Whose memories are they and where do they go? Problems surrounding internalization in children on...

Whose memories are they and where do they go?Problems surrounding internalization in children on

the autistic spectrum

Maria Rhode

Dept. of Children and Families, Tavistock Clinic, 120 Belsize Lane, LondonNW3 5BA, UK – [email protected], [email protected]

(Final version accepted 15 July 2011)

Recent work in neuroscience has highlighted the contrast between ‘procedural’memory for bodily experiences and skills, which is unconscious though unre-pressed, and verbalizable, ‘declarative’ memory, which includes autobiographicalmemory. Autobiographical memory is weak in people with autistic spectrumdisorder, who frequently turn to self-generated sensations for reassurance that theycontinue to exist. The author suggests that, instead of internalizing shared experi-ences leading to growth, children with autism can feel that they add to themselvesby taking over the qualities of others through the ‘annexation’ of physical proper-ties that leads to a damaged object and can trigger a particular sort of negativetherapeutic reaction. Clinical illustrations drawn from the treatment of two chil-dren on the autistic spectrum illustrate some ramifications of these processes inrelation to the sense of a separate identity and the capacity to access memories.

Keywords: annexation, autobiographical memory, autistic spectrum disorder, child analysis,internalization, procedural memory

My aim in this paper is to describe some emotional facets of processesinvolved in autobiographical memory as they emerge during the treatmentof children on the autistic spectrum, and to illustrate the contribution that apsychoanalytic approach can make to the understanding of how memoriesare experienced subjectively. Autobiographical memory is an essential com-ponent of the sense of identity, and the problems faced by children on theautistic spectrum in establishing and maintaining a relatively stable sense ofself could be expected to affect their ability to establish and access suchmemories. More particularly, I wish to suggest that these children’s extremeanxieties concerning bodily survival and their reliance on bodily sensation inorder to counter these can interfere with the symbolic capacities involvedin autobiographical memory.

Some components of memory

Memory is central to our sense of who we are. Beginning with Breuer andFreud (1893, p. 7), who described hysterics as suffering from reminiscencesand who defined acting out as a substitute for remembering, psychoanalystshave focused on those aspects of memory in the broader sense that shapeour lives in ways we may be conscious of or not, as distinct from thecapacity to reproduce learned material. Melanie Klein’s poetic concept of

Int J Psychoanal (2012) 93:355–376 doi: 10.1111/j.1745-8315.2011.00507.x

Copyright ª 2012 Institute of PsychoanalysisPublished by Blackwell Publishing, 9600 Garsington Road, Oxford, OX4 2DQ, UK and350 Main Street, Malden, MA 02148, USA on behalf of the Institute of Psychoanalysis

�e International Journal of

‘‘memories in feeling’’ (Klein, 1961, p. 136) concerns the process by whichwhole areas of the self are re-awakened within the transference relationship,without there necessarily being a link to verbalizable memories of discretehappenings. Proust’s famous description of how the taste of a madeleinedipped in tea at first flooded him with happiness and then brought to lifememories of the town in which he had spent his childhood holidays seemsto imply a notion of ‘memories in body’. He writes:

The past is hidden somewhere outside the realm, beyond the reach of intellect, insome material object (in the sensation which that material object will give us) … Andas for that object, it depends on chance whether we come upon it or not before weourselves must die.

(Proust, 1913, Swann’s Way, Part 1, pp. 57–8, my italics)

I wish to suggest that, in children with autism, the reliance on sensationcan be excessive and can interfere with the articulation of emotion and verb-alizable memory, rather than existing in balance with these as in Proust’saccount.

In recent years, much neuroscientific research has focused on the elucida-tion of different memory systems and of the areas of the brain in whichthese are processed (for overviews, see, for example, Mancia, 2006; Pally,2000; Solms and Turnbull, 2002). Thus, implicit, procedural memory – thekind involved in learning and remembering bodily skills like riding a bicycleor playing the piano – is contrasted with ‘explicit’ memory, which is alsocalled ‘declarative memory’ and which is verbalizable. Declarative memory,in turn, has various subdivisions. Semantic memory refers to general factsand knowledge, including personal knowledge such as one’s place of birth;‘episodic’ or ‘autobiographical’ memory concerns specific episodes or eventsin one’s life. Implicit and explicit memory systems are processed in differingparts of the brain; the ways in which they interact remains a matter ofdebate, as does the time at which declarative memory systems come onstream.1

These findings are relevant to a number of psychoanalytic topics. Forexample, the concept of bodily, implicit memory has sparked interest amongpsychoanalysts in the idea of an unrepressed unconscious (cf. Mancia,2006); it also links with the suggestion by Stern and his co-workers (1998)that changes within ‘implicit relational knowing’ are an important factor intherapeutic change. Schacter (1996, p. 232; cited in Pally, 2000, p. 64) hasrephrased Freud and Breuer’s description of hysterics as suffering fromreminiscences in this contemporary language when he suggests that they ‘‘areplagued by implicit memories of events they cannot remember explicitly’’.

Episodic, autobiographical memory is known to be a particular weaknessof people with ASD (Autistic Spectrum Disorder), though some may have

1For example, Solms and Turnbull (2002) suggest that Freud’s ‘riddle of infantile amnesia’ can beexplained without reference to repression simply by the fact that declarative memory systems do notbecome fully functional until the age of 18 to 24 months. In contrast, Gaensbauer (2002) adduces bothexperimental and clinical evidence to support the idea that declarative memories can be formed muchearlier in infancy and secondarily become linked to language.

356 M. Rhode

Int J Psychoanal (2012) 93 Copyright ª 2012 Institute of Psychoanalysis

exceptional capacities for rote recall. Even those children with autism whocan reproduce every detail of a past event often do so in a way that seemsqualitatively unusual. It can feel as though they were reliving the occurrencerather than recalling it, much like one of Oliver Sacks’s patients (Sacks,1985) whose brain tumour appeared to reactivate memory traces in such away that episodes of her life were constantly replayed before her like a film.Such children appear to lack a sense of temporal perspective.

Some experimental findings

The deficit that people with Autistic Spectrum Disorder manifest withregard to autobiographical memory has been quite widely investigated byexperimental psychologists. For example, Crane and Goddard (2008),working with adults on the autistic spectrum, have demonstrated a deficit inpersonal episodic memory in comparison to a control group, though therewas no deficit in personal semantic memory. They concluded that their find-ings suggested ‘a distinctive pattern of remembering’ in autistic spectrumdisorder. Hare et al. (2007), also working with adults, suggested that theimpaired capacity of participants with ASD to recall recently performedevents could be linked to impairments in their capacity for self-awarenessand self-monitoring. Similarly, Crane et al. (2010) noted that adults withASD ‘extracted less meaning’ from their narratives than did the controlgroup: they proposed that ‘‘difficulties in eliciting meaning from memoriessuggest[ed] a failure in using past experiences to update the self’’ (p.383).Crane et al. (2009), again comparing adults with and without ASD, foundthat adults with ASD showed a reasonably intact memory for ‘general eventknowledge’, but that their event-specific knowledge was impaired. Whilecontrol subjects used personal goals as a way of organizing both their gen-eral memories and their event-specific memories, the participants with ASDdid so only in relation to their general (semantic) memories. The authorstook these results as providing some confirmation for the idea that theparticipants with ASD had difficulty with ‘using the self as an effectivememory cue’. Russell and Jarrold (1999), working with children, similarlysuggested that participants with ASD were distinguished by a deficit in ‘self-monitoring’: in an experimental memory task, children with autism did notremember actions they had performed themselves any better than actionsperformed by someone else. Williams et al. (2006) also found that thememory systems of children with ASD seemed to be organized differentlyfrom those of the control group. Interestingly, in view of psychoanalyticfindings on the experience of space in children with autism as discussedbelow (Meltzer et al., 1975), they reported that it was a measure of spatialworking memory that discriminated most accurately between the childrenwith autism and the control group.

Such findings seem to imply something of a vicious circle, in which defi-cits in the sense of self lead to problems in laying down, organizing orretrieving autobiographical memories, problems which in turn could beexpected to contribute to further deficits in the sense of self. This line ofthought converges with reports by psychoanalytic workers that children with

Internalization and annexation 357

Copyright ª 2012 Institute of Psychoanalysis Int J Psychoanal (2012) 93

autism often experience difficulties surrounding internalization. For example,Alvarez (1999) has pointed to their difficulties with introjection, which shesuggested could be partly linked to their problems in regulating arousal lev-els. Shapiro (2000, pp. 650–1) refers to Mahler’s comment (Mahler, 1968)that ‘‘these children were unable to ‘use the mothering principle’’’, and hesuggests that their behaviour implies ‘‘incapacity and a different way ofincorporating the world about them’’.

