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CHAPTER TITLE

AUTISTIC TRANSFORMATIONS

AUTISTIC
TRANSFORMATIONS
Bions Theory and
Autistic Phenomena
Clia Fix Korbivcher

First published in Portuguese in 2010 by Imago Editora


First English edition published in 2014 by
Karnac Books Ltd
118 Finchley Road, London NW3 5HT

Copyright 2014 to Clia Fix Korbivcher.


The right of Clia Fix Korbivcher to be identified as the author of this work
has been asserted in accordance with 77 and 78 of the Copyright Design
and Patents Act 1988.
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CONTENTS

ACKNOWLEDGEMENTS

vii

ABOUT THE AUTHOR

ix

FOREWORD by Guiseppe Civitarese

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PREFACE TO THE BRAZILIAN EDITION


INTRODUCTION
CHAPTER ONE
A dissonant duo: report of a childs analysis
With comments by Frances Tustin

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xix

CHAPTER TWO
Some thoughts on the psychoanalytic object

15

CHAPTER THREE
Primitive mind and thought

25

CHAPTER FOUR
The theory of transformations and autistic states.
Autistic transformations: a proposal

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CONTENTS

CHAPTER FIVE
The analysts mind and autistic transformations

69

CHAPTER SIX
Bion and Tustin: the autistic phenomena and
Bions referential

93

REFERENCES

119

INDEX

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ACKNOWLEDGEMENTS

First of all, I would like to thank Karnac Books for publishing the
English edition of this book. Milena Basaria translated the book
into English. I owe her recognition for her excellent work and for
complying with Karnacs instructions, thus making this edition
possible.
I thank John Wiley & Sons Ltd for kindly granting permission to
reproduce the paper Bion and Tustin: The autistic phenomena and
Bions referential, written by me and published in August 2013 in the
International Journal of Psychoanalysis, 94(4): 645665. I am also grateful
to Routledge for permission to reproduce the above-named paper,
also published as a chapter in the book Primitive Mental States. A
Psychoanalytic Exploration of the Origins of Meaning (edited by Jane Van
Buren and Shelley Alhanati, 2010).
I thank my colleagues and friends: Antonio Carlos Eva, Cecil Jos
Rezze, Darcy Portolese, Evelise de Souza Marra, Fernando Giuffrida,
Ione Vitorelo Castelo, Julio Frochtengarten, and Roberto Vilardo, with
whom I have established a rich dialogue in recent years. This dialogue
contributed to the development of many of the thoughts gathered in
this book.

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ACKNOWLEDGEMENTS

I also thank Joo Carlos Braga, always a generous and available


presence, on whom I was able to count as a major interlocutor
indeed, a questioning interlocutor. With him, I learnt to become more
demanding and to sharpen my arguments. Without his collaboration,
this would be a different book.
I owe my gratitude to Cecil Jose Rezze for having greatly
contributed to my personal development. I am mainly grateful for the
encouragement he gave me to question, to investigate, and to think for
myself.
I am particularly grateful to James Grotstein for his generous
contribution and detailed comments on some chapters of this book.
His interest in the proposals I have developed, along with his respect
and encouragement, were a great incentive to deepen my ideas and to
publish the book.
Finally, I thank Mnica, Michel, Camila, Luciano, Theo, Bruno,
and Ruy for their patience. I particularly thank Ruy, my lifetime
companion, always present, supporting and encouraging me. Without
him, none of this would have been possible.

ABOUT THE AUTHOR

Clia Fix Korbivcher is a training and supervising analyst, child


analyst, and a member of the Brazilian Psychoanalytic Society of So
Paulo. For several years, Dr Korbivcher has been working in private
practice, analysing children, adolescents, and adults. She has focused
on the study of autistic phenomena in neurotic patients and has written several articles on this subject. Her papers have been published in
both Brazilian and international journals, including the International
Journal of Psychoanalysis. She authored the original Portuguese edition
of this book, published in 2010 by Imago Editora. Dr Korbivcher was
awarded the Fabio Leite Lobo Prize in the years 2001 and 2008. She
received The First International Parthenope Thalamo Bion Prize in
2004, and the Ninth Frances Tustin Memorial Prize in 2005.

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FOREWORD

Giuseppe Civitarese

But how come you know these songs? Marieta asks her analyst.
That immediately reminded me of the similar surprised response of a
patient of mine: You mean you also watch these trashy pulp films!?
This is, first and foremost, a book about the importance of speaking
the same language as ones patients. Each is different from any other;
each has his or her own history, guards his or her secrets and carries
the burden of his or her troubles. We see these patients passing in
succession as we read. We meet Ana, silent, motionless, and
constantly chewing gum. Next comes Marieta, just mentioned, whom
we encounter first at the age of six, and then at nine. Marieta initially
presents with wild Jo (violent emotions), then calms down and is
able to ask for what she needs: Abracadabra, be sweet, sweet, sweet,
very sweet! The magic works. She, too, is asking to be fed: for a sweet
can mean either a candy or behaving sweetly. Five-year-old Mrio, on
the other hand, is more demanding and yells at the analyst, I WANT
FOOD NOW! GIMME, GIMME, GIMME NOW! Then there is Pedro, six years
old, who is afraid of dreams and has night terrors, so he can neither
get to sleep nor be awake.
It is odd, but that is the way it is. Night dreams and daydreams
are the minds way of going about the task of transforming emotions
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FOREWORD

into thought. Just as there are daydreams, so, too, there is daytime
sleep, which we call the waking state, and, just as they do at night, the
two go together. When dreaming is possible, in the sense of successfully conferring a personal meaning on experience, waking sleep is
the seeming facility with which we move between persons, our nave
realism, and the smooth surface over which everything appears to
glide.
Next in line is six-year-old Lus, who comes alive only when his
father licks his face. He is followed by Caio, aged four, who communicates only with the names of television characterssounds in
search of a mind. However, other fantasy characters, too, bring to life
the vivid and moving stories that allow us to participate intimately in
the joys and pains that Clia Fix and her guests share, sometimes for
years on end: the whale, the platypus, France or Brazil as places in the
mind or in the analytic field, or songs such as Chega de Saudade.
The names of all the patients, whether big or small, remain
impressed on our memory. It is they who are in the foreground. Clia
Fix knows how to summon them up in the way that only the best writers can, by the masterly use of just a few details. Through the manner
of her presentation, she enables us to see them as living persons. No
distance between them and the reader is noticed. That is no doubt
why, every time I picked up the book, I was pleased to discover
myself so thrilled by the stories that I could hardly put it down.
Another reason might be that, as in the most felicitous examples of
psychoanalytic writing, Clia Fix does not care to weigh down her text
with jargon. She takes with her only the basic essentials, like someone
venturing into the desert or the high mountains. That is when certain
tools become important. Clia Fix has obtained some of these from the
preferred authors whom she mentions, such as Tustin, Bion, and
Green; other tools, as we shall see, she has constructed for herself, as
Bion recommends all analysts to do.
Yet, even if the conceptual apparatus remains in the background,
due respect is accorded to it. Clia Fixs ambition is to put forward a
new development of the paradigm that has gained increasing acceptance in psychoanalysis since autism first came to be studied. From
Bleuler to Kanner, to Meltzer and Tustin, we can now trace the precise
line of its evolution. The past few years have witnessed a flowering of
literature that has taken up and expanded Frances Tustins insights on
autistic barriers in neurotic patients. Since the publication of her fasci-

FOREWORD

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nating books, we have become accustomed to the idea that the


concepts bound up with the paradigm of autism describe forms of
psychic functioning that are present in us all, and fortunately so, we
might say, because they are, after all, defences that can preserve us
from the traumas of life and become pathological only if they persist
for too long or ultimately come to dominate all the other resources
that might be available to us. This is in line with a consistent trend
applicable to the principal concepts of psychoanalysis, which come
into being to illustrate an aspect of pathology and then prove equally
useful for throwing light on normal modes of mental functioning.
These lie on a continuum that extends from the normal to the pathological and differ not qualitatively, but only quantitatively.
The paradigm of autism enables the analyst to confront previously
intolerable situations of chaos. In addition, it belongs within the wideranging theoretical sphere of sensory phenomena that precedes and
paves the way for thoughtthat is, the protomental. Winnicott
would say that a subject (an ego) must first come into being and can
only then experience the conflicts that stem from the drives. Kristeva
calls this dimension the semiotic chora. Something very useful for clinical work that we have learnt is that words, too, are action and that
the sensory floor of the ego that precedes symbolic functioning accompanies us throughout our lives. It is no coincidence that another of the
most fruitful developments of Tustins research, in my opinion, is
Thomas Ogdens concept of the autisticcontiguous position, which is,
incidentally, so close to Blegers notion of the glischro-caric position.
This entire area of study is of extraordinary interest and comes
together in the conceptualisation of the inaccessible or nonrepressed unconscious, one of the frontiers of research in psychoanalysis. The issue is how to transform states of mind that do not
correspond to representationstraumas presumably recorded only in
implicit memoryinto something representable.
What is the main advantage of the paradigm of autism? We have
developed an attitude of the kind Meltzer calls peripheral vision,
like that possessed by autistic children and which we all have in a
literal sense in the retina around the fovea. It is a hypersensitivity that
allows us to apprehend phenomena that previously went unnoticed
or were deemed insignificant, but which now prove essential in some
forms of psychic suffering, when separation is experienced like a
wound to the body. In order to perceive the stars at night, we must

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FOREWORD

avoid the light pollution of big cities; in other words, we must give up
certain notions that do not help us to see and adopt new ones instead.
Clia Fix now contributes authoritatively to the expansion of this
theoretical field. As stated, she does so not only by gathering together
the heritage of the masters, but also by forging instruments of her own
which she puts at our disposal in this book. Chief among these is
autistic transformation.
The concept of autistic transformation is a valuable addition to
Bions series of psychic transformations. Unlike rigid-motion transformations (as produced by the classical transference), projective
transformations (responsible for the phenomena of splitting and
projective identification) and transformations in hallucinosis, autistic
transformations organise a set of phenomena, some of which are very
obvious, while others that are highly subtle have been observed in
pathological autism, but might also be encountered in neurotic
patients with autistic or encapsulated nuclei. In an analytic session,
these patients defend against awareness of their separateness from the
analyst by resorting mainly to the distorted use of sensations. They
envelop themselves in autosensual activities so as to divert their
perception away from something that might plunge them into terror.
Just as Dantes Beatrice refuses to smile at the beginning of Canto XXI
of Il Paradiso in order not to incinerate him with fascination for her
(the fate that befell Semele), so, for these persons, the object has a
Medusa-like quality against which they must defend at all costs.
Analysts might experience these moments, which sometimes appear
interminable (it is characteristic of these situations that the arrow of
time seemingly comes to a halt), by succumbing themselves to autistic transformations. They get bored and distracted, decathect the
patient and use theory as a source of what itself ultimately amounts
to autosensual stimulation and not in order genuinely to thinkthat
is, they are not in living contact with the emotional situation of the
moment, but are isolated in an unreal and closed-off world.
The concept of autistic transformation combines a number of hitherto scattered theoretical components into a conceptual framework
that helps us to recover a sense of vitality when faced with these
despairing situations, and, as we can see, to recognise the signs of
autistic transformations in ourselves, too, and not just in the patient.
If the analyst succeeds above all in escaping from this spell, the result
is an anti-autistic transformation that might help the patient to regain

FOREWORD

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a modicum of trust and vitality. The challenge to us as analysts is,


therefore, to make good use of thesometimes physicallyintolerable emotions of emptiness and desperation that we shall inevitably
experience sooner or later in these difficult situations. Whenever we
succeed in this, we get closer to the patient and exorcise the fear of
contact underlying that of separation, which is experienced as a physical laceration.
This conceptualisation is all the more important when these
phenomena are vaguer and more difficult to identify, as in persons
who, despite the flatness of their affective lives, retain sufficient
operational capacity to cope with the demands of everyday life. It
is precisely in these situations that ones vision must become keener
and ones reasoning more perspicacious. Obsessional defences, hallucinatory sensations, and psychic integuments mediated by symptomatic or seemingly well-adapted behaviour may be used in different
ways by different patients to withdraw into a kind of autistic shell. To
reach these patients, analysts must possess conceptual equipment
allowing them to cross the desert of non-thought and of protomental
or inaccessible states of the mind. An essential requirement is receptivity to the slightest changes in climate, whether in time or in space
and however imperceptible, and to the reveries that visit us if we
succeed in achieving the correct state of passivity, without memory or
desire, as recommended by Bion.
The crucial theoretical step taken by Clia Fix with the concept of
autistic transformation, in my opinion, concerns the reincorporation
of all these phenomena and concepts, which feed on each other,
within a never-ending circularity, in the sense that in order to see we
need theories, and that the phenomena we observe then modify those
theories. She fits everything into a radically intersubjective framework
of the birth of the mind, in accordance with Bions view, as implied by
the notion of transformation. This step is both crucial and fruitful
because it changes our understanding of clinical work and, precisely,
induces us to apply new instruments. In other words, the author
grafts these on to the fertile plant of Bions thought and of the developments in psychoanalysis since Bion. This leads naturally to the use
of different models and techniques in our daily work. Another of the
books unparalleled merits, which Clia Fix shares with very few
other authors, is that she enables us to see how Bion can inspire our
clinical work.

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FOREWORD

As stated earlier, however, the main focus of the volume is never


on theoretical concepts, which rightly remain in the background. This,
for me, is the best possible demonstration an author can give of how
he or she works. She does not run away from us: we know nothing
about a non-writer, but if someone writes, we get to know everything,
whether good or bad. A writers style always tells us something about
the person and the analyst alike. As in analysis, lying is impossible. It
is the unconscious at work. Just as Marieta, Pedro, and Ana come to
life as characters in the round, so we can be sure that Clia Fix
succeeds in instilling new life into them when she welcomes them into
her home. We can, likewise, be sure that she sees them against the
background of psychoanalytic theories and not the other way round.
That is why she is not afraid of not understanding, of getting exasperated, of hating, and of feeling bored. Rather than hastening to
consult the sacred texts, she lets them work with discretion. In this
way, she feeds her patients; she gives them food for the mind, as Bion
puts it.
Again, Clia Fix gives us a valuable indication of her conception of
analytic work through a fine quotation from Viderman. Analysis, like
dreams and art, does not reproduce the past or the visible, but itself
renders visible, causes things to come into being before our eyes,
creates a world that was not there before, and confers meaning on life.
Everything, therefore, centres on the experience of analysis with the
patient in the here and now of the encounter, as witness the serious
jocularity and humour of which the author shows herself to be capable, less emphasis being placed on reconstruction of the past (the great
advantage of working with children would merit a chapter in its own
right).
Moreover, conceptual and affective genealogies are here recombined. A token of the climate of humanity, intimate participation, and
gentle wisdom that pervades the entire book comes in the first chapter, when the author describes her felicitous meeting with Frances
Tustin. The celebrated analyst respects and encourages the pupil as
she takes her first steps; there could surely be no better illustration
precisely because it is offered indirectly by way of a personal
memoryof the forging of the bond that creates the mind (the spark
of every new idea) and lies at the root of creativity in psychoanalysis.

