in infants and children. The Second World War increased the opportunities for child psychologists to study the psychological problems of infants and children.

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    In Britain, over 1 million unaccompanied children were evacuated from cities and many high-profile psychologists and psychoanalysts including Klein, Isaacs and John Bowlby established the Cambridge evacuation survey to study the effects of such major environmental changes B.

    Harris, ; Rose, : At the same time, Anna Freud established wartime nurseries in London for children who could not be evacuated Burlingham and Freud, Klein, Isaacs, Bowlby and Anna Freud employed theories of unconscious processes to explain pathological thought in the infants that they observed. All of these studies drew similar conclusions. Bowlby and Bender, in particular, thought that these disturbances affected the unconscious mental processes of these children causing them to retreat from the outside world.

    Klein and her supporters claimed that they had found evidence for subjective responses to instincts in infants that presupposed the existence of complex mental mechanisms which could control, redirect and repress unconscious instinctual urges from the very first moments of life. Isaacs claimed that from the moment that an infant experienced an instinctual urge, he or she also had the capacity to fantasize about that urge and to imagine the direction it might take.

    Fantasies could be associated with libidinal instincts or drives as well as destructive instincts and impulses. Infants were also thought capable of altering and prohibiting their unconscious desires Heimann, []. Within this model, it was possible to understand how infants could employ hallucinations in a pathological way which prevented them from developing a satisfactory relationship to reality.

    Child psychology and psychiatry in Britain and the introduction of autism prior to 1959

    Psychopathology could thus be created, via relationships, in infants from the very first moments of life. The critics of the Kleinian analysts argued that they were attributing advanced psychical processes to infants without giving thorough evidence and explanation for these claims. The child had no awareness of the effects of his actions on others, had no sense of guilt or anxiety over his actions, and no sense of loss Freud in King and Steiner, : — These discussions of whether, and at what age, one could attribute desires and thoughts to infants were never concluded.

    Yet they continued to exist as important conceptual problems in child psychology because they concerned the origins of relational thought. Cyril Burt and other educational psychologists in the s also debated how to attribute mental activity and thoughts to infants, clashing dramatically with behaviourists such as J. Watson who argued that it was not the vocation of psychologists to describe the thoughts that they imagined infants to have Watson, ; Burt, Unlike Klein and Isaacs, Kanner was reserved in the attribution of unconscious thought processes and a symbolic life to infants.

    Instead, he described a list of cases in which he had observed similar symptomatology. He also noted that these children tended to use language in a very literal fashion and that they failed to relate to other people physically Kanner, However, his article was significant because it presented a new way to describe infantile thought. Rather than attributing complex unconscious thought processes to children that he observed, he simply described the behaviour of a group of children with similar symptoms.

    However, this descriptive mode in child psychiatry was not standard at this time and many other child psychological professionals in both Britain and the USA continued to employ the concepts of autism in conjunction with autoerotism, primary narcissism and symbolic thinking to understand infantile psychopathology and problems with developing relationships. After the war, the controversies over how to describe infantile thought continued. The diagnoses of schizophrenia, psychosis and autism in children were largely interchangeable during the s and s.

    In the USA, Bender and others employed a Kleinian model to understand infant and child psychopathology and focused on schizophrenia as the central psychopathological problem of childhood. Bender was an important figure in the development of perceptual tests for children. She defined childhood schizophrenia as.

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    Bender, : She also claimed that they were particularly driven by infantile aggression. Whereas in normal children, symbolism became abstract and appeared only in dreams, fantasies and fairy tales, the symbolic thought of schizophrenic children remained concrete and structured their entire thought disorder. In the UK, Elwyn James Anthony and Kenneth Cameron at the Maudsley Hospital employed similar theories of the infantile unconscious to understand childhood schizophrenia and autism. Anthony, who had trained under Aubrey Lewis and Jean Piaget Hersov, ; Institute of Psychiatry, 13 , argued that observations of these children could be used to formulate a general theory of infantile thought and psychology.