On the other hand, children with autistic spectrum disorder often do, at acertain stage of therapy, begin to refer to experiences they have had outsidethe session. I take this to be an encouraging sign, as do their teachers. Itsuggests that the children feel more able to access, own, and communicateinternalized experiences; and, therefore, that they may also be able to drawon what has taken place in a session once they and I are no longer together.This cannot be taken for granted with children on the spectrum, as thosewho work with them well know. Until, for instance, a child actually demon-strates at school the capacities that I have been able to observe in a session,there are no a priori grounds for supposing that he will be able to do so.

In this paper, I wish to explore some of the phantasies and, more particu-larly, some of the physical experiences that can be associated with episodicmemory in children with autism. I shall suggest that such children feel thatthey add to themselves by a concrete process that could be called annex-ation, as opposed to the symbolic process of internalization. This seems toapply to many kinds of nourishment, whether the nourishment is actualfood or the kind of nourishing relationship that would normally support agrowing and stable sense of a separate identity, but does not easily seem todo so in children on the autistic spectrum.

In order to make my meaning more clear, I shall begin with a brief reviewof some of the relevant psychoanalytic formulations concerning internaliza-tion, as well as descriptions of the bodily anxieties and self-protectivedevices that may be observed in children on the autistic spectrum.

Internalization: Obstacles and alternatives

The concept of internalization as being central to the growth of the person-ality has its roots in Freud’s formulation that the super-ego is heir to theOedipus complex (Freud, 1923).2 This type of internalization, whichpromotes development, depends on the child’s ability to relinquish directoedipal strivings and to identify with the parental imagos that are estab-lished within the self. Subsequently, Melanie Klein (1932) described theinterplay between introjection and projection, leading to the internalizationof both good and bad part objects and, later, of whole objects. While sheheld that the first good introjected object, the mother’s breast, became thecentre around which the ego cohered, she also outlined anxiety situationsconcerning the possibility of keeping good objects safe within the self, anxi-eties that became acute with the onset of the depressive position (Klein,

2Previously, in Formulations on the two principles of mental functioning, Freud (1911) had referred to theego’s introjection of objects that were the source of pleasure, by which it absorbed them into itself.

358 M. Rhode


1935, 1940). More particularly, she proposed (Klein, 1940, pp. 351–2) thatreparative efforts could sometimes be halted, and growth slowed down orbrought to a standstill, if the very possession of reparative capacities andthe progress they allowed became confused with the wish to triumph overthe parents by means of reversal. In a similar vein, Joan Riviere (1936)described the overwhelming sense of guilt in patients who were particularlyprone to a negative therapeutic reaction, and which she felt was oftenmasked by their narcissistic stance. In her view, these patients were markedby an ‘extreme unconscious altruism’: their failure to get well in analysisoften stemmed from the belief that anything they had or achieved must beacquired by depriving the analyst, and from their inability to deal with theensuing guilt. These formulations, as I hope to show, are highly relevant toautistic children’s problems with internalization.

Meltzer (1974) has stressed that the introjective type of identificationoutlined above implies the acknowledgement of dependence on a separatenurturing figure. This brings with it the persecutory anxieties of the para-noid–schizoid position and the many painful conflicts of the depressiveposition, including guilt, concern for the survival of precious loved objects,and pining for them when they are felt to be lost. In contrast, these conflictsappear to be side-stepped in the two types of identification (projective andadhesive) that he termed narcissistic in view of the fact that they concern sit-uations in which the child fails to acknowledge separateness and dependenceand takes over the qualities – ultimately the identity – of parental figures.This type of projective identification, which involves the phantasy of takingover the other person’s identity by getting inside them – literally steppinginto their shoes – was first described by Klein (1955) in her paper, On iden-tification. Children with autism, who tend to lack the concept of a spaceinside themselves or another (Meltzer et al., 1975; Tustin 1981, 1986, 1990),are typically unable to make use of projective identification until they haveachieved substantial improvement, whether this is projective identification ofthe type described by Klein (1946, 1955) or the type that Bion (1962) saw asthe means of nonverbal communication between mother and infant andwhich is essential for normal development. Instead, these children typicallytake over the qualities of another person by means of surface mimicry. Thismechanism was first described by Bick (1968) in patients who lacked theexperience of a psycho-physical skin of their own and who appeared to havethe phantasy of becoming the person to whose skin they stuck themselves.Both Meltzer and his co-workers (1975) and Tustin (particularly, Tustin,1990) saw adhesive identification as playing a central role in children withautism who had not yet achieved the concept of a space inside themselvesand others.

Not all introjection, however, leads to development or proceeds on thebasis of a successful negotiation of depressive position anxieties. In Mourn-ing and melancholia Freud (1917) delineated the destructive relationshipsthat can become established within the self when a concrete identificationwith an object takes place in the context of unresolved hostility. Concreteintrojective processes have been described by many subsequent authors,including Abraham (1924), Rosenfeld (1964) and Sodr� (2004). Indeed, the



title of Sodr�’s paper on this phenomenon – ‘Who’s who’ – highlights theconsequences that this type of non-symbolic introjection can have forthe sense of identity. She suggests that introjection of this kind involvestaking over the identity of the object and that, during this process: ‘‘Theintegrity of the object has been damaged or destroyed‘‘ (Sodr�, 2004, p57).This seems to me to be central to what I wish to describe in children withautism: what I refer to as ‘annexation’ has precisely the characteristics andconsequences that Sodr� describes, with the additional feature that the pro-cess by which the child adds to himself at the object’s expense is experiencedon a bodily level. This seems to apply even to systems (such as episodic,autobiographical memory) that normally involve symbolic levels of function-ing. I discuss this further in the next section, in the context of the bodilyterrors of children with autism that lead them to sidestep the experience ofseparateness, so that the conditions for symbol formation are not in place.

Some psychoanalytic findings concerning children withautism

Infantile autism was first described by Kanner (1943), who stressed the chil-dren’s ‘extreme autistic aloneness’. In the following year, Asperger (1944)independently reported on a group of children with a similar lack ofemotional and social relatedness, though without the mutism or serious delayin language development that is characteristic of Kanner’s autism. The notionof a spectrum of autistic disorders (ASD) including both Kanner’s autismand Asperger syndrome is accepted by many workers in the field, though byno means by all (see Simpson, 2004). Autism is a behavioural diagnosis; the‘triad of impairments’ (in the areas of socialization, communication, andimagination) that Wing and Gould proposed in 1979 remains fundamental(Wing and Gould, 1979).

Psychoanalytic work with children with autism continues to be controver-sial in the view of many, for a wide variety of reasons.3 Some of theseappear to be based on the mistaken idea that a contemporary psycho-analytic approach presupposes the belief in a purely environmental aetiologyand a disregard of findings that suggest a strong genetic linkage. Anothermisunderstanding concerns the idea that the elucidation of the child’sinternal objects – of his experience of parental figures – has aetiologicalimplications. For example, a child with congenital disturbances of sensoryprocessing may experience the world as an overwhelming and confusingplace and may mis-attribute this fact to the intentions of his parents ortherapist: this may be central from a therapeutic point of view, but meansnothing from the perspective of aetiology. Other caveats concern the

3One of these is historical: an understandable reaction against Bettelheim’s unjustifiable statement thatthe children’s condition was caused by their parents’ death-wishes (Bettelheim, 1967). Contemporaryworkers are often erroneously thought to share this view, despite repeated disclaimers by Tustin (1972)and many others. While autistic-like behaviours can arise in a small percentage of children exposed toextreme conditions of privation (Rutter et al., 1999), the naturally-occurring condition shows a stronggenetic component: some professionals appear to believe that this should rule out a psychoanalyticapproach.

360 M. Rhode


children’s ability to understand interpretations4 and the question of whetherit is justifiable, for instance, to regard the characteristics of their play asexpressions of unconscious phantasy, as would be the case with other chil-dren (see, for example, Shapiro, 2000).

The following is by no means intended as an exhaustive overview ofpsychoanalytic work with children on the autistic spectrum: my intention isto focus on authors whose formulations concerning the bodily experience ofchildren with autism seem particularly relevant to the issue of annexation asopposed to internalization.