PREFACE TO THE BRAZILIAN EDITION

Many theoretical publications in psychoanalysis contain personal


elaborations of original ideas belonging to the foundation of psychoanalytic knowledge. A few of them contain the spark of a new idea,
an idea that will necessitate reviewing the field of study, furthering
and expanding it. The concept of autistic transformation is one of
these ideas. The present book outlines the history of the development
of this idea. Initially, we recognise the new idea; we then identify its
origins. It is a marriage of W. R. Bions theory of transformations with
the theorisation on autism developed by Frances Tustin. Finally, the
authors careful elaboration leads us to review the theory of transformations through which we gain a better perception of the presence of
autistic manifestations in personalities that attain adequate levels of
symbolic development.
The first three chapters come from papers written between 1992
and 2005. They provide a view of the clinical problems that stimulated
Korbivchers investigation. The next three detail the autistic transformation hypothesis, its clinical and theoretical elaboration. The book
ends with an examination of the consequences of the authors
approach, but at a higher level of abstraction. This sequence elucidates
the authors view.
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PREFACE TO THE BRAZILIAN EDITION

Based on her clinical experience with children and adults who


presented primitive forms of mental functioning, the author examines
these phenomena from the viewpoint of the theory of transformations,
creating an original approach to the autistic phenomenon. The inclusion of autistic transformations, conversely, widens the psychoanalytic theory. Korbivchers observations, and the hypothesis she uses to
organise them, broadens our notions of the mind beyond the realm of
the senses, beyond objective thoughts, beyond hallucinations, beyond
authenticity, and beyond future thoughts. It also broadens Tustins
perspective of the existence of an autistic part of the personality,
besides the neurotic and psychotic parts.
Quite a few problems and difficulties arise from the concept of
autistic transformations. The author puts us in contact with several of
them and proposes ways to approach them, both theoretically and
clinically. As with any new idea, these are steps in the dark, and the
data raised lead to doubts. However, what Korbivcher proposes will
have an impact on our future discussions of ideas we tend to treat as
already settled.
The importance of Clia Fix Korbivchers contribution can be evaluated by the awards her work has received from the psychoanalytic
community, both in Brazil and abroad: The Fabio Leite Lobo Prize,
from the Brazilian Association of Psychoanalysis in 2002, the 2004
Parthenope Bion Talamo Prize from the Italian Society of Psychoanalysis, and the 2005 Frances Tustin Memorial Prize.
Joo Carlos Braga
Brazilian Society of Psychoanalysis of So Paulo

Introduction

This book is a collection of six papers in which I present ideas concerning the clinical aspects of primordial states of the mind, more specifically, autistic and non-integrated states present in neurotic patients. In
such states, bodily sensations prevail in place of fantasies and
emotions.
I believe that it would be useful at this moment to describe the
path I followed until I decided to publish this collection of papers
about this topic.
My entire training was strongly influenced by the ideas of Bion.
Moreover, my contact with the contributions of Frances Tustin was
extremely significant.
In 1990, I had the privilege of meeting Tustin in person. This
opportunity arose purely by chance. A colleague, in supervision with
Tustin, mentioned a paper I was working on, in which I presented the
report of an analysis of a six-year-old girl who, during a session, asked
me whether I knew a strange animal called platypus. She defined it
as a very strange animal which spills milk through its pores. She
then added, Pores are holes.
At that time, Tustin had published her book, The Protective Shell in
Children and Adults. On the cover of the book, there is a photograph of
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INTRODUCTION

a sculpture of Henry Moores in which a woman has a hole in place


of a nipple. On hearing about my experience, Tustin was vividly interested in the image of the platypus and asked me to send her my paper.
I felt greatly honoured by her interest. I have considered Tustin a
great authority, a renowned personality, in the world of psychoanalysis. I sent her the text, and was very surprised, a few days later,
to receive a long letter in which I found, not the great authority which
I had imagined, but, rather, a humble, generous person, making an
effort to inform me of her ideas about that childs material and introducing me to her view of what she calls the autistic part of the
personality.
A year later, I went to London and decided to contact her for some
supervision. I was impressed with her personality, especially her
enthusiasm about her work and about psychoanalysis in general. I
was moved by her careful, respectful attitude towards me as we made
appointments to meet at her home in Amersham, where she lived
with her husband, Arnold. Tustin received me warmly, always with a
magnificent tea, and we would then talk for hours about her view of
my clinical work.
Her ideas were decisive in the sense that they broadened my
view of primitive mental phenomena in my clinical work. Tustin
introduced me to the notion, until then unknown to me, that even
in neurotic patients there might be an autistic part of the personality in which prevail encapsulated autistic nuclei, inaccessible to
contact.
Since then, Bions and Tustins ideas have followed me and given
me a constant incentive for reflection.
The theoretical referential which I adopt in the analytic session is
that of the emotional experience shared between the analyst and the
analysand, and the theory of transformations (Bion, 1965) is the
method I use to observe the phenomena in this field.
The six papers which I have reproduced in the chapters of this
book are: A dissonant duo: a report on the analysis of a child, with
comments by Frances Tustin, 1992; Some thoughts on the analytic
object, 1995; Primitive mind and thought, 1999; The theory of
transformations and autistic states. Autistic transformations: a
proposal, 2005b; The analysts mind and autistic transformations,
2005a; Bion and Tustin, the autistic phenomena and Bions referential: an attempt to become closer, 2007.

INTRIDUCTION

xxi

In the first chapter, I describe the moving analytic experience of a


child who, during the process, as Tustin remarks, was able to develop
the capacity to be separated from the object and, along with this,
develop a thinking apparatus. As a result of these acquisitions, this
child began to make a broader use of her inner resources and to
expand considerably her notion of herself.
Based on the experience of analysing this patient, I became interested in thinking about what entails the analytic task and reflecting
about the processes involved in the relationship between analyst and
analysand during the session, in order to become closer to the analytic
object.
In Chapter Two Some thoughts on the analytic object, I return to
the ideas formulated by Tustin in her comments on my paper that
comprises Chapter One, and in Chapter Three, Primitive mind and
thought, I investigate the analysts need to discriminate, during the
session, the different levels of mental development on which the
patient operates at every movementneurotic, psychotic, or autistic
level. This proposal arose because I observed that the primordial
communications, linked to the autistic part of the personality, often
have such an impact on the analysts mind that they hamper the
recognition of the phenomenon involved in them, especially in
neurotic patients who exhibit autistic nuclei.
During the same period, I also became interested in thinking about
Bions theory of transformations (1965), particularly its epistemological foundations. In this theory, Bion highlights different types of transformations: transformations in rigid movement, projective, in
hallucinosis, in K (knowledge), in K (minus knowledge), and in O
(being), leaving open the possibility that other groups of transformations may be included in this theory.
However, based on my experience with some patients and the
contact with Tustins ideas, I began to look at the possibility of integrating the autistic universe with the theory of transformations,
giving continuity to the uneasiness that had been following me for a
long time.
In Chapter Four, The theory of transformations and autistic
states. Autistic transformations: a proposal, first published in 2001, I
suggest the addition of a new group of transformations to the theory
of transformations, the autistic transformations in which the autistic phenomenon prevails. In the same way as Bion highlighted the

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INTRODUCTION

phenomenon of hallucinosis, proposing transformations in hallucinosis, which is different from hallucination, in the autistic transformations the autistic phenomenon prevails, which should not be confused with autism as pathology. I point out that the autistic transformations do not apply to autistic patients, but to those who have autistic nuclei, despite operating with the neurotic part of personality.
It should also be mentioned that the phenomenon that prevails in
autistic transformations, despite being somewhat similar to the
phenomenon of hallucinosis, is of a different nature. The emotional
experience in autistic transformations is that of emptiness, an absence
of emotion, while in transformations in hallucinosis, the emotional
experience is intense, full of life. I immediately realised that this
apparently simple proposal was more complex than I had expected,
and that this topic would challenge and encourage me to keep investigating.
In Chapter Five, The analysts mind and autistic transformations, originally written in 2004, I develop ideas about the impact of
autistic transformations on the analysts mind. I investigate the need
to highlight and delimit the parameters of the autistic universe,
considering that this universe organises itself under the aegis of sensations and is, thus, ruled by laws of its own, different from those found
in the realm of neurosis and psychosis. From this perspective, I
explore the possibility that this universe will become a new paradigm
for psychoanalysis.
The final chapter, Bion and Tustin: the autistic phenomena and
Bions referential, originally penned in 2007, furthers the idea of integrating the autistic phenomena to Bions referential as I try to relate
these phenomena to some of the concepts used in Transformations
(1965). My purpose, in this text, is a stricter look at the appropriateness of the proposal of autistic transformations. To that end, I ask:
how do these phenomena relate to the beta elements? How will they
be part of the Grid? What is their relationship with the emotional links
proposed by Bion? In which of the dimensions of the mind are they
situated? I think that once the autistic area is included in Bions referential, this referential will be extended and begin to cover a new area
of phenomena predominantly linked to sensations.

CHAPTER TITLE

CHAPTER ONE

A dissonant duo: report of a


childs analysis
With comments by Frances Tustin

Introduction
t is common in our clinical work to encounter patients who, when
faced with strong inner or outer pressure, do not have resources
other than discharging this pressure into the analysts mind in
order to obtain relief. These are patients who have not developed a
mental apparatus able to contain this tension, work it through, and to
transform it into thought.
The analyst faced with this type of communication is often
engulfed by the power of the situation and has trouble maintaining
both his analytic standpoint and the ability to think. However, when
it is possible to rescue his position, he has no alternative other than to
step back and wait for an opportunity to attempt communication with
the patient.
In order for this communication to become accessible to the
patient, the experience shared by the pair must be transformed by the
analyst, who, with his capacity for reverie and alpha function, should
present it to the patient in a way that will render it more palatable.
In my opinion, repeated experiences like this will allow patients to
develop a psychic apparatus capable of containing these undesirable

AUTISTIC TRANSFORMATIONS

contents in their minds, rather than just discharging them. When they
develop a psychic apparatus with such capability, they increase their
contact with themselves and become more able to expand their
resources, to expand the functions of their minds.
Six-year-old Marieta, the patient whom I present here, has this
kind of mental functioning. My intention is to illustrate with her clinical material the process she experienced during analysis, in which she
was gradually able to construct a mental apparatus that could think
the thoughts and, thus, creatively transform many of her states of
mind into words and metaphors.

Case study: Marieta


Marieta was brought for analysis by her parents. She has a fraternal
twin sister and a brother who is two years younger than her.
They were referred by Marietas school, because of her lack of
attention and disinterest. Her classmates were hostile to her; she
isolated herself and clung to her sister, not relating to other children.
She was visibly unhappy at home, always dissatisfied and demanding. She had tantrums when she was opposed and became very
aggressive on such occasions.
Her sister had begun analysis some time before, and this made
Marieta insist on having her own analysis. From that time on, the
dynamics between the two changed. Marietas sister dethroned her
and became the dominant twin.
My attention was drawn initially to Marietas extremely unkempt
appearance. Her clothes were actually ragged, torn, and, sometimes,
even filthy.
At our sessions, she was anxious and frightened, clearly distressed
about being adequate to the situation. She obviously experienced
some suffering owing to being separated from her sister. She insisted
on bringing her sister along, and sometimes even brought her to the
office, saying that her sisters analyst had occasionally let her come
to their sessions, which made her happy. The idea of an existence
separate from her sister was foreign to her. As her sister became
increasingly independent because of her own analysis, Marieta felt
threatened by the feelings brought up by that. She feared that her
sisters analyst would occupy her place as a twin sister. In the same

A DISSONANT DUO: REPORT OF A CHILDS ANALYSIS

manner, excluding her sister and being alone with me made her very
anxious.
This was what I faced when I began this analysis. Many questions
were in my mind, mainly concerning the work with a twin.
For some time, we maintained an apparently cordial relationship
in which Marieta appeared to be enthusiastic and co-operative.
Slowly, as she felt more comfortable, she began to express herself
more freely and started to react with violence as a result of frustration.
We began to experience moments in which hate and destructiveness predominated, triggering situations of real bellicosity. Marieta
would kick and hit me, throw objects at me, and damage the room.
She became next to intolerable. She would leave the room, swing from
the top of a jabuticaba tree in the garden, and call me names while
doing that. As soon as she arrived at my office, she would invariably
ring the bell incessantly, until someone came. As she walked down
the hall, she scratched the wall and, when seeing me, she would kick
and hurt me. As much as possible, I tried to stop her and keep her
manifestations from transgressing the analytic setting, but often, by
the time I realised what was happening, it was too late to do anything
about her aggressive acts.
Often, after such incidents, Marieta would be co-operative in the
next session, trying to repair the damage she had caused, at least
until her feelings of persecution disappeared.
Then, there would be new attacks. I understood that this behaviour reflected the way her inner world was organised, and that was
the nature of her object relations.
In a session during this period, when a climate of intense hostility
was already looming, Marieta refused to come into the room with me.
She stayed outside, and I remained inside. At some point, she began
to hum French childrens songs. I did so, too. Marieta felt the impact
of that situation. She entered the room and asked me, But how come
you know these songs? She went on to say, It was my father who
taught me! Hes French!
She became very interested in teaching me other songs that I did
not know. She taught and I learnt! At other times she suggested
that we should sing Alouette together, one harmonising with the
other. She had great fun with this, and that is how we began to experience the first moments of a certain peace, a sort of armistice in our

AUTISTIC TRANSFORMATIONS

relationship. This situation surprised me. The hateful, cruel little girl
began to show some sweetness and light-heartedness.
At that time, her toy box was a complete mess. The lid was broken
and dirty, and the objects looked like rubbish. Marieta asked me to get
her a new box, and I did. She started a challenging process of selection to separate the good things, as she called them, from the
rubbish. I found it extremely curious, because not only did she
show great interest in this activity, but she also covered the outside of
the old box with white paper and restored it. She also covered the new
one, in order to have two similar boxes, one with the rubbish, and
the other with the good things. In my opinion, the two boxes had
the function of splitting what was good from the rubbish.
Slowly, the hostility ended and was replaced by a situation in
which she was very enthusiastic about coming to the sessions. She
then began to come alone to the office, taking care of her own appointments.
In several sessions, when she arrived, she would snuggle into an
armchair in the consulting room, hold the curtain cord, and hum
songs, often in French, asking me to sing along. On one occasion, she
started talking about certain changes that were taking place in her
house. She was now getting her own room, and her siblings would
sleep in another room. She started singing and I watched her.
Suddenly she asked me, What are you looking at? I replied, You!
She was surprised that I could be looking at her, only her, with my
full attention. She seemed to understand that she was the only one
there and that she did not need to share anything with anyone else.
Apparently, for the first time, she realised that this was a place that
belonged only to her. I think that it was through multiple experiences
of this kind that Marieta began to feel more secure in our relationship,
and processes of integration began to appear.
From that moment on, I noticed some changes in our relationship.
Her capacity to wait increased. When she arrived, she would go to the
waiting room and stay there until I called her. She no longer used
the two boxes. All the material was contained in a single one. She
began to express herself through songs whose words were related to
the feelings she experienced, or some metaphors, images, and even
stories. Her sensitivity and closer contact with her psychic life and the
beauty with which she transformed her emotional experiences were
touching.

A DISSONANT DUO: REPORT OF A CHILDS ANALYSIS

I shall now report some of these situations and also fragments of


two sessions, so that the issue can be considered in a more lively form.
In one of her sessions, she arrives and finds me chatting with the mother
of another child whom I had just seen.
Following that, I invite her in. On the way to the consulting room, she
asks, What about my clay? Did you bring it? No, no, I dont want clay, I
want plastic [which was close to the window in the room] to make a
mask.
She begins to make a mask over her face, and then abandons it and says,
That boy who was here before me is strange, isnt he? He asked me why
I come here; I said I didnt know.
I say, You think that the other children who come here are strange,
different . . . Maybe you think that it is strange to come here not knowing the reason why you are coming . . .
She then asks me for the clay.
I add, You want me to give you many things. Apparently, you feel that
youre missing something which I might have.
I bring her the clay and she says, Gosh, Clia, what kind of clay is this?
It is different!
She begins to model the clay and says that she is going to make a whale.
She says: Clia, do you remember when I came here the first time? There
was a very small table and I was counting a few sticks, and you counted
with me in a very low voice. You were really a bore! Do you remember?
I ask her, And what were you like?
She says, I used to hit you, I dont hit you any more.
I tell her, It seems I have changed for you!
After some time, she begins to hum a Brazilian song: Como pode um peixe
vivo viver fora dgua fria? Como poderei viver, como poderei viver, sem a tua,
sem a tua . . . sem a tua companhia. [How can a live fish live outside cold
water? How can I live, how can I live, without your, without your, without your, without your company?] She repeats it and shows me that she
changed the words: How can I live without our company. She says,
Clia, did you know that my grandfather died last month? Maurcio [her
younger brother] saw his photo yesterday and cried a lot. My father went
to his bedroom to talk to him.