    Wing, ; Rutter, : Anthony argued that the age at which a child developed autism or psychosis affected the form that the disorder took. This barrier enables the child to focus and not to be distracted by every passing stimulus. In this situation, the infant then develops his own secondary psychotic barrier which then blocks all stimulation Anthony, a : He employed standard Piagetian tests in order to confirm his theories ibid.

    This emergent intellectual ability was paralleled with a new emotional ability to relate to objects. Table by E. All of these UK-based theorists assumed that hallucinatory thinking preceded the establishment of relationships with other objects or individuals.

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    Their understanding of autism was framed by a broader disciplinary-wide agreement that developmental psychology was a science that tracked the emergence of subjectivity. If they did employ basic statistical methodologies, these were used as an adjunct to these theories. The rest of this article explains how epidemiological studies were employed from the late s in order to radically overturn this model of child development and the concept of autism which supported it. The s witnessed major transformations in the care of the mentally ill in Britain.

    In , the British Government passed the Mental Health Act which discredited most legal powers that had previously compelled the mentally defective and insane to institutional treatment. It abolished the Board of Control that had previously managed this process, thereafter making local authorities responsible for institutional and community care. The Act led to major administrative problems resulting from the large-scale closure of institutions for individuals with mental abnormalities.

    This led to the development of new social-scientific methods as it became paramount to demarcate the mental problems and needs of children and adults who had previously been confined but were now being integrated into the majority population. One of the most significant fields to develop following the closure of institutions was the technique of psychiatric epidemiology. The unit was funded by the Medical Research Council MRC and became a world-leading centre for epidemiological and statistical research in mental health, in particular relating to schizophrenia and autism.

    The psychological experimentation that was emerging from the unit in this period was greatly influenced by the work of Hans Eysenck who was then heading the psychology department. He argued that Freudian analytic concepts concerning the unconscious were speculative impressions and he challenged the efficiency of psychoanalytic psychotherapy as a curative technique Eysenck, : —9.

    In , Mildred Creak set up a working party to identify the key features of childhood schizophrenia and to establish a firm basis for research in childhood psychopathology Creak, ; Lotter, Whereas intelligence tests were by then well established as psychometric instruments, measures of psychopathology in children were new. The children were rewarded if they gave correct responses to tactile, auditory and visual stimulation. Finally, the auditory and visual sensory systems became dominant.

    A Case Study In Psychoanalytic Treatment Bettelheim On Autism

    They developed a spontaneous preference for tactile and visual stimuli and found it difficult to renounce this preference when presented with auditory stimulation. Rutter had trained in medicine at Birmingham and specialized in psychiatry at the Maudsley under Aubrey Lewis and Eysenck. In , he studied with the comparative psychologist Herb Birch and the psychiatric epidemiologist Ben Pasamanick. Along with Pasamanick, Rutter was interested in using epidemiological methods in order to determine causation rather than simply to measure prevalence rates Rutter, He thereafter worked closely with the World Health Organisation in developing a multi-axial system of psychiatric diagnoses ibid.

    In line with these efforts, Rutter initiated a study of childhood autism in a cohort of children in Aberdeen and encouraged further population studies of this condition in order to assist the general field of child psychiatry. At the same time, Rutter and Tizard embarked on a major study of the complete rates of psychiatric disorder in all children resident on the Isle of Wight Rutter, Tizard and Whitmore, According to Rutter, epidemiological studies could gather similar research subjects who could help determine the causes of autism and other disorders thereby eradicating the need for speculative child psychoanalysis and psychology.

    Wing and Victor Lotter from the MRC Unit who designed the first mass survey of an entire population cohort in order to generate a percentage figure for the rate of autism in the general population of Britain. However, Lotter, following Rutter, considered that clear-cut purely behaviouristic criteria were paramount to the development of that epidemiological research on autism despite the fact the psychological state that was being described concerned the capacity to relate to other people.

    He then developed a list of statements which were used in order to identify children with autistic conditions. This form was issued to teachers of 76, children between the ages of 8 and 10 attending schools in the Middlesex area. Children identified by teachers were then further assessed to confirm their autism.

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