Melanie Klein (1930) emphasized her 4 year-old patient Dick’s inability tocome to terms with any aggressive impulses, and the degree of his anxietyabout inflicting damage. This anxiety appeared to be particularly related tothe consequences of oral aggression. For example, Dick took the head of afather doll into his mouth as though he were biting it off, and commented:‘‘Tea Daddy’’ (‘eat Daddy’). Klein found that interpreting unconscious anxi-ety mobilized Dick’s capacity to experience conscious anxiety and to engagein object relations. Rodrigu� (1955), who proposed that his 3 year-oldpatient retreated into a ‘shell’ in order to remain fused with an idealizedinternal object and prevent the incursions of a ‘bad’ outside world, thoughtthat this encapsulation of an ideal object also occurred within the child. Inconsequence, this ideal object remained unassimilated, and the child wasunable to access his internal resources for fear of inflicting damage whiledoing so. Meltzer et al. (1975) have similarly emphasized their patients’ ‘pre-mature’ fear of damaging the object. They suggested that the children theytreated showed very little sadism, and typically ‘dismantled’ their sensoryapparatus so as to adhere to whichever channel of sensory input was mostalluring. The outcome was an object that had not been damaged, as itwould have been by destructive splitting, but that was defined by one or twodimensions rather than by three. In the absence of an internal third dimen-sion, thought processes (including memory) could not take place.

Frances Tustin (1972, 1986) and, following her, Genevi�ve Haag (1985;Haag et al., 2005) emphasized the bodily terrors suffered by children withautism. Some of these terrors had previously been highlighted by Winnicott(1949) and Bick (1968, 1986). They include the experience of falling forever,of liquefying and spilling out, of having the skin torn away, of burning andfreezing, and of losing part of the body when the experience of being physi-cally separate from the carer impinges. (Interestingly, many of these terrorsfall in the realm of what would now be called disorders of regulation.) Moreparticularly, Tustin’s patient John, when he was emerging from his autisticstate, showed her that he had previously experienced the nipple or teat aspart of his own mouth (Tustin, 1972, Chapter 2). After watching a baby

4Many workers in the field have emphasized the importance of keeping interpretations short and simple,and of phrasing them in such a way as to minimize the likelihood that they will be misunderstood asstatements of fact. However, simply the fact that a child is not verbal does not necessarily mean thatthey are cognitively unable to grasp interpretations. For example, Tito Mukhopadhyay was confirmed byLorna Wing as being a classical autistic, mute, with gaze avoidance and a number of typical behaviours;but, beginning at the age of 8, he has written a number of books with poetic and imaginativedescriptions of his subjective experience (Mukhopadhyay, 2000, 2003).



being nursed, he arrived at his session full of his momentous discovery:‘‘The red button grows on the breast!’’ When Tustin asked him where he hadimagined it might be, he pointed to the inside of his mouth. In the absenceof this button-as-part-of-him, he experienced his mouth as containinginstead a ‘‘black hole with a nasty prick’’.5

John’s ‘button’ appeared to be the prototype of what Tustin (1981, p.92)called ‘‘the hard extra bit that ensures survival’’. The need for this ‘hard extrabit’ seems to underlie the dependence of children with autism on the so-called autistic objects (Tustin, 1980) that they typically clutch for the sake ofthe hard physical sensation that reassures them that they exist. Equally, Haag(1985; Haag et al., 2005) has described how children with autism can experi-ence separation from mother or analyst as though it meant the physical lossof half of their body or of a limb, not just of parts of their mouth. They canfeel that the end of a session literally costs them ‘an arm and a leg’. Suchbodily experiences were central to both the children whom I discuss later.

In line with the fact that these terrors are experienced on a bodily level,and that, by implication, it has not been possible, for whatever reason, forthem to be adequately contained, the preferred refuge of the child withautism is self-generated bodily sensation. Tustin has described the sense ofstrength derived from the (non-symbolic) use of hard autistic objects(Tustin, 1980), and the self-soothing afforded by soft ‘autistic shapes’(Tustin, 1986) such as breath and spit. Meltzer et al. (1975) similarly empha-sized the hypersensuality of many children on the spectrum. This means thatsuch a child often lives in a tactile world of surfaces – the world of adhesiveidentification – and that any move towards a world of shared space carrieswithin it the threat of falling forever (Bick, 1986; Winnicott, 1949). If this isso with regard to a sense of visual perspective, it may be relevant to the lackof temporal perspective that I have already referred to as occurring in thenarratives of Asperger’s children.

Another of Tustin’s patients, the 10 year-old whom she called David,constructed a suit of armour that suggested to her the idea of autisticencapsulation (Tustin, 1972, Chapter 3, p.45). David added to this by ‘‘snip-ping bits off his father as though he were a lifeless thing’’. (‘Now I’ll havesome of his hair’, he might say, for example). Although Tustin did notexplicitly elaborate on the implications, this is the first instance of which Iam aware of a child adding to himself by what one might call bodily annex-ation. In the first of my clinical illustrations, I shall focus on the move fromthis kind of annexation to more ordinary internalization as far as thisapplies to the ownership of memories.

Segal (1957) has argued that the capacity to function on a symbolic levelpresupposes the working through of the depressive position – of ambiva-lence and guilt, of love and hate – vis-�-vis an object whose separateness isacknowledged. The catastrophic anxieties that children with autism associatewith bodily separateness need, therefore, to be modified before the child can

5Interestingly, Susan Isaacs has described how, in normal development, the sensations in the hungryinfant’s mouth may be experienced as though he were being ‘‘forcibly and painfully’’ deprived of thebreast, or as though it were biting him (Isaacs, 1948, p. 92).

362 M. Rhode


move from concrete annexation to symbolic identification, and before mem-ory can become an abstract function that is appropriately located in time.Otherwise memory, like any other symbolic capacity, seems to be experi-enced physically, in procedural mode, as though it were another instance ofTustin’s ‘hard extra bit’ that is torn off someone else.6

The need to return an ‘annexed’ quality to the parent figure may underliesome kinds of apparent negative therapeutic reaction. I have already referredto Joan Riviere’s view that failure to develop during analysis could often belinked to ‘unconscious altruism’, to the need to restore everything good tothe parent or analyst. Susan Isaacs (1948) describes an adolescent who simi-larly could not allow himself to own his capacities; this was also true of theadults discussed in Riesenberg-Malcolm’s paper (Riesenberg-Malcolm, 1981)on Expiation as a defence. All the patients discussed seemed to share thetheory that only one person could possess whatever was desirable. On a partobject level, the idea that only one person could be potent

arose in the depths of [the patient’s] mind from the early phantasies of incorporat-ing his father’s genital … By electing to renounce everything in favour of hisyounger brother (ultimately of his father) the boy modified and controlledhis aggressive impulses towards both his parents, and his fears of them.

(Isaacs, 1948, p. 102)

I suggest that, in children with autistic spectrum disorder, renunciationcontinues to operate on this concrete, bodily level with regard to the sensa-tions in the mouth (John’s ‘red button’) that allow the children to feel thatthey exist. In that way renunciation can exert a global influence on thedevelopment of the sense of identity and present a major obstacle toprogress.

First clinical illustration: Daniel

My first clinical illustration concerns Daniel, a 9 year-old boy with autismwhose capacity to retrieve and own his memories and other internalresources was undermined by his reliance on annexation as a means of add-ing to himself and by the resulting fears of damage to the object, whichcould easily become hostile. Initially, he behaved as though drinking meanttaking over a solid part of the bottle and, therefore, damaging its structure.In the course of treatment, he became able to distinguish a solid struc-ture from the liquid it contained, which meant that he could drink withoutcausing damage. It also meant that he could conceive of inside places withinthe object. This stimulated phantasies about breaking in, together withresulting fears about getting lost down a well inside me. Seemingly in identi-fication with my insides, his own then became a well into which memoriescould get lost.

6For example, Tustin’s patient Ariadne described how she had unthinkingly taken over a suggestion byher mother concerning her schoolwork, ‘‘like snipping off a rose from someone else’s garden, withouttheir knowing, to put in my button-hole to show off with’’ (Tustin, 1990, p. 161). Tustin understood thisin terms of an experience of taking over the nipple (John’s ‘red button’), and then feeling vulnerable toattack by a despoiled object.



With continuing work on Daniel’s experience of bodily mutilation, on histerror of me as someone who caused this, and on his fear of his own oralaggression, he could begin to be less frightened of the effect of his own hos-tile impulses. This was accompanied by a lessening degree of withdrawal anda greater belief in my survival and in his capacity to bring me back. Workingon his feelings of anger when he encountered boundaries and on the wish tobreak through them allowed my internal spaces as well as his own to appearas less dangerous, and he began to feel able to retrieve experiences of nour-ishment from within himself, though still on a concrete level. His capacity toaccess and communicate what he had internalized also began to improve.