AUTISTIC TRANSFORMATIONS

I tell her, It is very painful to be far away from people you love. As in the
fish song, How can I live without our company. Today is Thursday,
tomorrow, the day after, Sunday, you wont be coming here. Soon it will
be our vacation. You say that you get sad and miss me.
She answers, That is not at all what it is. I like it here, but I dont like
you! She takes the clay, models it, shows me the whale she made and
says that it is ugly. She says that she is going to make a house. She shows
it to me and says, This is the building of the house.
I tell her, It is like what the two of us have been doing since the first day.
We have built many things here together.
After some time, she says, intrigued, which surprises me, You know,
Clia, once I saw an animal in a book at school, it was so strange!!! It has
a duckbill, duck feet and milk spills out of its pores. The young babies lick
the milk. Its very strange!!! It stays in the water all the time. Have you
ever seen this animal? It is called a platypus!
I feel touched at her description. I spend some time trying to explain
something appropriate to her mental state. So I tell her, You find it
strange that so many cubs come here, like you, who really like, who
lick, what I have to give. You dont understand, you find it all very
strange!
While we talk, Marieta makes clay balls, several of them, throwing them
against the wall, where they stick.
She says, These are the platypuses, because they stick to the wall.
I tell her, You want to stay here, stuck; you dont want to have to leave!
I let her know that time is up, but she wants to stay a bit longer.
She takes a piece of clay and says, Im going to show it to my mother, so
that she can see if its any good.
I tell her, It seems that you want to take something of our company with
you and also show it to mummy, so that she can see what it is like.

At the following session, I had asked her to come late in the afternoon instead of in the morning.
She is eating a sort of doughnut, a sonho, as she arrives. (In Portuguese,
the word sonho, doughnut, also means dream.) She mentions that
she waited a few minutes at the door, until somebody came. We enter the
room and she immediately says, The sonho is cheap. It costs three reais

A DISSONANT DUO: REPORT OF A CHILDS ANALYSIS

[Brazilian currency]. I got home from school, I wanted to eat something,


and asked my mother for money to buy a sonho. She gave me fifteen reais.
With the change I am supposed to bring home a litre of milk. I actually
wanted to eat two sonhos.
She sits on the table, picks up the clay. She looks much sweeter today.
I tell her, You have been waiting since this morning for this session: it
seems that you were very hungry, that you really wanted to be here.
I am intrigued by what sonhos and milk mean to her. I tell her that she
wishes she had two sonhos, two breasts, which she wants to have inside
herself and to have something to take home.
She looks at me with attention and curiosity; she seems very interested.
She continues to knead the clay and begins to shape balls, several of them,
and at the same time she whistles a certain song. She wants me to guess
the words and the name. She writes on the wall with the clay, and I try to
guess. She writes, Riacho Fundo! and adds, It is a song from my grandmothers time, and talks about pain and missing someone.
I tell her, Maybe you missed me during all these days and this bothered
you.
She transforms the letters into balls and then throws them against the
wall. She talks about the platypus, and says, Do you want me to bring
the story about the platypus? Last year my teacher read the story about
the platypus and nobody knew about it. I didnt know what pores were.
I asked the teacher and she showed me the holes in the skin. I will look
for the story at home and bring it to you.
I say, Pores are holes. It seems as though holes are what remain when
you are alone and feel that you are missing something.
She begins to write my name on the wall and hers under it. She makes a
clay plaque with my name and hers and removes the balls that are stuck to
the wall, putting them elsewhere in the room. This takes up all the space.
I tell her, You want to remain here, stuck to me, Marieta and Clia,
together.
After doing this for some time she says, I am going to buy another
sonho, but then she changes her mind and says, No, Im going to take
one for Maurcio [her brother] and another for Mnica [her sister].
I say, When we two chat about whats happening to you, it seems that
you feel better fed, the hole disappears, and you can even share what is
yours with your brother and sister.

AUTISTIC TRANSFORMATIONS

She says, Mnica is very nice; shes also going to save her allowance and
buy each of us a present.
I reply to her comment, saying that she wants her siblings also to have this
sonho, which she is experiencing here with me.
In one of the sessions following this one, while playing with clay and
sticking balls, she says, Clia, I looked for the story about the platypus at
home and I couldnt find it. You know why? Because its down in the
cellar where I keep all the things from last year, the year before last year,
the year before the year before last year, before, before, before. I tell her
that the things which we are discussing and what she is feeling belong to
a very distant past, but it is only now that she is able to recover it and talk
about it.

Comments
In this material, Marieta takes off the mask she carries and her
mental life sprouts from inside her. From then on, analyst and analysand interact with each other and find a word which sums up
Marietas emotional experience as she lives in the session: Platypus!
A strange creature, a species halfway between bird and mammal,
something which she brings from her primitive world and which also
represents the different cubs who must share what emanates from
that creature. The bill is hard; it nudges, like the thorns. There is a
perception, then, condensed in this figure, not only about herself, but
also about the analyst. I think that the emergence of the figure of the
platypus is related to the movement in the relationship which gradually developed between Marieta and the analyst, each feeding the
other. Marieta sees this experience with strangeness and questions,
What strange figure is this? Her perception of strangeness arises
when, during the session, she feels that her analyst returns her undesirable inner contents to her in a more palatable form. When she talks
about ending up without our company, she associates this to the
death of her grandfather. Or, when she refers to Riacho Fundo, a
song which speaks of pain and of missing someone, Marieta
expresses her feelings and the analyst gives them meaning. The analyst tells her that being far away hurts; it makes someone miss another
someone, causing suffering. The analyst, at this point, becomes a
very strange animal, different from any other being with whom

A DISSONANT DUO: REPORT OF A CHILDS ANALYSIS

Marieta had contact up to that point. She feels welcome and nourished, possibly fused with the analyst, from whom she no longer
wants to separate.
Marieta also feels the strangeness of observing herself. There is
gratefulness and collaboration from her when she realises that,
despite her hard duckbill, the analyst always manages to survive
her attacks without letting herself be destroyed and, furthermore,
being able to feed her needs.
Marietas capacity to transform her internal objects into this
strange figure, as well as the way she relates to them is surprising.
Pores are holes, as she says, from which milk may pour, or, if there
is no milk, there is a lot of pain. Lacking this, she creates sonhos
(dreams). As she says, they are cheap, they are her dreams/sonhos;
she can eat and retain them within herself, which allows her to bear
the absence of the external object.
In the second session, we see productive interaction between
Marieta and the analyst, Marieta through her associations, and the
analyst with her transformations, which allows the development of
the situation. Her sonhos, food, is transformed into a creative interaction between analyst and analysand in which Marieta asks the analyst
to guess or feel her Riacho Fundo emotion, and also to teach her
what pores are. Her curiosity about herself arises, and, once her
need has been satisfied, she feels very close to the analyst. She no
longer feels that something is missing, and even begins to feel that she
has something to share with her siblings.

Discussion
Marieta was initially confused with the figure of her twin sister. Not
only did she not discriminate between herself and her sister, she also
did not establish a separation between the analyst and her sister.
The experience of the analysis threatened to break down this
configuration. She reacted by launching violent and cruel attacks
against her analyst, probably manifesting her hatred, which might
have come from feelings of neglect and deprivation.
The analyst was able to contain these destructive attacks emanating from the patients mental life and to preserve herself. The French
songs made it possible to retrieve the good object from her internal

10

AUTISTIC TRANSFORMATIONS

world, represented by the figure of her father: It was my father who


taught me these songs.
The songs are present throughout the analytical contact. They not
only express poetically the emotional experience of the moment, but
also give Marieta moments of intense delight. She forms a duet, a
dissonant duo with the analyst, which gratifies her. She enjoys this
situation to the hilt, developing the beginning of a relationship with a
good object.
At the same time, the episode of the two boxes arisesone
contains the rubbish, the other, the good things. This situation has
a similar function, to create a split between the good and the bad
object, cautiously separating them. This is the view that she now has
of her analyst, of containing both good and bad aspects, despite being
separated from one another.
Marietas self-knowledge progresses, enabling another type of
relationship. All her material is now contained in a single box, and she
begins to think that she is unique in the analytic situation. She is now
conscious of her own existence, independent and separate.
Having such consciousness allows her to use her own resources in
a more productive way. She creates the figure of the platypus, in
which she sums up her perception of the object and of herself. This
animal is strange! A state of greater integration becomes evident in
this context. Pores, holes, appear, from which milk pours,
although its duckbill is hard.
She inserts the rivals who no longer threaten her into this figure.
She has a greater tolerance of psychic pain, which she can transform
and include, instead of eliminating. She develops the capacity to
dream, broadening her imaginative world. The analytic link is
strengthened, and she is interested and collaborative in investigating
her mental life.
In a recent session, shortly after returning from an interruption
caused by the analysts holiday, Marieta brought a tape with the song
Chega de Saudade (in English, No More Longing). She asks the
analyst to listen to the song. Then she begins to sing along and finally
invites the analyst to join her.
The analyst feels moved by the songs theme, (Sadness go and tell
her I cant live without her . . . Tell her in a prayer to come back),
through which the patient poetically expresses her distress, the pain
and longing which she feels when they are separated.

A DISSONANT DUO: REPORT OF A CHILDS ANALYSIS

11

The analyst conveys this idea to her. They continue to sing and
Marieta seems very enthusiastic about the duet, which she calls a
dissonant duo.
I decided then to use A dissonant duo as the title of this chapter, because, on further reflection, I asked myself if this name did not
express precisely what an analytic duo is. Isnt the analytic pair dissonant to a certain extent? Isnt there a distance/separation, a dissonance between its elements, which allows the analyst to apprehend
the shared emotional experience of the moment?
I believe that the analytic relationship implies a certain dissonance
in which the communication from the analysand occurs in one tone
and the analysts approach in another. It is in this space that the
psychoanalytic conversation takes place.
The title, A dissonant duo, in my view, defines the analytic experience. It is a pair consisting of dissonant elements from each of the
elements in the pair. This dissonance allows the achievement of a
more global view of the relationship.

Comments by Frances Tustin


Finally, I attach comments made by Frances Tustin about this text.
Tustin sent me a letter in which she generously offered a rich assessment of this clinical material, and which I reproduce here.
17, Orchard Lane, Amersham, Bucks, HP6 5HA
19.1.91
Dear Dr. Korbivcher
Thank you for sending the very interesting account of your work with
a young child and for the information about the Ornitorrinco (The
animal is called a Platypus in English often referred to as the duckbilled platypus).
In terms of my scheme of understanding, the child was enabled, by
your sensitive and skilful handling of the analysis, to work through
the autistic part of her personality.
I have come to see that the crux of the difficulty in psychogenic autism
has been that awareness of bodily separateness from the mother has

12

AUTISTIC TRANSFORMATIONS

been unduly brusque and unbearably painful. At one time I thought


that there was a normal autistic stage in early infancy when mother
and child were fused together and that emergence from this stage has
been unbearable for autistic children.
I have now realized that there is no such stage, as has been demonstrated by infant observers such as Trevarthen, Stern, etc. (Mrs. Klein
always said that in normal development infant and mother had a
sense of bodily separateness from the beginning of life and infant
observers are confirming this.)
I now realize that a sense of fusion and non-differentiation between
mother and baby is an abnormal situation even in early infancy.
Autistic children have suffered this, because the mother has needed to
feel that they were still part of her body, and the infant has been of the
type that colluded with the mothers need. Joyce McDougall has written about this situation and has described what she calls the cork
child. This is an infant who has been called upon to fill the hole of the
depressed mothers emptiness and loneliness, (i.e.), to act as a cork.
(The Henry Moore sculpture illustrates this very well.)
For an infant in this situation awareness of bodily separateness from
the mother comes traumatically. It is unbearable. It is felt as a hole.
The mother cannot help them to cope with it. The child copes with it
by developing a protective shell (the mask of your patient) to cover
over the trauma. For these patients missing the analyst is more than
just missing, it is a re-evocation of the traumatic hole (i.e.), the sense
of loss is experienced as a bodily part. Such children have no internal
objects. They live in terms of outside surfaces to which the mother (or
other parts of the mother) have adhered. Awareness of separateness
from the mothers body is felt as a tearing apart. This is associated
with tantrums of panic and rage. (The destructiveness of your patient
in her early sessions.)
Such children have no psychic organization (I rejoin with you when
she separated the good things in her box from the trash) organization was appearing such as Melanie Klein has described. Autistic
states such as your little patient demonstrated in her sessions are preKleinian.
The primitive animal who has holes instead of nipples is the undifferentiated, crude, primitive infant who is so close to the mothers breast
that the nipple is eliminated. The nipple is the father element (the
daddy nipple as I call it), which prevents pathological closeness to the
mother from developing.

A DISSONANT DUO: REPORT OF A CHILDS ANALYSIS

13

The nipple helps the child to wait to get the milk in the proper way
it makes the child work. The milk doesnt just pour into her mouth it
has to be worked for. It has to be waited for. It introduces the child to
the need to sustain tension and delay action. It holds impulsiveness in
check.
Your little girl, as you say, demonstrated all this beautifully. The clay
balls were thrown at the wall where they remained stuck, just as she
had remained stuck to her mothers body. When awareness of her
bodily separateness made her feel wrenched away, the nipple was felt
to be torn out. It left a hole. There was no daddy element to discipline
her and bring about psychic organization (the good and the trash).
By your patience and your willingness to try to understand her, you
helped her to gradually differentiate herself from you. Then symbol
formation could develop. When she was so stuck, and in such a rage,
when she felt wrenched away from you, symbol formation could not
develop.
. . . What a wonderful title A Dissonant Duo. Such children have been
too consonant and the dissonance of finding that their body was
separate from that of the mother has been unbearable. You have
helped her to bear and grow from the dissonance.

As we can see, this comment by Tustin broadens considerably the


understanding of this material.
Tustin introduces the idea of an autistic part of the personality.
When this part predominates, as Tustin says, what we see is that the
patient attempts to maintain a state of bodily continuity with the
analyst, in order to avoid the pain of the awareness of being separated
from the object. From this standpoint, I believe that analytic work will
favour the encouragement of what entails the analytic task and reflecting about the processes involved in the relationship between analyst
and analysand during the session, in order to become closer to the
analytic object.
In the following chapter, I return to the ideas formulated by Tustin
in the 1992 paper and I write Primitive mind and thought, in which
I investigate the analysts need to discriminate, during the session, the
different levels of mental development to help the patient set aside
autistic manoeuvres and replace them by live contact, by human
contact, enabling him to develop the condition of being separate and
tolerating everything which results from this.

CHAPTER TWO

Some thoughts on the


psychoanalytic object

Introduction
y experience with Marieta, the patient discussed in the previous chapter, encouraged me to investigate further the
processes involved in the analytic task and the experience
that takes place between analyst and analysand during a session. My
idea is to reflect about the movements that bring the analyst close to
the analytic object. For that, I make use of theoretical developments
concerning the analytic object, especially those of Bion and Andr
Green, and I use Marietas clinical material to illustrate these ideas.
The opportunity to take a step back and think about the clinical
experience helps us sharpen our professional tools. The fact that we
become restless when participating in an analytic experience might be
valuable. It leads us to question the nature of our task. Therefore, I
think it is important to delimit the field of observation of the phenomena present in the analytic session, in order to look only at what is
essential without deviating from the focus of interest. I believe that
this attitude favours contact with the emotional experience at hand,
that is, with the field of phenomena shared between analyst and
patient in the analytical session.

15

16

AUTISTIC TRANSFORMATIONS

Many psychoanalytic authors are interested in this topic.


However, as we look at the psychoanalytic literature, we see that each
specific author focuses on the analytic task according to his or her
theoretical reference.
According to Freud (1937d) we should consider during the
analytic work that the analytic pair is constituted by two entirely different parts, each with a specific task. Analysands should be induced
to remember something which they experienced and repressed. The
task of the analyst, as mentioned by Freud (1937d, pp. 258259), is
. . . to make out what has been forgotten from the traces which it has
left behind or, more correctly, to construct it. The time and manner in
which he conveys his constructions to the person who is being
analysed, as well as the explanations with which he accompanies
them, constitute the links between the two portions of the work of
analysis, between his own part and that of the patient.