Daniel came from an extremely deprived background and had had atraumatic history. He was referred to a National Health Service clinic by hisresidential school when he was 9 years old. His teachers found him extre-mely lovable, and were encouraged by the progress in toilet training he hadmade since being taken into care at the age of 6. However, any change, orany request to fit in with the school routine, provoked a major tantrum inwhich Daniel would tear wallpaper off the walls or bite his own hand, whichhad become badly scarred. He was described as uneducable, and the localauthority was considering a 52-week boarding placement.

Daniel made rapid progress in once-weekly sessions, which were laterincreased to two sessions a week: this was the maximum that was practical,as his school was far away from the clinic. I saw him for seven years, untilhe was 16, by which time he was well settled in an excellent foster place-ment. Although much of his behaviour remained obviously autistic, he wasdoing well at a special school and integrating into mainstream school oneday a week. He was able to tell his foster-mother that he loved her, andenjoyed attending discos with his foster-sister.

Quite soon after beginning treatment, Daniel learned to read and beganto show interest in other children. This unusually rapid progress could beconceptualized in terms of his success, before he came to treatment, inbeginning to establish a helpful split (an important stage discussed byRodrigu� in 1955) that allowed him to look for a good maternal figure inthe outside world. Each early session began with a delighted recognitionof the room’s various features: ‘‘Green curtains! Three grey radiators!’’However, the split easily broke down. After an early session during whichhe had engaged well, he looked into a dark corner in the corridor and whis-pered: ‘‘Monster’’. After going downstairs at the end of the time, he wouldstagger along the corridor to the waiting-room as though the floor were acontinuation of the stairs rather than a level structure. Separating from meat the end of the time seemed to rob him both of his physical and his emo-tional foundations, and also to damage his bodily integrity: before his firstholiday, he said: ‘‘Poor mouth; poor skin’’. Equally, if he was brought lateto his appointment, I became a terrifying stranger who might tear his armoff or rip off his skin; his paranoid anxieties were of a psychotic intensity.On such occasions, it was only the familiarity of the toys that made it possi-ble for him to stay in the room, and it might take half an hour’s workbefore he would look at me in surprise and say: ‘‘Mrs. Rhode!’’ as thoughhe were waking up from a bad dream.

364 M. Rhode


An early session illustrates his reliance on annexation and the anxietiesthat follow from this:

Daniel had arrived with a little plastic bottle of lemonade. He tapped on the closedlid of the bottle, emphasizing that it was shut. When he unscrewed the lid anddrank, a plastic ring that had been part of the lid remained on the neck of thebottle. He passed this ring back and forth between the bottle and his mouth. Whenit was on the neck of the bottle, he showed me that his empty mouth was open inthe shape of a hole; when the ring was in his mouth, he looked at the bottle fear-fully, as though expecting to be attacked. Once the bottle was empty, he threw itinto the bin and shrank away from it.

Daniel seemed to equate drinking the lemonade – emptying the bottle –with annexing the plastic ring as part of his own mouth: this made thebottle into a damaged object of which he felt frightened. (The alternativewas that the ring belonged to the bottle, which left him with a hole in hismouth.) This links with Tustin’s patient David, who snipped bits offhis father; and also, of course, with her patient John, who, when the ‘redbutton’ nipple was not part of his mouth, felt that it contained instead a‘black hole with a nasty prick’. We spent much time working over whatseemed to be his experience that his mouth was competing with the feedingobject for a hard, nipple-like structure, the lack of which meant that one orthe other was physically incomplete. The implication was that Daniel addedto himself by annexing this hard bit from the bottle or from me, and thathe must fear being robbed in turn. It was a major development when herealized that he could drink water from a sponge without damaging thesponge’s structure. Over and over again he soaked the sponge full of waterand then squeezed it out, showing me that it remained intact. In otherwords, in contrast to the lemonade bottle, the solid structure of the spongewas not impaired when he sucked and drank its liquid contents.

For a child with autism, it can be a major achievement to be able toconceive of spaces within a three-dimensional object (Meltzer et al., 1975).This development, however, brought with it the need for Daniel to confrontto some extent the resulting hostility towards a separate other who couldexclude him.7 The following material from his fourth year of treatment illus-trates the move from annexation (with its unresolved see-saw between theexperience of bodily mutilation on the one hand and renunciation fuelled byfear and guilt on the other) to a position in which Daniel felt that he couldretrieve experience from a place inside himself:

At the end of a session when Daniel had been repeating: ‘‘Jump into that WonderfulWorld’’ in relation to an anticipated school fete, he tipped himself abruptly out of

7Partly, this is the ordinary hostility that all children work through during the so-called ‘terrible twos’: afriendly independence from parents is based on the security of believing that love ultimately outweighshate. With Daniel, as with many children on the autistic spectrum, this process was complicated by aseeming lack of belief that he could get through emotionally without breaking through physically: asthough an emotional ‘brick wall’ must follow inescapably from bodily separateness. Like many childrenon the autistic spectrum (Rhode, 2000; Wittenberg, 1975), he appeared to confuse an object that wasemotionally pre-occupied with one that was physically occupied. He also appeared to confuse limits (acircumscribed ‘No’) with a refusal of his communications (a global ‘No’): his teachers had noticed thathe seemed to misunderstand ‘No’ as meaning ‘I don’t want to know’).



an armchair. He seemed to experience the end of the time very concretely as beingdropped out of the world of the session into the abyss. He then crashed through theclosed doors of the waiting room so vehemently that he fell over.

The next time, he arrived in a very withdrawn state and lay on the couch, suckingand biting his thumb while his other hand reached inside the cover on a cushion. Ireviewed the end of the previous session: he had seemed to feel dropped, andblocked from getting into a Wonderful World. Perhaps coming back felt like crash-ing into me, or biting his way in, and he couldn’t believe that I wouldn’t get broken:maybe it was safer to feel all joined up, the way his hands were joining his mouthand the cushion. He looked straight at me and responded, very unusually, with awhole sentence: ‘‘I want to get in’’. At the end of the session, he issued commandswe had learnt to associate with a frightening Tiger part of him: ‘‘Give me thatpen!’’ – ‘‘I want it now!’’ – ‘‘Sharp teeth!’’

The next time, Daniel again began by fiddling with threads on the cushion, whichhe called Party Flags. When I reviewed his fears about crashing or biting his way inwhen he felt excluded from a party, he responded: ‘‘Tasty Meal!’’ Holding the cush-ion by the threads, he repeatedly threw it over his head and then down towards hisfeet, saying: ‘‘Down the well!’’ before bringing it back into view.

I said that he was bringing the cushion back. Perhaps when he couldn’t see me, itwas hard to believe he could bring me back, and not to worry that his sharp teethmight have hurt me. Then perhaps he also worried about what happened to his TastyMeal inside him. To my amazement, he responded: ‘‘Tasty Meal down the well!’’

This session illustrates Daniel’s considerable progress since the session withthe lemonade bottle. At that point, drinking the liquid was not properlydifferentiated from annexing the ring (standing for the nipple or teat) as asource of sensation in the mouth. Now, Daniel has developed awareness ofboundaries between self and other (like the door), which imply that a partycould happen in an inside space from which he is excluded. He seems to asso-ciate this with being physically tipped out of a chair at the end of the session.Having to wait, with all the attendant bodily anxieties, provokes the Tiger partof him to threaten me with his sharp teeth. He seems to be confused aboutwhether he comes back to his session legitimately, because it is the right time,or as the consequence of his angry impulses. This means that, like Rodrigu�’slittle patient, he finds it hard to distinguish between opening the door andbreaking through it and, in this way, turning me into a ‘well’ that he might fallinto just as he had fallen through the waiting-room doors. His own insides, inequation with mine, are then felt to be a well into which food – and experience– can get lost. Finding me again after a separation may have encouraged himto play this variant of the cotton-reel game with the Tasty Meal cushion – agame that concerns his ability to retrieve what he has internalized.

Daniel’s fears for his own safety as well as for mine gradually became lessoverwhelming as we continued to work on the way in which his aggressiveimpulses were triggered by separation.8 This progress was supported when

8For a child with autism, as I have attempted to convey, separation signifies bodily catastrophe, not justrejection.

366 M. Rhode


the respite home where he spent his weekends returned to former premisesthat the children had been temporarily moved from while the home wasbeing refurbished. He was delighted and encouraged to find again familiarrooms that had been repainted and objects that had been restored. At thispoint in the therapy, he began to refer to actual events that had taken placeoutside the sessions, both in words and in his drawings. ‘‘Trampoline! Movethe equipment!’’ as he said in relation to the sports facilities in the respitehome; and this seemed to extend to a belief that he could move his mentalequipment from place to place without doing damage. An adult patientcalled this capacity being able to ‘carry herself around with her’, and it hasobvious implications for the stability of the sense of self.

Let me recapitulate the hypothetical sequence of events that I am propos-ing. Daniel seemed to experience the separation at the end of a session asthough he were being physically dropped and, presumably, abandoned tothe bodily anxieties that I have outlined. It was as though he confused asituation in which physical access was blocked with one in which I wasemotionally impenetrable and hostile. ‘Getting through’ – like legitimatelyopening the door when he came back – could then become confused withbiting in anger (‘sharp teeth’) or with smashing through the boundary ofthe door. This was felt to damage my internal structure, turning it into awell into which Daniel could fall. His own inside could then be equated withthis well, so that experience (the ‘Tasty Meal’ cushion) got lost down itinstead of being digested, assimilated and owned. Focusing on the sensuouselement of experience – the feeling of nipple or teat in the mouth, forexample, or of the Party Flag threads between Daniel’s fingers – blurs thedistinction between self and other, and can therefore be a way of circum-venting these dilemmas; in particular, of circumventing the fear of doingdamage. Until this fear of doing damage has been modified to some degree,it can be difficult for children such as Daniel to own and communicate whatthey have internalized, including episodic memories.

Second clinical illustration: Lina

Daniel had moved from a position of annexation to being concerned withwhat happened to anything he internalized and how he could access it: interms of memory, with problems of retrieval. In contrast, Lina, a girl with adiagnosis of Asperger’s syndrome, did not seem to have reached this point.She attempted to circumvent anxieties about annexation – about theimplications for me if she owned and acknowledged her experiences andcapacities, including her memories – by concretely lodging these elsewhere:in the books that she carried around with her, for instance, or in the physi-cal unit that she seemed to feel she recreated with me whenever we cametogether in the therapy room. It was as though Daniel had remained perpet-ually attached to an ever-full lemonade bottle, so that the consequences ofannexation never arose.

Later in treatment, Lina became able to elaborate the temporal perspec-tive of autobiographical memory as long as she had the bodily support ofher chair actually touching mine, leaving no physical space between us.



Finally, firmer limits and the approaching end of therapy made it impossiblefor her to ignore the fact of physical separateness. This ushered in a phaseof aggressive behaviour, even of physical violence. I saw the attempt to dealwith this as an essential step towards a more solid sense of identity, thoughLina did not reach the stage that Daniel did of focusing on the retrieval ofinternalized experience.

Lina had been seen three times weekly for two years by a therapist inanother country who had to stop work after intermittent episodes of illness;Lina and her family remained realistically worried about a possible fataloutcome. She was the first child in the family, and had been referred at theage of 4, soon after her brother’s birth. At that time she had only a fewwords of language, she avoided eye contact, and did not relate to other chil-dren. She was later given a diagnosis of Asperger’s Syndrome – probablywrongly, in view of the history of her language development. I began to seeher once weekly in a National Health Service setting when she was 6 and ahalf, some six months after her family had come to England, with the aimof helping her to come to terms with the experience of immigration and ofher former therapist’s serious illness. The treatment lasted for six years, untilshe was nearly 13; I would have preferred to continue until later in heradolescence, as had been the case with Daniel, but external circumstancesprevented this. Practical considerations and her parents’ reluctance meantthat I was never able to see her more than twice a week. The events I shallfocus on occurred in her fifth year with me, in the six months leading up toher 12th birthday.

Like her previous therapist, I found Lina very rewarding, not leastbecause of her gift for a poetic turn of phrase. However, at the time I wishto discuss, two conflicting impulses in her had became much more clearlydifferentiated: excitement at growing up, on the one hand (‘‘I can’t wait togo to secondary school’’) and, on the other, a clinging to autistic ways ofmanaging, such as carrying toys and books around with her everywhere andanswering every comment by a reference to whatever was her current ‘obses-sion’. I wondered whether these coping devices were being reinforced by herfears of the greater degree of individuation that adolescence would entail:age-appropriate competition and rivalry would appear even more frighteningin view of catastrophic autistic anxieties surrounding separateness.9

Lina did her best to gloss over the gaps between appointments andbetween us. For example, she used emotionally significant stories or car-toons to elicit my comments. These were then recited back to me verbatimin the following sessions, in a monotonous, unmodulated voice, or shewould attempt to make me repeat a previous remark by herself repeatingthe story that had prompted it. Though she remembered every word thatshe and I had said to each other, it did not feel as though she could digestthe experience and grow from it. Instead of owning her memory of past

9Indeed, she appeared to experience the onset of menstruation in terms of the characteristic autisticanxiety of spilling out, and she habitually reinforced the body outline of the animals she drew so as tomake sure that there were no gaps in the genital area. However, the details of her sexual development arebeyond the scope of this paper.

368 M. Rhode


events and assuming that I could own mine, Lina seemed to be ‘reconstitut-ing’ past sessions by reconstituting us as two halves of a unit once we wereback together. The memories of previous sessions seemed to lie somewherebetween us in an eternal present. This felt stuck and deadening, and I grewheartily tired of being treated like a vending machine.

I did feel that Lina had compelling reasons for trying to maintain thefiction that we were two halves of the same unit, linked by our so-called‘shared’ experience. Separating meant literally losing part of her body: whenI asked her why she was dragging one leg on the way back to the waiting-room after her session, she answered matter-of-factly: ‘‘It’s come off’’.Equally, as with Daniel, taking things in meant taking them over – literallytearing them off something or somebody else: her paperback copy of Charlieand the Chocolate Factory was hardly possible to read because of all the bitsshe had ripped off and literally swallowed. This seemed like a cruel experi-ence of separateness that stimulated cruel phantasies of incorporation, sothat I could understand why she remained in thrall to a popular cartoonseries in which ‘cute’, cuddly creatures were tortured in various ways, includ-ing being impaled and beheaded and having their skin ripped off afterresting their cheek on a hot stove.

The following material is from a session when Lina was 11 and a half,shortly after the Christmas break in her fifth year of treatment. It illustratesher fear that being separate and growing meant concretely ripping things offme and annexing them; it also illustrates how she attempted to sidestep thisby locating her memory in her drawings or by joining up with me physically:

On the way to the therapy room, she observed my feet very carefully in order towalk in rhythm with me, as though we were each half of a four-legged animal. Inthe room, she moved her chair so that it touched mine, then half turned her headaway while going through her old drawings. This felt strangely half-related, physi-cally very close but emotionally out of touch. After some while, I asked whether shewas looking for a special drawing. She answered, somewhat defensively: ‘‘I just likelooking at them, that’s all’’. I said that I could understand that, but that there couldbe many different reasons for this. Sometimes she used the drawings to help me tounderstand something, but today it felt more as though she were going off into adream world, as she had told me her parents said. She answered: ‘‘That’s not true’’,but moved her face very close to the drawings, as though she were being literallydrawn in. I described this, and reminded her of the time she had said that Charlieand the Chocolate Factory meant the world to her: perhaps that was something todo with feeling drawn right in, like today, and putting all sorts of feelings into thedrawings.

She said she had ‘‘already done the thing about spotting the differences’’. I won-dered whether she worried about differences, between her and me for instance: wasit all right for her to be different, to be herself, or did she feel that she left so muchof herself behind in the drawings that she needed to find them in order to getherself back?

At this point, she took hold of the clip inside the box-file, which she had previouslyworked loose while telling me about two cartoon characters who were robbers, andput it into her mouth. I reminded her of the material about robbers, and said that



perhaps she got muddled between keeping hold of things, whether in her mouth orin her mind, and robbing me of something so that I was left like a box-file with abroken clip. It was hard to imagine perhaps that she could get what she neededwithout robbing me. She put the clip back in the box, as though she had misunder-stood me as reproaching her. This illustrates just how concretely she experiencedwhat I said, in spite of my attempts at careful phrasing.

In this sequence, it is as though Lina were still dominated by the autisticmodel according to which anything she might gain was the equivalent of ahard bit of an object that was concretely transferred to her mouth, like theplastic ring on Daniel’s lemonade bottle. She seems to avoid the dilemma ofdespoiling me or being despoiled by joining up with me physically as thoughwe were two halves of a single entity, or by locating her memories (andindeed much of her personality) in me or in her drawings. There appears tobe no clear distinction between keeping things in her mouth or in her mind– between the declarative and non-declarative realms.