Klein (1952), in contrast, suggests the importance of observing


primitive mental states experienced in the analytic relationship. When
Klein (1946) discussed mechanisms of projective identification, she
was dealing with the observation of the interplay of emotions triggered in the analytic context. Petot (1979) mentions that when Klein
formulated the concept of projective identification, she broadened the
notion of transference, proposing the idea of total transference situations, that is, situations experienced in the relationship with the
analyst transferred from the past to the present. In the preface of
Petots book (1979), Barros states that, owing to the notion of projective identification and the total transference situation, analysts
turned not only to what patients say, but also to the way they say it,
their use of language, their actions in the office, and also the way they
act throughout the transference. Although Klein introduces observation on the interplay of emotions in the session, this does not appear
to be the focus of her interest. Some later authors devoted their attention to issues like these.
Bion (1963), concerned with the processes of thinking and developing the alpha function theory, provides a description of the movements of the analytic pair during the session. Other authors delved
into this material, including Baranger and Baranger (1969), who
coined the phrase analytic field, Green (1975), with his work
Potential space in psychoanalysis, Joseph (1985), who developed the

SOME THOUGHTS ON THE PSYCHOANALYTIC OBJECT

17

issue Transference: the total situation, Viderman (1982), with the


idea of analytic space, as well as others who have deepened this
investigation.
Bion (1963), introducing the concept of analytic object, proposes
a reflexion of the nature of the object created by the analytic pair in
the session. This analytic object, according to him, is the result of
successive processes of integration and disintegration which take
place at moments of the analytic encounter. It is from these movements that the selected fact emerges. Bion says,
Taken with other similar psycho-analytic elements it and the other
elements together form the field of incoherent elements in which it is
hoped that the selected fact, that gives coherence and relatedness to
the hitherto incoherent and unrelated, will emerge. Thus nominated, bound the psycho-analytic object has emerged. It remains to
discern its meaning. . . . To conclude: the elements in psycho-analysis
are ideas and feelings as represented by their setting in a single gridcategory; psychoanalytic objects are associations and interpretations
with extensions in the domains of sense, of myth and passion. (1963,
p. 103)

Green (1975) also formulates important ideas concerning the


psychoanalytic object. He mentions that we only know what happens
inside the patient from what he tells us. We do not know the source
of what he says or its consequences. He suggests that ignorance of this
inner space can be overcome by observing the effect that the patients
communication might have on the analysts affective and bodily
impressions and mental functioning. He says,
. . . we cannot claim that this is what is taking place inside the patient,
but only what happened to us provides an analogue or homologue.
And we displace the knowledge of what is happening in our own
internal space into the space between him and us. (1986, p. 47)

Green also states,


What the analysand communicates is an analogue, a double of his
affective and bodily experience; what the analyst communicates is a
double of the effect produced on his own bodily, affective and intellectual experience by the patients communication. Thus, the communication between analysand and analyst is an object made up of two

18

AUTISTIC TRANSFORMATIONS

parts, one constituted by the double of the analysand, the other by the
double of the analyst . . . What is called therapeutic alliance or
working alliance which I prefer to call the analytic association is, in
my belief, founded on the possibility of creating an analytic object
formed by these two halves. (1975, p. 288)

This formulation, according to Green, corresponds precisely to the


etymological definition found in the Roberts Dictionary: An object
cut in two, constituting a sign of recognition, when its bearers can
bring together the two separate pieces. In Greens opinion, this is
what happens in the analytic context. In this manner, analysts supply
the part that is missing in patients by observing the homologous
processes in themselves. Green goes on to say that the analytic object
is neither internal nor external to the analysand and to the analyst, but
is situated between the two, at the meeting of their utterances, in the
potential space between them, limited by the context, which is interrupted at every separation and reconstituted at every meeting. The
author refers to Winnicotts concept of transitional space as a potential space between the baby and the mother, a space of transition
between the inner world and the outer reality, a space between what
is sensorial and mental. As Green maintains, this is the analytic
space.
Green describes, from his standpoint, how the analytic encounter
takes place. He delineates how the movements of the pair occur, and
deals with the issue of the analytic object in an attempt to delimit the
space in which analysis occurs.
Thanks to Klein and, later, to Bion, the analytic task has become
circumscribed to the limits of the analytic context, that is, to the observation of all phenomena which occur in analysis. According to Bion,
these phenomena are limited to the dimension of the senses, myths,
and passion, which must be considered when the psychoanalytic
object is understood. Bions formulation involves the (PSPD) movements that occur during the analytic session. These movements enable
the selected fact to emerge and allow proximity to the analytic object.
He examines the different movements of the analytic pair, attempting
to be close to the ongoing mental phenomena. Green emphasises that
this approach occurs through doubles, through homologues from
both the analyst and analysand, and that the psychoanalytic object is
formed where these two communications come together. They both

SOME THOUGHTS ON THE PSYCHOANALYTIC OBJECT

19

allow us to detach ourselves from the clinical practice and move into
a field of thought in which abstractions lead to great expansion in the
field of investigation.
As Viderman (1982) said,
Klee taught us that art does not reproduce what is visible, it renders
visible . . . The most profound function of Interpretation is not to say
what was, reproducing it, but to make figures appear in the psychoanalytic space. These figures are not visible anywhere else because
they have no existence other than the one given by the analytic space
which, by rendering them visible, makes them exist. (Translated for
this edition)

Case study: Marieta


Marieta, the patient mentioned in the previous chapter, is now nine
years old. For over four years, she had three weekly sessions of analysis. The session that I am going to report occurred after two years of
analysis.
This is the second session of the week.
Marieta arrives and, before entering the room, asks me, Are there more
tangerines there? She points to the neighbours tree, referring to the previous session in which she picked up tangerines from there and ate them.
She has brought an object that belongs in the waiting room and says it is a
gift for me. She also mentions that her mother made it and sent it to me.
I tell her that she wanted to give me a present.
Once she is in the room, she begins to provoke me, as though she were
going to hurt me by hitting me with the gift. She leaves the room to fetch
the tangerine. She soon returns without it, saying, Im going to hit you.
She then begins to kick me, and later, brings an object from the waiting
room, saying that it was a gift for me. She mentions that her mother made
it and sent it by mail from Australia, telling her to deliver it to me.
Inside the room, I try to communicate something to her about her frustration at not finding what she wants, the mother-tangerine, who is
far away. I get stuck and have trouble thinking.
After some time, things have already calmed down a bit, and she asks me
very curiously Clia, do you know about Jo? Do you know what a Jo

20

AUTISTIC TRANSFORMATIONS

is? A wild Jo? [in Portuguese, Jo Bravo]. She shows me her foot and
says, I have a thorn in my foot. She continues, My uncle taught me
. . . Jo is a plant, a tall plant, like this [she indicates its height with her
hand], with lots of thorns, and it hurts you if you get close to it.
I hear that and feel slightly perplexed because, although Marieta did not
realise it, I noticed that I had been in contact with this wild Jo from the
beginning of the session.
She tries to hit me and then throws water on me. I begin to feel very irritated, but manage to recover fast and tell her, I see you as this wild Jo
which you introduced me to. There is a Marieta in the middle, a flowerMarieta who brings gifts to Clia with one of her hands and with the other
hand, takes them away, because there are thorns around the flower that
hurt. She intends to please me, to join me, but the thorns prevent that.
She mocks what I am saying and screams, Shut up, you dumb thing!,
and then continues to nudge me physically.
I tell her You do not know how to join me, how you can lean on me.
She has a violent reaction and says, God forbid! She huddles behind the
sofa and remains there, lying on the ground, quietly. After some time, she
goes to her box where she finds a tangerine from the previous session.
She says, ironically, Did you think I wasnt going to eat the tangerine?
Heres one! She sits on a low wall in the room, peels the tiny tangerine
and shows it to me. She begins to talk. Abracadabra, be sweet, sweet,
sweet, very sweet. She opens the tangerine, takes a section and offers me
another. (Her expression has changed; she has become much sweeter.)
I tell her, You have found something which you have been looking for
since the beginning. A tangerine-Clia that becomes sweet as she talks to
you.
She comes down from the wall, and I tell her that the session is over. She
asks to play a game before she leaves. In this game we clap each others
palms and sing a song at the same time.
I tell her that she does not want to leave, that she would like us both to
stay there and that at last she appears to have found a way to join me.

Discussion
As we can see, at the beginning of the session Marieta expresses
intense emotion, which is only acted out, discharged. She does not

SOME THOUGHTS ON THE PSYCHOANALYTIC OBJECT

21

step back and think. After some time in this state, pointing to a thorn
stuck in her foot, she asks, Do you know the wild Jo?, and then
communicates her definition: Wild Jo is a plant tall like this, with
lots of thorns around it, and if you come close to it, it pierces, nudges,
hurts . . . This contribution from Marieta allows the analyst to
observe that her initial movements were related to this figure, and she
formulates that she saw herself as this wild Jo, who wants to be
with the analyst, but does not know how. This interpretation has a
strong impact on Marieta, who possibly wished that the thorns would
disappear as in a magic trick (abracadabra), and the sweet flower
which is inside it would emerge. Marieta, from then on, begins to
see her analyst as someone who is also sweet, who instead of
nudgingpiercing, can touch with the palms of her hands and go no
further. From the moment Marieta asks the analyst whether she is
familiar with the wild Jo, there is a change in the quality of her
communication, and the field between analyst and analysand
expands. A symbol emerges, through which it becomes possible to
start a conversation about her mental state. There is a split in Marieta.
She stops being the wild Jo and is able to name it. Possibly, the
analysts containment of Marietas discharges and her attempt to talk
about Marietas mental state brought back her ability to express
herself at a more developed level. A space arises where the analytic
conversation develops based on the transformations experienced by
both of them. Thus, the wild Jo Marieta created represents her
mental state on a symbolic level. This expression is the product of the
analysts complementation of the meaning lacking to Marieta. She was
not able to give a meaning to her own experiences. I believe that we
are now approaching the analytic object, that is, the idea that Marieta
has a loving core desirous of contact, of acceptance, a core that is
covered by thorns which prevent her from approaching. It is important to remember that the possibilities of a relationship between the
analytical pair in a session are of different qualities. One possibility
would be a relationship such as the one the analyst experiences with
Marieta, in which the communication between analyst and analysand
occurs in such a way that one modifies the other at every turn. The
subsequent communications are evolutions of the previous ones,
furthering some contact with the moments emotion.
Another very frequent possibility, as we know, is that the analysand will obstruct knowledge in the session, attacking the analytic

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AUTISTIC TRANSFORMATIONS

work. This is the material that should be treated, but often it is not
accessible to an analysand, and so they utilise the session space to
repeat their obstructive attacks.
Concluding, I would like to discuss a few important points. The
first concerns the notion of space, potential space, analytic
space, highlighted by Green in the references mentioned earlier. It is
useful to point out that both the analytic space and the psychoanalytic object involve psychic qualities and not sensorial or concrete
ones. It is important to circumscribe and delimit the terrain of the analytic task so as to focus on aspects involving psychoanalysis. In this
manner, the latter will not be taken over by other variables, which
would render it difficult for the analyst to maintain his observation
point. It is necessary for a space to emerge between self and object so
that the movements of the analytic pair can occur, fulfilling the role of
a psychoanalytic investigation. Under this condition, it is possible to
think and to name emotions in the field of emotional experience. This
space emanates from a succession of multiple spaces, divisions, separations, and retreats having occurred in both analysts themselves and
in their relationship with their analysands. This is the only thing that
makes it possible to work through and, consequently, enable mental
development. Otherwise, there will be merely a repetition of the
phenomena with no new knowledge.
Another point involves the idea of doubles, of analogues,
proposed by Green, and of transformations, proposed by Bion. I
believe that both indicate a space in the mind in which the emotional
experience itself is separated from its verbal expression. It is in this
space that communication containing the mental representation of the
experience undergone and the formation of verbal thought will come
about. The psychoanalytic object emerges in this space, in the
encounter between the analysts and the analysands communication, an experience shared by the analytic pair.
My final point concerns the difference between childrens and
adults means of expression. Since children are less developed, they
need a concrete space to contain their inner world and its representations. Language as communication alone does not suffice, because
children have not yet attained the degree of abstraction needed for
symbols to form. Therefore, it is necessary to be aware of separation
between me and the other. This is an ability that results from
emotional development, in which absence, neediness, and space can

SOME THOUGHTS ON THE PSYCHOANALYTIC OBJECT

23

be tolerated and possibly replaced by thinking. The symbols created


in this space represent and replace the original emotion, thus establishing communication between the analytic pair in the analytic space,
a space that only exists owing to the interaction of the being of the
analyst and analysand at the time of the encounter. This is the analytic
task.
The concept of analytic object is not often found in the psychoanalytic literature. I assume that from the way Bion defines it, the
analytic object is related to the nature of psychoanalysis itself and its
object of investigation, that is, to the encounter of two minds which
move in a given time and space. If the standpoint of observation is the
psychoanalytic one, the entire lack of definition and precision inherent in the situation must be contained. The psychoanalyst moves in
this context. Thus, the psychoanalytic object will be apprehended
within the co-ordinates of doubt and uncertainty, and the search for
the unknown will guide us in this task.
To conclude, I think that the following quote from Green (1975,
p. 288) about Vidermans (1982) thinking summarises many of the
ideas that I tried to develop:
The meaning we seek before the analytic situation never existed . . .
Meaning is not discovered, it is created. I prefer to describe it as an
absent meaning, a virtual sense which awaits its realization through
the cutting and shapings offered by analytic space (and time). It is a
potential meaning. . . . It is constituted in and by the analytic situation;
but if the analytic situation reveals it, . . .it takes it from absence to
potentiality and then renders it real.

CHAPTER THREE

Primitive mind and thought

Introduction
he work in clinical practice with patients in long-term analysis
can provide a continuous incentive to elaborate some points
that arouse interest in further investigation.
As we know, the communication of each patient during the analytic session shows the level of mental development at which this
patient is operating at that moment. In some mental organisations,
more primitive states prevail, whereas other mental states are more
developed. In my view, it is essential that analysts try to identify the
level of mental development of their patients in order to get through
to them. The understanding of the material offered by the patients is
directly related to the levels that the analyst has reached, of his own
mental state, through his life experiences, his analytic experiences,
analytic work with other patients, and his own personal analysis.
However, it is not always possible for the analyst to apprehend what
the patient is trying to communicate. As I present in this chapter, there
are several factors which make this a difficult understanding.
Often, when we begin an analysis, we encounter patients with
mental configurations which present a fragile psychic organisation, a

25

26

AUTISTIC TRANSFORMATIONS

minimal mental balance which suffices only to ensure their survival.


Pedro, six years old, is a thin and shy boy. He arrives for the first
session in a very sombre mood. When asked if he knew why his
parents had brought him for analysis, he responds seriously, after
some hesitation, Its because I dont sleep at night, Im frightened!
They said that you could help me. Later on, while investigating his
fears, he explains, Im actually really afraid of my dreams!
Mrio, aged five, is a plump child, with a bizarre appearance
reminding one of a mega baby, because, despite being large and
relatively mature, he still uses a dummy, which he will not let go of. In
his sessions, he often becomes extremely agitated. Whenever he does
something that hints at achieving some insight, he suddenly stops and,
although we do not know what he thinks, he starts crying and shouting, I WANT FOOD NOW! GIMME, GIMME, GIMME! NOW! HE ALSO SHOUTS, I
WANT TO GO! His despair and urgency are such that they have a strong
impact on the analysts mind, temporarily immobilising her.
As we see, Pedro and Mrio present marked characteristics of a
primitive mental functioning, although they are clearly at different
levels of mental development. Pedro fears contact with the products
of his mind, his dreams, as he calls them. We might ask ourselves
what these dreams mean to Pedro. He does not have real dreams,
with elaborate activity, but rather an accumulation of concrete
elements which occupy his mental space and, given the level of
violence involved, these mental elements become terrifying, preventing him from sleeping, dreaming, or even staying awake.
When Mrio is present, he expresses intense anxiety and despair.
Why does Mrio demand food, what does he want to communicate?
These might be internal experiences in which connections do not
form, or, when they do, they quickly disintegrate into fragments and
experiences of emptiness. In this context, food does not appear to be
symbolic or representative. Mrio had not developed a mind that
could contain these fragmented states and transform them in such a
way that the resulting emptiness would be replaced by psychic content.
As mentioned, Pedro and Mrio present different levels of mental
development. The phenomena in Pedro, despite being so primitive,
are more developed than in Mrio. There is representation in his
communication when he expresses his fears.

PRIMITIVE MIND AND THOUGHT

27

Mrio is terrified because he feels a deadly threat owing to his


awareness of bodily separation from the object. He desperately tries
to find something from the concrete world, the food, which will
give him a feeling of cohesion so as to avoid non-integrated experiences of extreme vulnerability. As I said before, these patients require
a specific approach at each level of communication.
In this chapter, using Pedros and Mrios clinical material, I examine different levels of mental development found in manifestations of
the primordial mind, and I highlight the levels dominated by feelings.
According to Frances Tustin, feelings such as these have no representation in the mind. In addition, I investigate the tools available to
psychoanalysis to work with these primordial areas of the mind.

The development of thought and thinking


In Formulations on the two principles of mental functioning (1911b,
p. 221), Freud writes, Thinking was endowed with characteristics
which made it possible for the mental apparatus to tolerate an
increased tension of stimulus, while the process of discharge was
postponed.
Freud proposes the idea of a mental apparatus that would, among
other things, process thoughts. This allows containment of the
increased tension and, thus, restores inner balance and the achievement of pleasure. Klein (1935) developed the theory of schizoidparanoid and depressive positions, suggesting that in mental activity there
is a constant fluctuation between the two positions. She also introduced the concept of projective identification (1946). This concept was
later expanded by Bion (1957), according to whom projective identification is the first mode of communication between mother and baby,
as well as constituting a defence mechanism. He maintains that thinking starts with this communication and fluctuation, PSPD.
For Green (1998, p. 655),
Emotional experience is the first step towards a thought . . . At the end
of the road we find thinking. To eliminate emotional experience and
to replace it by abstract thinking is usually the work of science and
specially mathematics, but in psychoanalysis we have to keep the
emotional experience in mind and to reflect on it, to transform it without evacuating it, to be aware of it without either being overwhelmed

28

AUTISTIC TRANSFORMATIONS

by it or by eliminating it. So, thought cannot be dissociated from pain,


suffering, pleasure or ecstasy. Pain, like experiences of intense pleasure, is difficult to tolerate. Psychoanalysts, as far as possible, should
be able to continue analysing, to continue thinking under such circumstances.

Bion, based on his analysis of psychotic patients and on his work


with groups, looked at the manifestations of primitive states of mind
and hypothesised about the origins of thinking as a psychic activity
and also a psychic impairment. The author (1962a) considers the
process of thinking as a development imposed on the psyche by the
pressure of thoughts, which require an apparatus to think them. He
introduced the concept of alpha function, a function of the mind that
converts sensorial information into alpha elements by exercising the
capacity for reverie. These alpha elements supply the psyche with the
material for dream thoughts that enable sleep, dreaming, consciousness, or unconsciousness. The alpha elements are stored and transformed. They constitute the contact barrier that allows us to
discriminate between the conscious and unconscious.
Along with the patient, the analyst performs a mental activity
comparable to the mothers reverie. According to Bion, when this
capacity for reverie fails, the child no longer understands what is
projected and reintrojects a nameless terror. The sensorial elements
that could not be transformed by the alpha function become beta
elements. Bion also mentions the existence of a contact barrier
composed of beta elements named beta screen, which is formed by
accumulated beta elements. The force of its elements together can trigger emotions in the analyst, affecting his thinking and impairing his
analytic function. In place of what would be the contact barrier of the
alpha function, what is observed is its destruction. This is due to an
inversion of the alpha function, which happens when those elements
that form the contact barrier are dispersed and converted into alpha
elements without any of the features that separate them from beta
elements. These elements are projected to form the beta screen. The
inversion of the alpha function does not bring back the original beta
elements; it leads to new beta elements with the addition of traces of
ego and superego. These are known as bizarre objects.
It should be emphasised that a mothers capacity for reverie might
fail not only because of her own anxieties and depressive states, or

PRIMITIVE MIND AND THOUGHT

29

through the excessive envy and hate from the baby in his very early
states, but also because of the strength of the stimuli aimed at her by
the baby. In this configuration, the babys states of non-integration or
disintegration prevail, creating such disorganisation and turmoil in
the mother that she is no longer able to contain and transform it.
Mrios clinical material will illustrate these manifestations.

States of mind
Tustin (1990), based on her work with autistic children and observations of the motherbaby relationship, made valuable contributions to
our understanding of primitive mental states which are manifested
even before the schizoidparanoid position. Manifestations at a protomental level prevail in these states, in which the physical and the
mental are not differentiated. The power of such stimuli on the object
is considerable given their degree of non-integration.
We should recall Freud (1923b, p. 25), who considered that
The ego is first and foremost a body-ego. It is not merely a surface
entity, but is in itself a projection of a surface. . . . The ego is ultimately
derived from bodily sensations, chiefly from those springing from the
surface of the body. It may thus be regarded as mental projection of
the surface of the body.

At the end of her life, Tustin stated (1990, p. 160),


I have come to think that a sense of bodily separateness is the heartbreak at the centre of all human existence, and that for various
reasons, some people experience it in a more drastic way than others.
How it is dealt with seems to affect the development of the whole
personality . . . which are the basis for states of mind throughout life.

She also says (p. 217),


The hypothesis that I raise concerns what I call states of consciousness.
Since birth, there are fluctuating states of consciousness which are the
basis for states of mind throughout life. Some mother and babies maintain themselves in a state of indifference and, in this circumstance,

30

AUTISTIC TRANSFORMATIONS

if the separation is too abrupt, this infant will suffer what I have elsewhere called an agony of consciousness.

In this passage, Tustin asserts that there would be a part of the mind
that would refuse to be born (the protomind), as if remaining encapsulated in the space of the mothers body. There are consciousness
states of the corporal separation and, possibly, each psyche will be
organised differently according to each individuals capacity to tolerate separation. Tustin also says that some people who present certain
primitive mental configurations feel the experience of separation, not
as the absence of the object, but as though parts of their own body had
been torn from them. This would cause feelings of annihilation, of
being crumbled, of internal holes, black holes, or the emptiness that
some patients describe.
In such states, the individual builds for himself a protective shell
in which he takes shelter and remains absorbed in auto-sensual activities, seeking sufficiency through that. In this way, they protect themselves from a state of terror triggered by non-integrated experiences
of great vulnerability. Here, relations between me and not me
occur by means of sensation-objectsautistic shapes and autistic objects (Tustin, 1981, 1984).
This kind of manoeuvre is used to close the hole caused by the lack
of a concrete object. Tustin defines autistic shapes as sensorial impressions left by an object when it touches the skin surface. These are predominantly experiences of soft objects and of bodily substances that
are comforting and calming. The autistic objects provide sensorial
experiences of hardness and edges. The resulting experience is felt as
an armour that protects against a nameless terror.
Meltzer (1975b) and Bick (1968) address this and suggest that in
the autistic sphere, the contact between me and not me occurs
through what they call adhesive identification, that is, by the adhesion of surfaces that touch one another. This does not occur in projective identification, as it does in areas where the notion of separation
between me and the object exists, so that there is projection. Tustin
suggests replacing the term adhesive identification with adhesive
equation. She says that there cannot be an identification mechanism
in the autistic area because the notion of separation between self and
object does not exist: there is only an equation transforming the self
into the object.

PRIMITIVE MIND AND THOUGHT

31

This kind of primordial manifestation might cause a powerful


reaction in the object. Notable reactions are evasion (Prat, 1989) and
bodily manifestation, possibly in order to obtain protection from the
effect of these disorganising states.
In clinical work, we often face situations in which the patients
communication is expressed at these primordial levels of disorganisation. States of marked withdrawal likewise have a strong impact on
the analysts mind. The patient isolates himself for protection against
psychic pain and from non-integrated states. In these states there is
such an intense anxiety that an analyst can be thrown off track, immobilised, which prevents any communication between the pair.
Another possibility would be that the analyst could remain in this
situation and work it through, transforming the impact into meaning
and naming it for the patient. This procedure will help to open a
mental space in the patient, and these states may acquire representation and inscription. If these representations can be kept in the
patients mind, they enable the mental apparatus to perform its
specific roles more fully and, thus, it is no longer used only to
discharge tension. That is how verbal thought and symbols develop;
symbols which are essential for communication.
The development of an apparatus to think thoughts (Bion,
1962b) would be related to a subjects capacity to tolerate separation
from the object and to experience its absence. Mental life, fantasy life,
and dreams will develop predominantly in this space.

Case study: Pedro


This session took place three weeks after our first meeting, described
above.
Pedro is in the waiting room with his mother. He readily comes in with
me, sits quietly at the table and continues to draw and then tell stories, as
he had done in the previous sessions. He draws a king (Figure 1) with a
sceptre, and then he draws a chair and a cushion. He timidly gives information, as I take an interest in what he is doing. On the side he draws a
soldier which is double the size of the king.
He says, They are chatting. He does not appear to be very interested in
contact. He draws a circle around the drawing, adding a palace, and now

32

AUTISTIC TRANSFORMATIONS

Figure 1. Pedros drawing of a king.

he explains in a lively manner, The king is telling the soldier to fix the
leak. The pipe burst and there is a leak. He draws several blue drops
representing the water.
I tell him, You have drawn a king-Pedro and a soldier-Clia; I think that
king-Pedro wants soldier-Clia to fix the leak, that is, all the thoughts your
little head cant hold which end up pouring out.
He laughs and says he thought no story would come of it, but it did. (Since
the first session we have talked through drawings and stories.) Its the
story of the thoughts which come out and do not let me sleep. But I slept
last night. Mummy gave me a tranquilliser in bed. Daddy was working
and she told me a story. (He is referring to the tranquilliser.)
He goes on drawing drops and says that it is a golden leak. Above the
king he adds a soldiers helmet and a chest. He mentions that the chest
is closed. He laughs ironically, with a somewhat sarcastic air, and says,
I know, youre going to say that my thoughts are closed in the chest and
dont want to come out.
I tell him, Ah! Have you learnt how to talk with me?

PRIMITIVE MIND AND THOUGHT

33

He turns the page, makes a caricature of a dog (Figure 2) and says,


slyly, Now yes, theres a story: the boy went to the supermarket
and . . . Meanwhile, he draws the dogs ears, which are sausages. (This is
a stereotyped drawing, a caricature.)
I tell him, You turn the page and leave the chest on the other side all
locked with the gold!
He corrects what I said and, in a serious tone, says, Its the bad thoughts.
I want you to guess the bad thoughts. Youve guessed that the leak was
the thoughts. The atmosphere in the drawing then changes. The soldier
throws arrows at the king and bombs are thrown back. There is a lot of
violence. He appears to be mentally very excited and finds it difficult to
listen to me.
I say that I am going to tell him a story: Once upon a time there was a boy
who stays with his mummy at night, while daddy is at work. The boy is
very afraid that a soldier-daddy will come to attack him and beat him up.
He says, Thats why I cant sleep! He covers his ears with his hands and
says, I was worried during judo, and also because I walked in the garage
of the building here. The floor is full of small holes and it looks ready to
collapse. (He is referring to the garage floor.)

Figure 2. Pedros caricature of a dog.

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AUTISTIC TRANSFORMATIONS

He draws cockroaches, cockroach blood, and says, He shot the king, and
there is a cockroach with blood.
He turns the page, writes his name and his brothers several times. He
says, He is very angry! When I touch things in his room he gets angry.
When my grandma comes to our house, I take my bear, blanket, and
pillow and sleep in his room with him. Everything we have is the same,
and he says all those things belong to him; he thinks theyre his.
I tell him, I think that what you have the same is mummy. I believe that
you think he gets very angry if youre here with me, if youre with
mummy and he isnt, or if mummy gives you a tranquilliser at night.
And Pedro answers, Then everything is my fault. My mother scolds me
and says that I take his things.
I say that today we were able to talk about many of the fears that go
through his head. It seems that if you open this closed chest and the
thoughts about your brother come out, youre afraid of what may happen
to you, afraid that everything will spill out, like the broken pipe. You are
afraid that this brother will harm you very much.
He insists, saying, Everythings my fault because my mother thinks that
I take his things and she scolds me.
During the next session Pedro continues his drawing and his story-telling,
reproducing a videogame (Figure 3). He says, Im afraid of this game;

Figure 3. Pedros drawing of a video game.

PRIMITIVE MIND AND THOUGHT

35

one day I didnt sleep because of this game, you must talk to me! He
becomes very excited and remarks, The best thing will not fit in there!
He fills the entire sheet of paper with the drawing of balls, bombs, a snake,
a whirlpool . . . He writes, Game over and says, The game is over! He
goes on drawing more and more elements until he draws a balloon. Then
he makes a hole in the middle of the balloon and says, Theres a hole in
the balloon! He complains that he cannot get anything more on the
paper. He turns the page (Figure 4) and writes his name with a circle
around it. I tell him that here in the session he dreamed the dreams that
frighten him a lot. He wanted me to know what these dreams are like. At
this point he is relieved. He lays his head down on his drawing and, holding the pen in one hand, falls deeply asleep.

Comments
Pedro sees himself as an adult, clearly verbalising his complaint: I
cant sleep . . . Im afraid of my dreams. He appears to foresee the
possibility that an adult can help him work through what he calls my
dreams. Through drawings, he communicates the dreams contained

Figure 4. Pedros drawing of his encircled name.

36

AUTISTIC TRANSFORMATIONS

in his mind. He mentions that there is a burst pipe and a leak that
must be repaired. A king asks the soldier to repair the leak. The
analyst presents her version to him: Pedro asks Clia to repair the
leak, the thoughts his little head cannot hold and which end up pouring out.
She provides a meaning to his communication, which Pedro
immediately picks up and then proposes his transformations.
Relieved, he smiles and says, I thought that no story would come
from this, but it did. And he goes on, saying, Its the story of the bad
thoughts which come out and dont let me sleep. He is more confident about continuing the investigation and starts to insist that the
analyst should guess the meaning of his bad thoughts, as he calls
them. He then remembers his mother, who takes care of him at night,
giving him the tranquilliser which lets him sleep. This memory
breaks down the precariously organised previous state, triggering
excitement and intense mental disorganisation. He mentions the fear
of the hole, of the holes in the floor of the garage. He gets more upset
and cockroaches, blood, and arrows emerge and he sees himself
surrounded by them. The analyst contains this state and transmits the
idea to him that his fears and these anxieties show an oedipal situation. This formulation causes a certain initial impact, but what we see
next is that the pairs evolution and their movement allow those
contents closed into the chest to be examined. And now the previously mentioned elements acquire meaning. Pedro starts to communicate verbally, talking clearly about the situation, which involves the
dynamics of sibling rivalry and persecutory retaliation. As the relationship becomes closer, Pedro feels more relaxed and tells the analyst
about the live contact with his states of terror, probably those he
referred to at the early meetings as being the dreams which prevent
him from sleeping. He reveals that he is pursued by the threat that his
mental apparatus cannot contain all of the excitement caused by those
elements which do not have representation, and, since these are
concretely experienced, states of real despair are triggered. He tries to
get rid of this overload through a massive bombardment, both on the
sheet of paper and into the analysts mind. The formulations Game
is over and balloon is popped, and his complaint that there is no
more space on the paper indicate his perception of his state of mental
fragility and his urgent need for another mind to contain him. As the
analyst continues to accept him, she offers him the formulation that

PRIMITIVE MIND AND THOUGHT

37

he would like Clia to know and participate in the dreams which


dont let him sleep. At this, he feels greatly relieved. It allows him to
observe that she is not afraid of his minds contents, and neither
does she respond to them with violence, and this enables his state of
terror to subside. Finally, through his name, Pedro, written on the
reverse side of the sheet, he was able to recover parts of himself,
dispersed and disintegrated parts, lost in all that excitement. He could
then fall deeply asleep and possibly dream and keep his dreams.

Case study: Mrio


Mrio arrives for his session but is unable to separate from his mother,
so she sits just outside the office door while he restlessly comes and
goes from the room. This sets the scene for the session I will now
report.
Mrio goes to the toy box and examines its content excitedly, finding the
string he had left covered in glue in the previous session, and excitedly
shows it to his mother.
After a short while he says, emphatically, I

WANT TO LEAVE!