In the next weeks, Lina told me repeatedly about Mime, one of the char-acters in her favourite cartoon, whom she sometimes called by his pet name,Mimey. I understood this as a pun on My-Me, and as a communication thatthis was what I was meant to be – herself and her possession. When shetold me that Mime could speak perfectly well but chose not to, I took thisup at first in terms of her letting me know that she, like Mime, had thepower to take decisions whereas I was powerless. This had no effect on herritualized stories; neither did my suggestion that it was not to matterwhether I was in the room or not, and that I was to feel ignored and angry.At length, I came to think that I needed to demonstrate more firmness if wewere not to continue indefinitely in a situation in which she used her mono-logues, drawings and books in order to evade any sense of me as a separateperson. Accordingly, I explained why I would no longer bring her drawingsto the sessions or allow her to bring books or toys.

This may appear to be an enactment on my part, though I considered itvery carefully and did not resort to action until I had attempted over aperiod of time to address what I thought might be Lina’s communication.When this failed to make any difference, I felt that I needed to interrupt theway she used toys, drawings and books as a concrete repository of our pastinteractions that allowed her to feel fused with me. Such a decision mustremain debatable, but workers treating children with autism have sometimesfound it necessary to act in order to deal with a stalemate in which the childused autistic objects to evade reality. For example, Tustin (1986, pp. 281–3)describes telling a patient who seemed to be stuck that it was important tostop sucking the insides of her cheeks. This manoeuvre had allowed herto sidestep the realization of bodily separateness, and, in Tustin’s view, she‘‘needed to be sternly encouraged to give up her massive evasions of reality’’.Important developments in the treatment then followed.

In Lina’s case, when I prevented her from using books, toys and drawingsas an ever-present source of supplies that embodied the history of pastsessions and when I also stopped responding on cue to her repetitive mono-logues, she began to attack me physically: biting, hitting, kicking, grabbingmy cheek and twisting it as though I were the cartoon character whose skin

370 M. Rhode


was ripped off. I have an old scar on the cheek she attacked, and I thoughtthat, as well as reacting with anger to what may have felt like having some-thing torn off her, she was testing out what damage she was and was notresponsible for. This interaction felt real, though I could well understandwhy she would have wished to circumvent it; and it became increasingly pos-sible to base interpretations on my countertransference response.

In the following terms, Lina oscillated between themes of love and hate.She began every session by ‘being’ Mime, pretending to sleep on a chair thatshe brought up to touch mine. Within that physical framework, once I hadasked what was happening, she talked about Mime’s feelings, in her ownvoice and with emotional depth. She spoke about Mime as a baby, aboutwhat it was like to be ‘‘tiny and soft and helpless’’; but also about his pres-ent adult status, and his tender love for his girlfriend and their children. Shedid what she called ‘‘sight-sharing’’ with both Mime and his girlfriend, thatis, seeing things from their respective points of view. Although the physicalexperience of our two chairs touching was still indispensable, her introduc-tion of a developmental perspective in relation to Mime was encouraging.She told me spontaneously that he wanted his mother’s nipple to be part ofhis mouth, which I took as having transference significance; he stretched itas far as it would go as well as trying to bite it off. His mother had to warnhim (as I had had to warn Lina, perhaps) that he would be bottle-fed if hedidn’t stop, but she forgave him, and he learnt to suck her milk instead,though he was worried when she had none left. Though he was now grownup, he returned home to visit. I could begin to imagine that Lina mightenvisage finishing as something other than a catastrophe, as a consequenceof becoming able to rely on memories of her development during the courseof treatment. In complete contrast, however, I also heard that Mime hadsuddenly left his girlfriend because she wanted another child, and had goneto live with a ‘‘devil woman’’.

Setting a date for finishing made it impossible to maintain the illusion ofbodily continuity. The ‘‘devil woman’’ now came fully into the transfer-ence.10 Lina did everything imaginable to kill off any hope I might have hadfor the birth of new aspects of her personality. She spent whole sessions inthe toilets, or else in deafening recitals of tantalizingly meaningful materialfrom YouTube that left me no opening to say anything. She revealed herselfas expert in eliciting feelings of helplessness, humiliation and rage as well asdespair. I felt acutely that I would never be forgiven; that years of work hadbeen spoilt forever; that Lina’s parents might well lodge a complaint againstme; that precious developments were irredeemably lost. These feelings wereso powerful that it took me some time to realize that they might also be acommunication in the countertransference. In the last session, Lina thrusta present in my face – her mother’s idea, she said, not hers – and continuedher recital from YouTube until the very end. Later, I heard from her motherthat she had written the accompanying card completely by herself: ‘DearMaria, thank you so much, it really helps, Love, Lina’. In the follow-up

10I shall not go into detail here about the technical problems encountered during this phase, though thisis obviously of central importance.



appointment six months later, she asked me immediately how I was; exam-ined my face carefully, and then said that I seemed ‘‘good’’, and that shewas as well. I heard from her family and school that this was true to somedegree, but it must remain an open question whether my survival of the‘devil woman’’s onslaught will be enough to support her in going forwardwithout confusing her progress with phantasies of annexing my capacities.

Discussion

In this paper, I have attempted to explore the bodily aspect of the way inwhich two children with autistic spectrum disorder appeared to experiencetheir memories. I have argued that their catastrophic anxieties to do withbodily mutilation described by Tustin and Haag, and the way in which theytypically seek refuge in sensation, mean that the feeling of being physicallycomplete tends to be associated with ownership of a source of sensation,typically located in the mouth (Tustin’s ‘hard extra bit’). The vignetteconcerning Daniel and the lemonade bottle may serve as an example of this,and also of the phantasy of adding to oneself by physically annexing partsof the object. This can lead to an oscillation between fear of a despoiledobject and guilt about the state to which it is reduced: either of these canlead to the kind of renunciation described by Riviere, Isaacs and Riesen-berg-Malcolm. In the example of the lemonade bottle, mouth and breast orbottle seem to be competing for the nipple or teat (the ring): as with Isaacs’spatient, there seems to be only one of whatever is needed.

Daniel was able to move from this position, in which he equated drinkinglemonade with damaging the structure of the bottle, to a position in whichhe could distinguish between a container and its content and was able tosuck water from a sponge the structure of which remained intact. Thisimplied the attainment of the concept of a space within the object, and,therefore, within himself as well. I assume that the attention paid in therapyto his feelings about separation and, more particularly, to his bodily anxi-eties, would have contributed to this development. The next development,illustrated by the vignette concerning the Tasty Meal Down the Well,implies a link between the aggressive impulses stimulated when Daniel isexcluded or kept waiting, and the fate within him of his internalized object.This is the area delineated by Klein in 1935 and 1940, in which depressiveanxieties arise concerning the possibility of keeping the introjected objectsafe within the self: Daniel now appears to be adding to himself by internal-ization rather than by annexation based on sensory experience. The specificlink with memory is illustrated by the fact that he began to talk aboutexperiences that took place outside the sessions at the time he had beenreassured about the state of absent objects when he returned to his respitehome that had been restored.

For whatever reason, Lina was not able to achieve the same development;and, indeed, the end result that was achieved with her was less satisfactorythan was the case with Daniel. This may have been because external circum-stances forced us to finish before I would have chosen to do so, when shewas still in early adolescence. It may also be that she felt less well contained

372 M. Rhode


and understood during treatment than Daniel did, though she told meexplicitly that addressing bodily anxieties made sense to her and was helpful.Other factors that I have no means of assessing no doubt played a part aswell. In any case, love and hate still seemed quite separate when she finishedtreatment, and, when she came for follow-up, the state she found me in stillseemed central to how she could describe her own state.

The vignette concerning her box of drawings and the clip illustrates howshe seemed to equate having something in her mouth with having somethingin her mind, and both of these with robbing me. Later, when she was ableto develop a temporal perspective in relation to the different stages ofMime’s life, this still depended on her chair touching mine, so that separate-ness was circumvented, and her experiences, hopes and memories remainedbetween us or in the cartoon characters. The major bodily anxieties thatseparation elicited and the ensuing aggression were circumvented too untilthe fact of finishing treatment made this impossible. Even at their worst, heronslaughts felt more like a communication than like sadism that she enjoyedfor its own sake, but sadly it may not have been modified sufficiently for herto feel confident that development need not mean turning the tables andtriumphing over me as Klein (1940) described.