I tell him that he wants to see what happened to the things he left with
me last time and that he realises that a thread links and separates us
between sessions. I say, It seems you dont like this. (I refer to the fact
that separation appears to displease him.)
He looks again inside the box. He finds a pencil box, which he assumes I
brought him as a new toy, a gift. First, he thinks it is a notebook, but when
he realises his mistake, he is quickly discouraged. He tries to tie the string
to the door, but, abruptly, he gives up, throwing himself into his mothers
lap. He insistently screams that he wants to leave, and threatens to scratch
the door. His mother reacts to this energetically, preventing him from
doing so.
I try to follow his movements from the beginning. I tell him that when I
say something that suits him, he appears to calm down for a few short
minutes, as though what I said were a gift. But that is soon over. He is
very unhappy and uncomfortable, and thinks that the way of getting rid
of everything is to LEAVE.
He is still sprawled on his mothers lap, whining and insisting in a voice
that is increasingly loud that he is HUNGRY, VERY HUNGRY, and that he

38

AUTISTIC TRANSFORMATIONS

wants FOOD NOW!!! He throws himself on the floor, cries desperately,


shouts. His mother immediately answers that she will go to the car and
get him a cracker.
I say that he does not appear to lack real food, but something else, and
that neither he nor I know what it is, but that we might be able to find out
together.
He reacts with an expression of curiosity and some relief.
I tell him I see that he is interested in what I told him and that I find him
calmer now.
He stops crying, goes to the box, picks up the cubes, puts them together
two by two according to their colours, but quickly puts it all away and
starts crying again.
I tell him, Something I told you helped you and came together inside
you, but suddenly everything fell apart. Its one big mess. I think you
dont know what happens inside you that makes such a mess of everything and makes you unhappy. Then you become so desperate that you
make your mother think that what you need is food.
He covers his ears and says that I am a WITCH, and threatens to break
things, to knock down a picture in the hall.
I tell him that he wants everyone to be afraid of him.
He proudly answers, Im
thing!!!

TARZAN!

Ill break everything, scratch every-

At this point he is hanging on to his mother and sucking on his dummy.


I tell him that I see two Mrios: a baby with a dummy, clinging to
mummy, and a strong Mrio, Tarzan, who damages everything and is
very scary.
He finds it very funny and jokes, saying that he is strong! Unexpectedly,
his state of mind changes and he begins to shout insistently, I WANT
FOOD !!! I M HUNGRY !!! GIMME FOOOOD !!! I WANNA GO HOME !!! IS THERE
A KITCHEN HERE ? IS THERE A FRIDGE ? WHATS THAT GIRL S NAME ? (He is
referring to the secretary). He shouts desperately, very loudly: GIMME,
GIMME . . . He cries.
I tell him that he seems very desperate, complaining, and that he thinks
that he needs to get something into his stomach urgently so as to calm
down.

PRIMITIVE MIND AND THOUGHT

39

He begins to shout that he will never again come to the office, that he
wants to leave. I am very frightened at his threats and pressured by the
urgency and the despair of his situation. I realise that he wants me to get
him out of that state.
I decide to go to his box and try and talk through the toys. I begin putting
the dolls on the table, while he continues to scream, asking, IS THERE A
FRIDGE HERE? IS THERE FOOD?
I answer him, YES, there is EVERYTHING you want. I point into his box.
He immediately reacts, saying, Im not going to play!
I tell him, All right, but Im going to play! I take the dolls, the cubes, and
make a fridge, a stove, a table, and plates. I break pieces of chalk and put
them in a pot. With chopsticks I begin to stir and make comments, saying
that there was the food. I ask him, What do you like to eat? At this time,
I see he shows some interest in what I am proposing. I continue playing
out a scene in which a boy comes to meet Clia and he wants FOOD. I
wonder what kind of food he likes?
He becomes involved in the game and answers, I like spaghetti!
I ask, How do you like spaghetti?
He says, With tomato sauce.
I continue, Ah! Then lets make some tomato sauce! Here is the spaghetti.
Ill put a bit on Mrios plate and on mine too. I break the chalk and put
a piece on each plate. Mrio pays close attention to all of this; he also
begins to cut up the chalk and put it inside a toy truck. He then says cheerfully, The foods here! Great!
I tell him that he no longer wants to leave, that he was able to wait and
did not really have to eat. It seems that the food you really wanted was
play food. You thought that it was real food, like crackers, bread, chocolate, but thats not what it was. You needed the food that we made
together, where you could imagine, in your little head, what you wanted
to eat. With the toys, we were able to play at cooking. Just like this you
can imagine whatever you want and use the toys to play everything that
is happening to you.

Comments
Mrios communication shows that the he truly needs to depend on
external objects. The dummy and his mothers presence in the room

40

AUTISTIC TRANSFORMATIONS

are resources he uses to maintain this continuity and, thus, vouchsafe


a certain degree of integration and cohesion. From this point of view,
the string with the glue that Mrio selects when he rummages
through the box as soon as he enters the room could be considered the
representation of this state of fusional continuity and its breakdown.
An attempt is made to convey the representation of the emotional
experience of his inner drama at being separated. This state is so intolerable that he abruptly erupts with the expression, I want to leave!
In this painful situation he expresses a desire for relief. This desire also
contains the fantasy that there is some refuge where he will actually
be able to concretely re-establish a continuous relationship. However,
he perceives that his analyst is with him and is an interlocutor who is
trying to communicate something to him about his distress and
attribute meaning to his manifestations. He then recovers a modicum
of integration and once more looks in his box to try to find some
representations of his inner world experiences. On locating the boxgift-notebook, he attempts another movement of integration by tying
the string to the door. This action is abruptly interrupted, suggesting
that this representation does not correspond to his inner situation.
This might have been a fleeting response to what the analyst said,
which he had taken for a gift. Any movement, internal or external,
appears to threaten his state of continuity, and, thus, his fragile system
comes apart. He immediately seeks his mothers lap, where he goes
for protection. With the support of his dummy, he launches violent
attacks at his analyst through the figure of Tarzan. This is a curious
figure: he uses Tarzans strength to protect the fragile baby that lives
inside him. At this moment Mrio experiences the climax of his anxiety. Those small fragments that had been precariously linked crumble
and bring on a state of disintegration. Any attempt I make to approach
him is strongly rebuffed. Wrapped in despair, he locates his discomfort in his body, alleging HUNGER, A LOT OF HUNGER. When he says,
I WANT FOOD NOW, he demands immediate relief. This communication has a considerable impact on the analysts mind, given the degree
of despair and concreteness in his demand. Initially, she does not
follow Mrios communication on the level he had proposed, so that
his need is not satisfied, frustrating him even more. Manifestations of
intense hatred and destructiveness arise, resulting in a veritable
bombing of the analysts mind. Both are immersed in this dynamic,
which impairs the analysts ability to think. In this situation, Mrio

PRIMITIVE MIND AND THOUGHT

41

announces, Im leaving and never coming back! The strength of this


threat gives the analyst an idea of the dimension of the situation and
the inefficiency of continuing to communicate at the level at which she
was operating until then. In other words, given Mrios degree of
concreteness, verbal communication alone does not reach him, since
he is operating on another level. Only now the analyst was able to
hear him! When he asks again, IS THERE FOOD HERE? IS THERE A
FRIDGE?, she answers, Yes, there is everything you want! pointing
inside the box, indicating to him where to find what he had been seeking. Mrio is reluctant to accept the proposal, and says, Im not going
to play! He is reluctant to abandon the link of continuity. However,
at the same time, Mrio asks the analyst to help him find in himself
the ability to represent specific sensorial impressions and, thus, to
develop the symbolic capacity to stop depending on concrete objects
and acquire his own psychic existence. Mrio finally gives in and
accepts with interest the analysts invitation to play, adding, Great,
the foods here! Playing becomes an activity in which, by means of
the space created between self and object, Mrio uses the toys to
discover a different experience in communicating. As the analyst told
him, This is the food Mrio needs! In other words, his mental world
can be expanded by playing, and this is what can feed him.

Discussion
Both cases bring up issues that I discuss below. As I mentioned previously, there is a marked difference in the level of mental development
observed in each of these patients, and an analyst must take an
approach adequate to the ongoing communication. Pedro, from the
beginning, is consciously involved in investigating his mental world,
his terrifying dreams. He is very co-operative, as shown by the dreams
that he draws and has during the session. Indeed, he represents precisely and names his states of mind. Pedro regularly understands the
analysts transformations of his utterances, and this stimulates him to
make his own transformations. Thus, the conversation develops and
sets the stage for creating a common field of observation. At this point,
we can approach the emotional experience of the moment.
Then, in the words the pipe burst, the analyst, with her capacity
for reverie and alpha function, offers her transformation, and Pedro

42

AUTISTIC TRANSFORMATIONS

feels relieved and communicates what he understood: I thought that


no story would come of it, but it did. The story of the bad thoughts
which do not let me sleep . . . This illustrates the possibility of a meeting between the level proposed by the patient and the understanding
and response of the analyst, creating the approach to the analytic
object. In other words, an analytic third appears and is the product of
the recently established communication between the analytic pair.
The content of the fantasies involved in the words, But I slept last
night, mummy gave me a tranquilliser in bed . . . mummy told me a
story . . . daddy was working, triggers great mental excitement. We
see that Pedro expressly asks the analyst to perform the alpha function and transform these elements that he calls bad thoughts (locked
in the chest) into thoughts which acquire a bearable meaning so that
they can be contained in his mind. Pedro has clear insight into the
fragility of his mental apparatus. He fears not being able to bear the
increased tension generated by the excitement and violence. The
analysts transformation, as she offers her version of the oedipal
fantasies, initially provokes a break in his tenuously organised
system. And to that, he promptly responds: Yes, that is why I wont
be able to sleep at night. This seems to be a phenomenon of alpha
function reversion, and the alpha elements become bizarre objects,
blood, cockroaches. But as these elements are expelled and can be
welcomed by the analyst, Pedro achieves a more integrated state and
begins to have access to his anxiety, and then, by communicating
verbally, he names his fears connected to sibling rivalry.
It is worthwhile to take up once more the sequence that emerges
with the words: There is a hole in the balloon! Saying this, Pedro
invites the analyst to witness his fear of the rupture of his mental
apparatus coming from the excessive tension generated by the
dreams which prevent him from sleeping. He gets more and more
excited, and his excitement erupts into an explosion, manifested by
the hole in the sheet of paper. The analyst apprehends Pedros situation and tells him that it is a dream, a product of his mind. This information enables him to discriminate fantasy from reality, thus
providing him some relief, which attenuates his state of terror. Pedro
apparently reintegrates dispersed parts of the self, which, in the end,
allows him to fall deeply asleep.
Given the intensity of the phenomena observed, Mrios clinical
material clearly illustrates the states of mind at protomental levels. In

PRIMITIVE MIND AND THOUGHT

43

the presence of the analyst, who is entirely new to him, manifestations


of his primitive world predominate. This is a mind that is still partly
unborn, and the body is the surface on which the representations of
such a mind are inscribed. Possibly, in the place where the mind
should be, there is only a mouth, represented by an empty hole that
must be filled, closed by a dummy or by food in order to maintain
continuity with the concrete object. The function of this manoeuvre is
to avoid unbearable terrifying experiences of annihilation, coming
from the awareness of bodily separation. Perhaps what he feels is that
parts of his own body, and not the object, are being torn from him.
Mrios struggle to maintain the relation of bodily continuity between
self and object and, thus, avoid the experience of disintegration is
touching. Any threat of change to his system provokes an imbalance
that results in a fragmentation of the self into multiple particles. The
impact of these experiences on the analysts mind is such that her
capacity to think is affected and the analytic function temporarily
ceases. Mrio had to intensify his communication (threatening to
leave and not return) and the analyst had to tolerate this state, so that
she could recover her ability to be separate and think, creating an
intermediate space (the toy box). Through playing, sensorial impressions acquire representation and possibly expand Mrios contact
with his mental life.
At this point, I propose to discuss what follows: at a given level of
mental development, we have Pedro, with a mental apparatus whose
inner space fluctuates between states of greater integration, in which
he uses symbolic language to express himself, and other states, in
which his mental space is full of non-transformed beta elements that
form a beta screen. With the analysts containment capacity for reverie
and alpha function, these elements can be transformed into alpha
elements, which acquire psychic representation and, thus, can be kept
in the mind: therefore, they are thinkable. We might say that in
Pedros case, the resources available to the analyst can reach him and
the communication between the analytic pair is expanded.
Mrio is at another level: his mental apparatus is occupied mainly
by disconnected concrete elements. The connection emerges only for
a few fleeting moments. Under these circumstances, the alpha function and the analysts capacity for reverie do not find a developed mental apparatus that can accept such elements. This situation provokes a
dynamic between the analytic pair in which the communication that is

44

AUTISTIC TRANSFORMATIONS

established occurs on a concrete level, and this is apparently the only


level where contact is possible. However, one can see that ongoing emotional experience is unlikely to be achieved through this level. In the
session reported, the toy box allowed the analytic pair to raise the quality of their level of contact and introduced the possibility of creating
representations in the mind. None the less, often, in later sessions, when
the analyst proposed the same resource to him, Mrio responded by
shouting, I WANT REAL FOOD!!!
What tools do we have to achieve communication at these levels?
What resources do we have to work with adult patients who use
speech but communicate at a concrete level similar to Mrios?
Take, for example, Ana, aged forty. She is a patient who illustrates
the issue I am dealing with. Ana arrives for her session chewing gum.
She lies down, remains completely motionless, without any expression of life, only moving her mouth in an activity that I call ruminative. Considerable time passes before the analyst tells Ana about
what she was seeing. Ana begins to stretch and to make a few sounds,
as though she were awakening from deep anaesthesia. Bit by bit, she
says that she needs to tell me something, but that she is lazy. She uses
the analysts speech as a stimulus, a hook to begin talking. She
quickly begins a lively, endless narrative in which she meticulously
describes real facts of her daily life . . . The analyst feels isolated and
immobilised in that situation, both when the patient remains silent
and when she suddenly starts talking.
Bion calls the sensorial elements that did not undergo transformation at the psychic level beta elements. The term is used for a wide
range of phenomena that manifest themselves at different levels of
mental development, although the aspect of concreteness is always
present. I think that these cases show what I am talking about.
It would be interesting if we imagined a gradation of the different
nuances of communication in these phenomena (beta elements). Such
a register might be useful for analysts, allowing them to discern and
to approach their patients level of mental functioning. Through this
discrimination, an analyst could even situate the mental configurations that have not yet acquired representation. I recall an autistic
child whom I analysed. When I addressed her experiences, I was unable to convey to her any meaning appropriate to her psychic level. I
had no inner register, no representation for those phenomena. The
situation is similar to that of inhabitants of different planets who

PRIMITIVE MIND AND THOUGHT

45

cannot communicate. This was the only way I could talk to her. In the
patients state, it might have been useful for her to be with someone
who could recognise her isolation.
Continuing with the idea of developing a gradation of beta elements, I think that the most archaic level of mental functioning is
connected with autistic states. At this level, there is no perception of
the object.
The phenomena of projective identification occur at a higher
developmental level. The self splits and expels its undesirable parts,
placing them by projection inside the object. The fate of these elements
will depend on the intensity of the projection and on the transformations performed by this object. I wonder whether this area does not
include the beta screen, the reversion phenomenon of the alpha function, the formation of bizarre objects, the states of nameless terror, and
the states of fragmentation.
The phenomenon of hallucinosis present in the transformations in
hallucinosis (Bion, 1965) is, to a greater or lesser extent, present in all
states described, except the autistic ones, in which there is no notion
of the existence of the object.
I believe that other phenomena could also be highlighted, but, for
now, I will discuss only these.
It should be emphasised that the reference to the phenomena
mentioned is always connected to the idea of states of mind, to transient states.
In this context, where can we situate Anas, Mrios, and Pedros
communications? One should recall that, during a session, each of
these patients operates at times on different levels of mental functioning, which can be seen in the clinical fragments I have presented.
If we think in terms of the psychotic and the non-psychotic parts of
the personality Bion (1957) proposed, we would say that Pedro operates mainly with the non-psychotic part of his personality, and that he
appears to realise this when he says, I am afraid of my dreams. When
he becomes immersed in these states in which the psychotic part predominates, his mind operates in transformations in hallucinosis.
In this kind of transformation, the fantasy world acquires concreteness,
the conscious and the unconscious are confounded, the contact barrier
is not formed, and there is no separation between self and object.
Returning to Mrio, in the theoretical context presented so far, I
wonder what we are to make of his use of a dummy, of the food, and

46

AUTISTIC TRANSFORMATIONS

of his inability to separate from his mother. Obesity might be considered a cloak to protect an extremely fragile interior. We could ask
ourselves whether the dummy and also the food are objects and autistic forms used to cover the hole resulting from the consciousness of
bodily separation from the object. It does not seem to me that they are
objects with a symbolic meaning, created to establish a bridge
between self and object. They are not transitional objects. The resulting manifestations of despair and the constant state of excitement and
fragmentation appear to be resources used to avoid the pain of being
separated, which makes him prevent his mother from leaving.
As for Ana, I believe that her manifestation of isolation, when she
continues to chew gum, is a characteristic phenomenon of the primordial stages of development. Chewing gum is a self-generated autosensual object, and she completes herself with it, as Tustin suggests
when she addresses autistic forms (Tustin, 1984). The next movement,
when Ana emerges from a state of profound silence and produces an
endless monologue without establishing any contact, could be considered equivalent to the chewing gum she carries in her mouth. It would
be a kind of autistic manoeuvre to avoid states of intense vulnerability coming from non-integration, resulting from the consciousness of
bodily separation from the object.
As I said, it is essential for the analyst to discern the nature of the
phenomenon taking place during a session, so that her approach will
be appropriate for the specific levels of mental functioning. Still, such
discernment does not ensure that the analyst has the appropriate
instrument for that particular situation, which, as a matter of fact,
occurs most frequently when dealing with primordial levels of development. I believe it is better to be aware of the unknown and the limitations imposed on the analyst by the situation in order to face these
states, rather than substituting the approach with another, misleading
one, and with this, running the risk of unwittingly engaging in a situation which does not evolve. If we can sharpen the tools we use for
observation, we may be able to learn more about the quality of the
phenomena present in the analytic sessions and, thus, expand the clinical field of work to deal with other areas of previously inaccessible
phenomena. As Green (1998, pp. 655) said, psychoanalysts should as
far as possible be able to continue to analyse and to think, even in
painful situations.