I have differentiated the phantasy of annexation from projective identifica-tion, which involves getting inside an object, and from adhesive identification,which involves sticking to its surface. Annexation has the same consequencesof taking over ⁄ attacking the integrity of the object’s identity that Sodr�(2004) has described for concrete introjection. However, annexation does notinvolve internalization, and seems to be experienced on the level of sensation.I have suggested that there appears to be a convergence with the notion ofprocedural aspects of memory, which also concern bodily experience.

As Proust’s episode of the madeleine beautifully illustrates, proceduralfactors play an essential part in memories that feel alive. However, in thetwo children with autism I have described, the over-emphasis on bodilyaspects of memory posed an obstacle to development that proved difficultto overcome.

Acknowledgements

Earlier versions of this paper were presented as part of a panel on autisticstates at the IPA Congress of 2007 in Berlin; at the 4th Frances TustinMemorial Conference in Tel Aviv (May 2008); and at the Conference onChild Analysis, Psychoanalysis Unit, University College London, July 2009.The author wishes to thank Dr. Edna O’Shaughnessy and Dr. Margot Wad-dell for their helpful comments, as well as the London Editor of the IJPA,Dr. Catalina Bronstein, and the IJPA’s three anonymous reviewers. Someportions of Daniel’s material have appeared elsewhere within a differenttheoretical context (Rhode 1997, 2000).

Translations of summary

Wessen Erinnerungen sind es und worauf beziehen sie sich? Probleme um die Internalisierungbei Kindern im Autismus-Spektrum. Die neuere Forschung auf dem Gebiet der Neurowissenschaften



hebt den Unterschied hervor zwischen dem ,,prozeduralen’’ Ged�chtnis f�r kçrperliche Erfahrungen undF�higkeiten, das zwar unbewusst, aber nicht verdr�ngt ist und dem verbalisierbaren, ,,deklarativen’’ Ged-�chtnis, das das autobiographische Ged�chtnis umfasst. Bei Menschen im Autismus-Spektrum, die h�ufigauf selbsterzeugte Sinneseindr�cke zur�ckgreifen, um sich der Kontinuit�t ihrer Existenz zu versichern, istdas autobiographische Ged�chtnis schwach. Die Autorin behauptet, dass Kinder mit Autismus statt gem-einsame Erfahrungen zu internalisieren, die dann zu einem seelischen Wachstum f�hren, mçglicherweiseden Eindruck haben, dass sie zu sich selbst beitragen kçnnen, wenn sie die Qualit�ten anderer durch eine,,Einverleibung’’ kçrperlicher F�higkeiten �bernehmen. Das f�hrt zu einem besch�digten Objekt und kanneine besondere Form der negativen therapeutischen Reaktion hervorrufen. Klinische Beispiele aus derBehandlung von zwei Kindern im Autismus-Spektrum veranschaulichen einige der Auswirkungen dieserProzesse in Bezug auf das Gef�hl einer eigenst�ndigen Identit�t und der F�higkeit, auf Erinnerungenzur�ckzugreifen.

¿De quien son los recuerdos, y adonde se van? Problemas alrededor de la internalizacion enninos dentro del espectro autista. La investigaci�n reciente en neurociencia destaca el contraste entrememoria ‘procedimental’, para experiencias y habilidades corporales, que es inconsciente pero noreprimida y, adem�s, verbalizable, y memoria ‘declarativa’, que incluye la memoria autobiogr�fica. �stafflltima es d�bil en gente con trastornos del espectro autista, quienes a menudo recurren a sensacionesautogeneradas para asegurarse de que siguen existiendo. La autora sugiere que, en lugar de internalizarexperiencias compartidas que contribuyan al crecimiento, los niÇos con autismo pueden sentir que agre-gan algo a s mismos cuando se apropian de cualidades de otros mediante la ‘anexi�n’ de propiedadesfsicas. Dicha anexi�n resulta en un objeto daÇado y puede desencadenar un tipo particular de reacci�nterap�utica negativa. Se utilizan viÇetas clnicas provenientes del tratamiento de dos niÇos que se encuen-tran dentro del espectro autista para ilustrar algunas ramificaciones de estos procesos en relaci�n con lavivencia de una identidad separada y la capacidad de acceder a los recuerdos.

A qui sont ces souvenirs et ou vont-ils ? Les difficultes relatives a l’interiorisation chez lesenfants autistes. Des travaux r�cents dans le domaine des neurosciences ont mis en �vidence lecontraste entre la m�moire « proc�durale » qui, aff�rente aux exp�riences et aptitudes corporelles, estinconsciente bien qu’elle soit non refoul�e, et la m�moire verbale, dite « d�clarative », qui englobe lam�moire autobiographique. La m�moire autobiographique est mauvaise chez les personnes qui pr�sententdes troubles autistiques; celles-ci ont souvent recours � des sensations auto-g�n�r�es pour s’assurerqu’elles continuent bien d’exister. L’auteur de cet article consid�re que les enfants autistes, plut�t qued’int�rioriser des exp�riences partag�es, processus synonyme de d�veloppement, ont tendance � s’approp-rier les qualit�s des autres en « annexant » leurs caract�ristiques physiques, avec pour cons�quencel’endommagement de l’objet, qui peut provoquer � son tour une sorte de r�action th�rapeutique n�gative.Des vignettes cliniques extraites du traitement de deux enfants autistes illustrent certaines des ramifica-tions de ces processus dans leur rapport avec le sentiment d’une identit� s�par�e et la capacit� d’avoiracc�s aux souvenirs.

Memoria autobiografica o biografica? Problemi di interiorizzazione nei bambini con disturbodello spettro autitistico. Recenti studi neuroscientifici hanno messo in evidenza il contrasto fra lamemoria ‘procedurale’, che riguarda le funzioni e le esperienze fisiche ed � inconscia, sebbene nonrimossa, e la memoria ‘dichiarativa’ che � verbalizzabile e comprende la memoria autobiografica. Ques-t’ultima � debole negli individui con disturbo dello spettro autistico, I quali ricorrono spesso a sensazioniauto-generate per rassicurarsi sulla continuit� della loro esistenza. L’autrice avanza l’ipotesi che i bam-bini autistici, invece di introiettare le esperienze condivise in grado di promuovere il loro sviluppo, tenti-no di appropriarsi delle qualit� altrui, ‘annettendosele’. Ci porta alla percezione di oggetti danneggiati epu causare un tipo particolare di reazione terapeutica negativa. Esempi clinici tratti dal trattamento didue bambini autistici illustrano alcune ramificazioni di questi processi relativi al senso di una identiti�separata e la capacit� di accedere ai ricordi.

References

Abraham K (1924). A short history of the development of the libido, viewed in the light of mentaldisorders. In: Selected papers of Karl Abraham, 418–501. London: Hogarth, 1968. (The Interna-tional Psycho-Analytical Library.)

Alvarez A (1999). Addressing the deficit: Developmentally-informed psychotherapy with passive‘undrawn’ children. In: Alvarez A, Reid S, editors. Autism and personality, 49–61. London:Routledge.

Asperger H (1944). Autistic psychopathy in childhood. in: Frith U, editor, translator. Autism and Asper-ger syndrome, 37–92. Cambridge: Cambridge University Press. 1991. [‘Die ‘‘Autistischen Psycho-pathen’’ im Kindesalter’. Archiv fur Psychiatrie und Nervenkrankheiten 117: 76–136.]

374 M. Rhode


Bettelheim B (1967). The empty fortress: Infantile autism and the birth of the self. New York, NY:Free Press.

Bick E (1968). The experience of the skin in early object relations. Int J Psychoanal 49:484–6[(1987). In: Harris Williams M, editor. Collected papers of Martha Harris and Esther Bick. StrathTay: Clunie.] [(2002). In: Briggs A, editor. Surviving space, London: Karnac.].

Bick E (1986). Further considerations on the function of the skin in early object relations. Br JPsychother 2:292–9 [(2002). In: Briggs A, editor. Surviving space. London: Karnac.].

Bion WR (1962). Learning from experience. London: Heinemann.Breuer J, Freud S (1893). On the psychical mechanism of hysterical phenomena: Preliminary commu-nication. SE 2, 1–17.

Crane L, Goddard L (2008). Episodic and semantic autobiographical memory in adults with autismspectrum disorders. J Autism Dev Disord 38:498–506.

Crane L, Goddard L, Pring L (2009). Specific and general autobiographical knowledge in adults withautism spectrum disorders: The role of personal goals. Memory 17:557–76.

Crane L, Goddard L, Pring L (2010). Brief report: Self-defining and everyday autobiographical memo-ries in adults with autism spectrum disorders. J Autism Dev Disord 40:383–91.

Freud S (1911). Formulations on the two principles of mental functioning. SE 12, 213–26.Freud S (1917). Mourning and melancholia. SE 14, 237–60.Freud S (1923). The ego and the id. SE 19, 3–66.Gaensbauer TJ (2002). Representations of trauma in infancy: Clinical and theoretical implications forthe understanding of early memory. Inf Mental Hlth J 23:259–77.

Haag G (1985). La mere et le bebe dans les deux moities du corps. Neuropsychiatrie de l’Enfance33:107–14.

Haag G, Tordjman S, Duprat A, Urwand S, Jardin F, Clement MC, Cukierman A, Druon C, Maufrasdu Chatellier A, Tricaud J, Dumont A-M (2005). Psychodynamic assessment of changes in childrenwith autism under psychoanalytic treatment. Int J Psychoanal 86:335–52.

Hare DJ, Mellor C, Azmi S (2007). Episodic memory in adults with autistic spectrum disorder: Recallfor self- vs. other-experienced events. Res Dev Disabil 28:317–29.

Isaacs S (1948). On the nature and function of phantasy. In: Klein M, Heimann P, Isaacs S, Riviere J,editors. Developments in psycho-analysis, 67–121. London: Hogarth, 1952.

Kanner L (1943). Autistic disturbance of affective contact. Nervous Child 2: 217–50. Reprinted in:L. Kanner, Child Psyc: Init Stud and Insight. New York: Winston ⁄ Wiley.

Klein M (1930). The importance of symbol-formation in the development of the ego. In: The writingsof Melanie Klein, vol. 1: Love, guilt and reparation, 219–32. London: Karnac ⁄ Institute ofPsychoanalysis, 1975.

Klein M (1932). The psycho-analysis of children. In: The writings of Melanie Klein, vol. 2, 142–267.London: Karnac ⁄ Institute of Psychoanalysis, 1975.

Klein M (1935). A contribution to the psycho-genesis of manic-depressive states. In: The writingsof Melanie Klein, vol. 1: Love, guilt and reparation, 262–89. London: Karnac ⁄ Institute ofPsychoanalysis, 1975.

Klein M (1940). Mourning and its relation to manic-depressive states. In: The writings of MelanieKlein, vol. 1: Love, guilt and reparation, 344–69. London: Karnac ⁄ Institute of Psychoanalysis, 1975.

Klein M (1946). Notes on some schizoid mechanisms. In: The writings of Melanie Klein, vol. 3:Envy and gratitude and other works, 1–24. London: Karnac ⁄ Institute of Psychoanalysis, 1975.

Klein M (1955). On identification. In: The writings of Melanie Klein, vol. 3: Envy and gratitude andother works, 141–75. London: Karnac ⁄ Institute of Psychoanalysis, 1975.

Klein M (1961). Narrative of a child analysis. In: The writings of Melanie Klein, vol. 4, Note II to 28thsession. London: Hogarth, 1975.

Mahler M (1968). On human symbiosis or the vicissitudes of individuation. New York: InternationalUniversities Press.

Mancia M (2006). Implicit memory and early unrepressed unconscious: Their role in the therapeuticprocess (How the neurosciences can contribute to psychoanalysis). Int J Psychoanal 87:83–103.

Meltzer D (1974). Adhesive identification. In: Hahn A, editor. Sincerity and other works: Collectedpapers of Donald Meltzer, 335–50. London: Karnac, 1994.

Meltzer D, Bremner J, Hoxter S, Weddell D, Wittenberg I (1975). Explorations in autism. Strath Tay:Clunie.

Mukhopadhyay RT (2000). Beyond the silence: My life, the world and autism. London: NationalAutistic Society [(2003). The mind tree: A miraculous child breaks the silence of autism. New York,NY: Arcade.].

Pally R (2000). The mind-brain relationship. London: Karnac Books. International Journal of Psycho-analysis Key Papers Series.

Proust M (1913). Remembrance of things past, vol. 1: Swann’s way. Scott Moncrieff CK, translator.London: Chatto, 1922.



Rhode M (1997). Going to pieces: Autistic and schizoid solutions. In: Rustin M, Rhode M, DubinskyA, Dubinsky H, editors. Psychotic states in children, 231–44. London: Duckworth. (Tavistock ClinicBook Series.)

Rhode M (2000). On using an alphabet: Recombining separable components. In: Symington J, editor.Imprisoned pain and its transformation: A festschrift for H. Sydney Klein, 80–97. London: Karnac.

Riesenberg-Malcolm R (1981). Expiation as a defence. Int J Psychoanal Psychother 8:549–70.Riviere J (1936). A contribution to the analysis of the negative therapeutic reaction. In: Hughes A,editor. The inner world and Joan Riviere: Collected papers, 1920–1958, 134–53. London: Karnac,1991.

Rodrigue E (1955). The analysis of a three-year-old mute schizophrenic. In: Klein M, Heimann P,Money-Kyrle RE, editors. New directions in psycho-analysis, 140–79. London: Tavistock.

Rosenfeld H (1964). On the psychopathology of narcissism: A clinical approach. In: Psychotic states,169–79. London: Hogarth, 1965.

Russell J, Jarrold C (1999). Memory for actions in children with autism: Self versus other. CognNeuropsychiatry 4:303–31.

Rutter M, Andersen-Wood L, Beckett C, Bredenkamp D, Castle J, Groothues C, Kreppner J, Keave-ney L, Lord C, O’Connor TG (1999). Quasi-autistic patterns following severe early global privation.J Child Psychol Psychiatry 40:537–49.

Sacks O (1985). The man who mistook his wife for a hat, and other clinical tales. New York, NY:Summit.

Schacter DL (1996). Searching for memory. New York: Basic Books.Segal H (1957). Notes on symbol formation. Int J Psychoanal 38:391–7 [(1988). In: Spillius EB,editor. Melanie Klein today, vol. 1: Mainly theory. London: Routledge.].

Shapiro T (2000). Autism and the psychoanalyst. Psychoanal Inq 20:648–59.Simpson D (2004). Asperger’s syndrome and autism: Distinct syndromes with important similarities.In: Rhode M, Klauber T, editors. The many faces of Asperger’s syndrome, 25–38. London: Karnac.(Tavistock Clinic Book Series.)

Sodre I (2004). ‘Who’s who?’ Notes on pathological identifications. In: Hargreaves E, Varchevker A,editors. In pursuit of psychic change: The Betty Joseph workshop, 53–65. London: Brunner Routl-edge.

Solms M, Turnbull O (2002). The brain and the inner world: An introduction to the neuroscience ofsubjective experience. New York, NY: Other Press ⁄ Karnac.

Stern DN, Sander LW, Nahum JP, Harrison AM, Lyons-Ruth K, Morgan AC, Bruschweilerstern N,Tronick EZ (1998). Non-interpretive mechanisms in psychoanalytic therapy: The ‘something more’than interpretation. Int J Psychoanal 79:930–21.

Tustin F (1972). Autism and childhood psychosis. London: Hogarth [(1995). London: Karnac.].Tustin F (1980). Autistic objects. In: Autistic states in children, 111–26. London: Routledge, 1981; 2ndrevised edition, 1992.

Tustin F (1981). Autistic states in children. London: Routledge 2nd revised edition, 1992.Tustin F (1986). Autistic barriers in neurotic patients. London: Karnac 2nd revised edition, 1994.Tustin F (1990). The protective shell in children and adults. London: Karnac.Williams DL, Goldstein G, Minshew NJ (2006). The profile of memory function in children with autism.Neuropsychol 20:21–9.

Wing L, Gould J (1979). Severe impairments of social interaction and associated abnormalities in chil-dren: epidemiology and classification. J Autism Dev Disord 9:11–29.

Winnicott DW (1949). Birth memories, birth trauma, and anxiety. In: Through paediatrics to psycho-analysis, 174–93. London: Tavistock, 1958. [(1975). London: Hogarth.]

Wittenberg I (1975). Primal depression: John. In: Meltzer D, Bremner J, Hoxter S, Weddell D,Wittenberg I, editors. Explorations in autism, 56–98. Strath Tay: Clunie.

376 M. Rhode


Date post:	28-Sep-2016
Category:	Documents
Upload:	maria-rhode
View:	216 times
Download:	5 times

Whose memories are they and where do they go? Problems surrounding internalization in children on...

Documents