CHAPTER FOUR

The theory of transformations and


autistic states
Autistic transformations: a proposal*

Introduction
hrough my clinical experience, I have been interested in investigating specific psychic phenomena in which primitive, protomental states of mind predominate and are often inaccessible to
the analyst. Some patients, even though communicating predominantly on a neurotic level, hide a part of their personality in which
prevail certain impenetrable encapsulated nuclei, preventing the
analyst from accessing certain aspects of their minds and making it
difficult for real changes to take place in the course of their analyses
(Klein, 1981; Tustin, 1986).

* I presented an earlier version of this chapter to a meeting of the Brazilian Psychoanalytic Society of So Paulo in June 2002. Fernando Giuffrida and Carmen Mion were
respondents. I also delivered it at the Brazilian Congress of Psychoanalysis in So Paulo,
where it received the Fbio Leite Lobo award. In addition, I presented it at the First
International Bion Conference, which also took place in So Paulo. There, it received the
First International Parthenope Bion Talamo Prize from the Centro Turinnese de
Psychoanalysis (the Turin Psychoanalytic Centre) and from the Italian Psychoanalytic
Society. The version presented here is an expanded version, which was published in the
International Journal of Psychoanalysis (2005, pp. 15951610).

47

48

AUTISTIC TRANSFORMATIONS

Frequently, in these situations, my experience has been that the


relationship established between analyst and analysand is kept within
prescribed repetitive patterns of communication that conceal the
perception of the unknown by the analyst. This also brings about a
crystallisation of the analytic process and the acceptance of this situation by both analyst and patient.
I also observe that some specific manifestations of this phenomenon elude analysts and are left out of their field of observation.
I am referring, in particular, to sensorial manifestations in which
protomental phenomena prevail and where there is no differentiation
between physical and mental stimuli. The impact of these stimuli on
the analysts mind is considerable and, given its degree of primitivism, they do not acquire representation, and, thus, are not subjective to transformation. The reactions of the analyst to such stimuli
should be observed and included in his field of work, in which they
will be an essential element. Often these reactions replace thought.
Body language and evasion are expressions of these states.
Adopting Bions theory of transformations (1965) as a method of
observation in the analytic session, I propose a new group of transformations: autistic transformations, in which autistic phenomena
prevail. In my opinion, this concept might contribute to a better
understanding of these phenomena in neurotic patients who, when
confronted with situations in which mental pain is intolerable, resort
to autistic types of manoeuvres to avoid the pain.

The interpretation of phenomena


The same phenomenon can have different interpretations depending
on the standpoint from which it is observed. In psychoanalysis, it can
be said that the apprehension of a psychic phenomenon and the
meaning attributed to it is related, among other variables, to the theoretical referential used by the analyst.
For instance, imagine two trains on parallel tracks moving in the
same direction at a similar speed, 100 km/h. An observer on the
station platform will see them pass by and say that both are moving
at 100 km/h. Let us assume that the same observer is now inside one
of the trains and measuring the speed of the other. From this standpoint, he will say that their speed is zero. We may conclude that the

THE THEORY OF TRANSFORMATIONS AND AUTISTIC STATES

49

speed of the trains varies according to the referential adopted: still


observer on the platform, or moving observer inside the train.
This classical model allows us to conclude that the same phenomenon can be seen from different angles, all of them equally relevant.
This idea cannot be considered alone, but as part of an overall context,
otherwise we might make judgemental mistakes.
It is widely known that discoveries of modern physics completely
changed peoples thinking on many different subjects, altering
concepts of space, time, matter, as well as cause and effect.
We also observe this influence in the visual arts. The Cubist school
led to a break with the form of artistic expression that was used until
that time. It abandoned perspective as the way to represent an image
from a single static observation point and introduced the simultaneous view of different standpoints fused in a single image in painting
(Habasque, 1959). The Futurist movement, which followed Cubism,
led to another advance, especially with Marcel Duchamp, spelling out
in the painting the plastic representation of reality in movement that
contains a simultaneity of dynamic sensations and mood states.
I assume that, when developing the theory of transformations,
Bions ideas were part of an epistemological attitude influenced by
this new way of seeing the phenomena.
Grotstein (1981), when editing a collection of papers by various
authors on Bions ideas, chose very appropriately the title, Do I Dare
Disturb the Universe? It is well known that Bions theory (1962a, 1965,
1970) has created great turmoil and polemic within the scientific
community, inducing a state of anxiety.
The main theme concerning the development of thought present in
his ideas is itself unsettling, since thinking, as I understand it,
would contradict the strong human tendency for non-thought.
Moved by the need to avoid the pain that comes from the helplessness
inherent to their own condition of impotence and limitation in the face
of an unknown universe, individuals are impelled to create an illusory, or even hallucinatory, world to ensure a reasonable equilibrium.
Bions theory suggests that the analysts task is to change the organisation and try to develop in the analysand the ability to tolerate the
psychic pain in order to transform it, allowing it to contain the
contents which his mind produces and, perhaps, think about them.
The analysts field of work, Bion (1962b) maintains, is to learn
from the emotional experience shared by the analytic pair in the

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AUTISTIC TRANSFORMATIONS

session. The theory of transformations (1965) is proposed as the observational standpoint for phenomena in that field, allowing the analyst
to identify what kind of emotional experience he is undergoing.
By adopting this standpoint, the analyst can make his observations
knowing that the facts to be observed are distorted by the very act of
observing them, since the tool he has for his work is his own mind,
which is susceptible to psychic movements equal to those of his
patients. It is from the contact with these movements that the analyst
formulates his version of the ongoing emotional experience. This way,
the analyst abandons his position as authority, as possessor of knowledge, and as the vehicle of an absolute vision of mental phenomena.
In my opinion, this was how Bion (1965) dared to disturb what
was already established. He inserted into the analytic field the notion
of the analyst in movement, active, subject to the dynamism
imposed by all live contact. From the perspective of the theory of
transformations, any movement, whether by the analyst or the
analysand, is considered to be the link in a chain of successive movements resulting from the interaction established between the analytic
pair from the moment that the session begins. The analysts transformations come about in this field when it is no longer possible to assign
a definitive meaning to a particular phenomenon experienced in the
relationship. What he can do is offer the analysand his personal transformation as one of many possibilities to be considered in his dealing
with the material.
The participation of the analyst in the session is impregnated with
elements from his own personality and by the baggage he accumulated through his life, by his intuition acquired during his psychoanalytical training, and by his own analysis.
As we are aware, the concept of transformation contains the idea
of invariance. To bring about a transformation of an emotional experience, some elements in this transformation must remain, should not
vary, otherwise the experience is no longer a transformation of the
original situation, but, rather, just any experience. Therefore, it is not
just a random transformation, but a transformation in which the very
invariants of the theory adopted by the analyst are conjoined. This
theoretical system will partially determine the focus of his approach.
Bion, in my opinion, by proposing the theory of transformations as
a method of observing mental phenomena, reproduces in the analytic
situation an experience somewhat closer to a meeting of two people:

THE THEORY OF TRANSFORMATIONS AND AUTISTIC STATES

51

two minds in movement, interacting, one modifying the other with


each movement that occurs.
Within this approach, each analytic pair is a specific pair, each with
its own movements resulting from the ongoing emotional situation.
The analysts mind, like that of his patient, is susceptible to vicissitudes peculiar to human beings, and this requires the analyst to be in
a state of constant self-awareness. This is what makes him different
from the analysand. And so, why do we not imagine that the analyst,
subjected to strong emotions in these experiences, would also proceed
in states of non-thought in which predominate K links, as named by
Bion (1962a,b, 1965). The transformations of such an experience will
depend on the conditions of the moment in which he might find
himself and on the internal and external pressures he might feel. What
is expected, though, is that the analysts mental development will be
different from the analysands, that the analyst will be in better shape
for recovery from a K mental state, thus enabling him to rescue his
ability to think. Often, in such circumstances, the analyst, when trying
to avoid the upsetting experiences to which he is exposed, falls back
on theories and on concepts he uses as anchors, which give him the
appearance of having a certain organisation within the chaos of the
situation.

Transformations
Starting from the idea that, when sharing experience, the analyst has
access only to the transformations of the ongoing emotion, since he
does not have access to the emotion itself, the question presented is:
what type of transformations of the emotional experience is the
analyst sharing with the analysand on each movement? What would
be his transformation on that experience?
Bion proposes several groups of transformations: transformations
in rigid motion, projective transformations, in hallucinosis, in K and
K, as well as transformations in O. I shall discuss only the first three
groups.
In transformations in rigid motion, the field of observed phenomena includes the classical transference described by Freud, in which
situations from the past are transferred to the figure of the analyst
without being deformed (Symington & Symington, 1996).

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The mechanisms of cleavage and projective identification proposed by Klein (1946) prevail in projective transformations. Ones
mind projects undesirable parts of ones self on to the object in order
to obtain relief. It is the analysts task to accept the patients projections, receive them, and transform them, giving them some sense, so
as to inform the patient and make it possible for him to keep that
content in his mind and no longer expel it.
In transformations in hallucinosis, the emotional relationship
experienced with the figure of the analyst as a real object is transformed in such a way that the real person is replaced by another
figure created by the analysand. From this moment on, the relationship that the analysand establishes with the analyst becomes independent of ongoing facts, gaining their own existence, autonomous,
ignoring the reality.
As Bion says (1965, pp. 136137),
The patient whose transformations are effected in the medium of
hallucinosis might almost have as his motto actions speak louder than
words with its hint of rivalry as an essential feature of the relationship. . . . The general picture the patient presents is that of a person
anxious to demonstrate his independence of anything other than his
own creations. These creations are the results of his supposed ability
to use his senses as organs of evacuation, which are able to surround
him with a universe that has been generated by himself: the function
of the senses and their perfect counterpart is to create the patients
perfect world. The imperfection is an evidence for intervention of
hostile and envious forces. Thanks to the patients capacity of satisfying all his needs from his own creations, he is entirely independent
from anyone or anything other than his products.

Bion points out that, in any group of transformations, to a greater


or lesser extent, the hallucinatory phenomenon is always present,
since he considers this one of the minds functions. He also maintains
that Rivalry, envy, greed, thieving, the sense of being blameless: all
those manifestations deserve closer scrutiny as invariants under
hallucinosis.
By introducing the notion of transformations in hallucinosis, Bion,
in my opinion, widens the field of psychoanalytic observation, since
this concept sheds light on psychic phenomena with qualities which
are different from those previously considered, mainly concerning the

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53

projective identification described by Klein (1946). I think that the


approach of the theory of transformations leaves open the possibility
of other groups of transformations being equally observed.
Bion considers that the presence of the mechanism of hallucinosis
in neurotic patients is more frequent than we suppose. When subjected to great levels of pressure, patients such as these operate with
the psychotic part of their personality (Bion, 1957).
I see Bions concern to discriminate between the different groups
of transformation as an attempt to help the analyst orientate himself
when facing the different levels of communication proposed by the
patient, as well as to facilitate scientific exchange among peers.
I question whether it would be possible to include in the theory of
transformations another group of transformations, a group in which
the prevailing phenomenon has different features to those described
by Bion. I am referring specifically to the autistic phenomenon
observed in autistic states, which are discussed below.

Autistic states
In physics, the interpretations of experiments are called models or
theories and the realisation that all models and theories are approximate is basic to modern scientific research. Thus the aphorism of
Einstein, As far as the laws of mathematics refer to reality, they are
not certain; and as far as they are certain, they do not refer to reality.
Physicists know that their methods of analysis and logical reasoning
can never explain the whole realm of natural phenomena at once and
so they single out a certain group of phenomena and try to build a
model to describe this group. In doing so, they neglect other phenomena and the model will therefore not give a complete description of the
real situation. (Capra, 1975, p. 41)

Frances Tustin, among others, such as Winnicott, Bick, Meltzer,


Alvarez, and Grotstein, has contributed greatly to the study of autistic states. From her analytic experience with autistic children, Tustin
puts us in contact with idiosyncratic manifestations of these patients,
which she acutely describes.
Tustin (1986) and S. Klein (1981) assert that behind the neurotic
part of the personality lies a part in which encapsulated, impenetrable

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nuclei of the self prevail. These nuclei are resistant to changes and are
responsible for lack of emotional contact in the patient. These
emotional states produce phenomena similar to autistic defences,
whose purpose is to protect the primordial self from intolerable states
of non-integration.
According to Tustin (1981, 1984, 1986, 1990), autistic phenomena
are characterised by the presence of a state of emotional withdrawal
inside a self-generated protective shell. The self flees from affective
contact with the object in order to avoid painful experiences likely to
trigger feelings of disintegration and intolerable vulnerability. Such
phenomena occur mainly among individuals who manifest extreme
sensibility and exacerbated auto-sensuality. For these individuals,
awareness of separation from the object occurred abruptly without
means to bear it. This separation is experienced as if parts of their own
body had been wrenched from them, making them feel annihilated.
The notion of the object in the neurotic part of the personality is quite
different from the notion of the object in autistic states. In the latter,
there is no notion of the internal object, or of the external object;
instead, sensations predominate which do not acquire representation
on a psychic level. The relationships between me and not-me
occur mainly through relations with objects and autistic forms
(Tustin, 1984, 1986), both strongly impregnated with sensations. The
contact through these objects and autistic forms is essential, not
because they represent the object or because of the fantasy they might
trigger, but because they become the actual object. The awareness
of the lack of the object is shrouded by the autistic object, so that the
terror felt in its absence is suppressed. The relationships that are established through autistic forms are sensorial experiences that acquire
forms entirely personal and particular to that individual. They are
created from bodily substances or from objects experienced as such. It
is not a matter of forms shared with other people; they are sensed
forms which acquire a soothing function. They constitute predominantly experiences of soft objects and of bodily substances felt as
comforting and soothing. These autistic forms provide rudimentary
notions of limits and space.
Often, in clinical work, analysts come across configurations such
as the ones considered here. Through my experience with some
patients, I have discovered that, in my efforts to apprehend their
mental states, I have failed to notice some preverbal communication

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55

expressed by body language. Later, I discovered in the analytic relationship that these idiosyncratic communications revealed deep experiences for which the patient lacked sufficient verbal resources to
express. Given the degree of non-integration of these manifestations,
the analyst is often overwhelmed by the situation, using evasion as a
means of maintaining himself in a cohesive state and with a certain
psychic balance.
The analysts recognition and inclusion of such phenomena in her
practice can considerably widen her field of observation concerning
mental states and allow her to plumb primordial stages of her
patients emotional development. The awareness of these states of
mind and the access to them encourage the separation between self
and object, allowing the analysis to go on in order to promote the
elaboration of these states and prevent their mere repetition.
If we use the theory of transformations as a reference, I think the
apprehension of the autistic phenomena is modified. One can abandon the description of an isolated phenomenon, and the analyst
becomes no longer an outside observer from whom interpretations
are expected. The analyst then becomes actively involved in the
context of the emotional experience shared with the patient. Her
observations emerge as a link in a chain of successive movements
deriving from the pairs interaction. Thus, the analysts task becomes
circumscribed to experiencing these chains of emotional movements
and their consequences.
The atmosphere experienced by the analyst in the autistic sphere
is that of absent affective life, which triggers in her mind a high
level of anguish, favouring a tendency toward evasion, making it
difficult for her to keep in contact with the situation and to communicate with the patient. Such situations require the analyst to engage
in the discipline of constant self-observation, an essential condition
to keep her mind available, allowing her to keep herself present
and operative in the situation. In this case, it is left for the analyst
to communicate to the patient that his autistic manoeuvres are a
result of his state of terror. Admittedly, however, it is not always
possible to penetrate the autistic barrier. In the case of autistic transformations, rather than actual autism, one hopes, as Tustin (1990)
suggests, that fluctuations of consciousness and some contact can be
established. In the event, the patient can become aware of his state of
terror through the analysts interpretation; he might feel accompanied

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AUTISTIC TRANSFORMATIONS

by him, becoming sufficiently confident to regain contact with his


mind and momentarily experience his true condition. Anas clinical
material, which I present below, illustrates this point. By looking at
the elements described up to now from the standpoint of the theory
of transformations, it can be said that we are facing here this new
group of transformations, which I have named autistic transformations. In addition, it should be emphasised that the prevailing
phenomenon in autistic transformations, although sharing some
similarity with the phenomenon of hallucinosis, is of a diverse nature.
The emotional experience of the analyst in autistic transformations is
one of emptiness, lack of emotion, whereas in transformations in
hallucinosis, it is intense and full of life. Absence of affective life,
emptiness, and auto-sensual activities can be considered invariants
in autistic transformations, implying the absence of the object,
whereas in transformations in hallucinosis, the notion of external
object is present.
There is another significant feature that is worth mentioning: Bion
(1957) established a difference between psychotic and non-psychotic
parts of the personality, broadening the analytic field. When he
proposed transformations in hallucinosis, he made it possible to have
access to psychotic parts of the personality. Tustin (1986), by introducing the notion of autistic parts of the personality, broadened the
field even more. The proposal of a new group of transformations, the
autistic transformations, represents an attempt to facilitate the analyst
in the understanding of autistic nuclei functioning in neurotic
patients.

Transformations and the analytic pair


Based on clinical fragments from two patients, I will explain the
distinction between the quality of emotional experience shared by the
analystanalysand pair facing projective transformations, transformations in hallucinosis, and autistic transformations.
Mariana is a child who, in my opinion, functions primarily
through transformations in hallucinosis, even though there is also
evidence of projective transformations. Ana is an adult patient who
functions mainly with the neurotic part of her personality, but also
presents notable autistic nuclei. I hope to demonstrate what I mean by

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57

autistic transformations by contrasting Anas material with that of


Mariana. It is necessary to make a clinical distinction between autistic
transformations and transformations in hallucinosis because, as we
shall see, they share a series of characteristics, and failure to distinguish them can give rise to errors.
Mariana, an eight-year-old girl, arrives at the analysts office carrying a
huge bag full of paper, folders, and notebooks. While she is still outside
the analysts consulting room, in the doorway, she begins a conversation
with her imaginary students: Hi there, class! Ms Mariana has just
arrived! She throws kisses to everyone. Paying no attention to the analyst
and in the midst of great satisfaction and omnipotence, she spreads everything out on the table and begins to talk, addressing herself to imaginary
listeners. With her finger pointed to the sky and with an authoritative attitude, she says, People, today Ms Mariana wants you all very quiet! Ms
Mariana is tired, silence! I will teach you how to calculate today! After
that, in a very angry way, she says, I have already counted to four and
whoever blinks will be on time out! Is everyone here today? Andr,
Fernando? What a pity, Carolina did not come today! And you, what do
you want from Ms Mariana? Look how cute she is! The analyst gets
caught up in this situation along with all these beings created by Mariana,
beings who begin to exist, with a life of their own. Marianas superiority
and triumphant air are immense!
I try to communicate with her, but I am immediately interrupted by
Mariana, who says, You there, be quiet, not a word! She slaps the table
with her ruler and, addressing the other students, says, Look how silly
she is, she doesnt know a thing! Shes the worst of all of you! In this situation, I become immobilised, unable to think, react, or work. All I can do
is wait! I feel engulfed by that atmosphere, impotent, unable to act since I
could not even blink. For a few moments, I become the character that
Mariana has assigned to me: The worst of all her students. The session
goes on like this. When the time is up, she gathers all her belongings and,
from the door, says bye-bye to everyone, adding, Everybody be quiet.
Ms Mariana is leaving and when she comes back, she wants to find everything in order.

In this clinical vignette, the analyst finds herself predominantly in


the presence of transformations in hallucinosis, even though there are
some projective transformations as well. The analysand, with great
skill and shrewdness, creates a scenario in which her characters
acquire a life of their own. The analyst, as a separate entity, does not

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belong in this scenario, except as one of the students who performs the
very role reserved for her among all the students: The worst of all!
The atmosphere that prevails in this experience is that of rivalry and
superiority of the analysand in respect of the analyst. Her goal is to
maintain this relationship at any cost, so she reacts violently to any
threat of rupture to this state. The emotional atmosphere of the session
is intense; the situation is very vivid. Marianas action can be characterised as evacuative, with the function of trying to maintain control
over the analyst, so as to make her an object of her creation, and, in that
way, avoiding contact with the analysts live and dynamic presence.
She uses hallucinatory mechanisms to this end; had she not, she would
need to face her own helplessness owing to her true fragile and powerless condition. Her triumph over the analyst when she confirms the
superiority of her methods (Bion, 1965) is significant. All these elements together indicate that the transformations produced by the
analysand are characterised by phenomena in hallucinosis. In this
circumstance, the analyst is faced with a transformation in hallucinosis.
The analyst experiences a state of helplessness imposed by the
intensity of the situation. Keeping some distance, she is left only with
the possibility of informing the patient at a timely moment that, from
her point of view, all the action and emotion in which she had been
wrapped are the result of a state of hallucinosis. The awareness of the
patient of this situation changes and an interlocutor emerges, so that
the communication between the pair can be established at another level.
In this clinical vignette, it was mentioned that transformations in
hallucinosis prevailed, although some of the patients movements
could be characterised by the presence of projective transformations.
I point out that in these, it is possible to observe that the patient projects her undesirable internal content on the figure of the analyst. The
analyst feels the impact of what it is like to be a small child subjected
to violence coming from an authoritative adult. The intensity of this
projection overwhelms the analyst and incorporates her into the
scenario set up by the patient, so much so that the analyst loses
momentarily the perspective of the separation between them and the
fact that the action has nothing to do with her. These elements point
toward the presence of phenomena characterising projective transformations. In circumstances such as this one, the analyst should take in
the analysands projections and, using her own capacity for reverie

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59

and the exercise of the alpha function, transform them and assign
them some meaning. Communicating that meaning to the patient will
probably allow the projected content to resurface in such a way as to
become more bearable and likely to be kept in the mind.
As Bion (1965) points out, the phenomena related to projective
identification and hallucinosis permeate all communication to some
extent. For the analyst, it is important to determine the prevailing
ongoing phenomenon. This is important because the approach will be
different according to the type of transformation presented.
Ana has been in analysis for several years, coming to sessions
four times a week. In her field of work, she is a competent professional. She operates most of the time with the non-psychotic part of
her personality.
Her appearance is very well cared for. Her gaze is distant; her facial
expression demonstrates a certain absence of emotion. When Ana enters
the consulting room, she slowly and carefully places her handbag on the
couch. She lies down, straightens out her skirt on both sides and crosses
her feet, as if she were bandaged in some way. A few minutes later, she
presents matters related to timetables, honoraria, coming vacations, giving
the impression of being concerned about some practical aspect of the situation. I answer her questions, even though I am aware that her vacation is
still far in the future and that there is no evidence that such matters have
anything to do with separation anxiety. This subject wears out quickly and
she retracts herself once again. She remains in a state of absolute silence,
staying practically motionless for a long time, without any expression of
life, looking as though she were under the effect of a potent anaesthetic.
She only moves her mouth when chewing gum, as if she were ruminating
something and, at the same time, with one of her hands, fiddles with an
earlobe. I feel isolated, without anyone with whom to communicate. I
realise that it is necessary to make a conscious effort to keep in contact and
not evade things. If I do not intervene, asking about what she is thinking,
this situation extends until the end of the session. Sometimes, even with
this questioning, Ana does not react. This experience irritates me. I fantasise about shaking her. The atmosphere in the room is that of emptiness, of
absence of life. This triggers in me a state of dismay, a feeling of impotence
due to its repetitive pattern because I notice that pointing this out to her
does not help her, as was the case on other occasions.
During a session that took place at a later time, Ana repeats the same
ritual. She stands still, without uttering a word, until she interrupts this

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AUTISTIC TRANSFORMATIONS

state, stretches slowly, as though waking up from that anaesthetised state.


In a tone of voice as if talking to herself, she says, I need to say something. Facing this situation, I reply that it seems as though she has
momentarily become aware of my presence in the room and that she
might want to tell me something. I notice, however, that she does not
listen to me. She begins a long narrative of things that have happened, full
of minute descriptions, in such a way that it becomes difficult to comprehend what she is trying to communicate. She seems to be completely
immersed in the act of speaking. At first, I think the situation between us
has changed and that she is trying to communicate something with her
speech. I try to get hold of that and find a point of contact, offering her
some interpretation about the content of what she is communicating;
however, I notice that nothing that I say echoes. I notice that she hears
what I tell her, but that does not change her intention of keeping on with
her narrative full of detailed descriptions. Although I notice that I am
alert, in contact with the situation, I cannot find parameters to guide me
to operate on an analytical level in the face of that world unknown to me.
This has been a repetitive situation in our relationship, presenting itself
often as a chaotic universe.
Keeping some distance from the situation, I slowly observe some patterns
in the universe I share with Ana. I become aware that this ritual that she
repeats when entering the office, her questionings, the act of chewing gum
and the fiddling with her earlobe, are possibly manifestations, since she
apparently does not have any other resource at that moment to share a
lively experience with me.
I try to find some way of telling Ana that what is happening in the session
shows how she experiences situations in her life and that perhaps this is
the core of her mental life. I tell her that I have seen that she is terrified
whenever she becomes aware that she is a separate individual and that
she feels very vulnerable when facing this situation. I mention that the
long time in which she remains withdrawn, isolated, and the entire narrative she becomes so wrapped up in, as well as the gum, are stratagems she
has found to try to protect herself from terrifying experiences and to maintain a state of continuity with the analyst.
Ana listens to me attentively. I notice some change in her mental state, and
the atmosphere of isolation present in the room seems to have decreased.
She says she understands what I am saying. Then she adds that she withdraws in this manner whenever she fears that the situation in which she
finds herself does not meet her expectations. She says, Thats how I am
in any situation, real or imaginary. I think Ill never change. I need to feel

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61

totally safe, and that is only possible if the person Im with is inside of me,
but I know that will never happen.
I understand Anas suffering. I tell her that she is seeing things from a
totally different perspective now and that perhaps she can experiment
with being separate. After this, I notice that we begin to have some
proximity and that Ana seems more capable of gradually giving up her
defences. She seems to be a little closer to her own emotions and to be
better tolerating her vulnerability.

Comments
Being with this patient makes the analyst oscillate between feelings of
intense emotion and paralysis. In case the analyst is incapable of maintaining herself in a self-observing state, her tendency is to disconnect,
distance herself, and abandon the patient. Other times, however, when
the analyst observes the patient in that anaesthetised state, with nothing to say and with no means to reach her, she imagines herself shaking the patient in an attempt to wake her up from that state. She also
notices that her condition of staying in contact with the patients
empty space is not stable, and depends on the amount of suffering
involved, in addition to other imponderable factors. When contact is
possible, the analyst is able to rescue her capacity of thought and to
step back from the situation in order to see that such manifestations are
manoeuvres which the patient has developed to protect herself from
her extreme internal vulnerability. In this circumstance, the analysts
emotions change and she begins to observe that Anas detailed narration, prolonged silence, the gum, the manipulation of her earlobe, and
her body language take on another dimension: they express her experience of terror because of the awareness that she is physically and
psychically separate from the object. She withdraws from contact and,
through sensations in her own body, creates a state of corporeal continuity with the external object, thus avoiding the intolerable mental
pain brought on by the state of vulnerability in which she finds herself.
That way, she manages to preserve some cohesion of her self.
From my point of view, this clinical material shows how one can
understand autistic phenomena from the standpoint of the theory of
transformations. I will now examine some of the movements in the
session and identify autistic transformations.

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AUTISTIC TRANSFORMATIONS

The analyst, when she meets the patient in the waiting room, sees
a person with a blank look and lacking emotion. She notices nonverbal manifestations: the gum, the fiddling with the earlobe, and her
body movements when she lies down on the couch. The analyst
observes that the patient attempts to communicate through questions
about practical matters related to her analysis. On examining this
cycle of transformations, it is evident that the emotional experience
shared in the session becomes the key element directing the analyst
toward what Bion (1965, 1970) called O (being). It is unnecessary to
say that the theoretical invariants are part of what she sees. Within
this chain of movements, in the analysts opinion, the patients speech
is not related to its content, but seems to be a manoeuvre which, along
with auto-sensual activity, protects her from the pain deriving from
her awareness of being separate from the object and, thus, protects her
from the threat of annihilation. These manoeuvres are an attempt to
maintain continuity with the object. I suggest, therefore, that the
patients transformations are autistic transformations.
In the following cycle of transformations, the patient is still
absorbed in her autistic enclave. The analyst, not able to penetrate the
patients mental world, is overtaken by a discouraged feeling as she
remembers similar sessions from the past. She decides to wait. In this
chain of movements, I suppose that the patients transformations are
autistic transformations. I question whether the analysts transformations would be transformations in hallucinosis.
After a long period of withdrawal, the patient realises that she
must say something and begins a long narrative. The emotions experienced by the analyst are those of isolation and emptiness. She
suspects that the patients act of speaking, due to its sensorial
aspect, aim at maintaining a state of continuity with the object in the
same way as the gum and the fiddling with the earlobe. That way, the
patient would avoid experiencing feelings of terror brought on by the
awareness of the bodily separation. The analyst stays in the situation
and tries to find a way of letting the patient know what she is seeing.
In this cycle of transformation, I understand that the patients transformations are autistic transformations, whereas the analysts are
transformations in K.
The communication of these perceptions to the patient allows the
autistic barrier to become more permeable and the atmosphere in the
session changes. The emptiness disappears, and the contact between

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63

the pair becomes more vivid. With this new cycle of transformations,
we can observe that the analyst performs a splitting in her mind in
such a way that she is able to keep herself in the situation and recover
her analytic function, thus becoming able to communicate her observations in a more precise way. The patient shows interest in what the
analyst says. The protective armour the patient constructed in the
beginning of the session becomes more permeable. She seems to
develop confidence in her analyst and let herself reveal her vulnerability without feeling so threatened. She says, That is only possible if
the person Im with is inside of me, but I know that will never
happen. In this sequence, we observe that the patient is able to get in
touch with her condition of being separated from the object. In this
new cycle, I suggest that the analysts transformations are in K and
those of the patient are in KO.
It is important to point out that the transformations presented in
this session are peculiar to that particular analyst. Another analyst,
with different personality traits, who uses a different theoretical
framework, would address this material from a different, yet equally
valid, standpoint. I acknowledge that this session could have
unfolded in very different ways.

Discussion
At this point, I will try to share with the readers some concerns over
the ideas which were proposed.
I begin this discussion by characterising, through the two clinical
vignettes, what I call autistic transformations. To this end, I shall
contrast some of Anas material with Marianas. Then I shall try to
share some misgivings that arise from the ideas I have developed
here. The emotional atmosphere of Anas session is quite different
from that described with Mariana. During a session that took place at
a later time, Ana repeats the same ritual. She stands still, without
uttering a word, until she interrupts this state, stretches slowly, as
though waking up from that anaesthetised state. In a tone of voice as
if talking to herself, she says, I need to say something. Facing this
situation, I reply that it seems as though she has momentarily become
aware of my presence in the room and that she might want to tell me
something. I notice, however, that she does not listen to me. She

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AUTISTIC TRANSFORMATIONS

begins a long narrative of things that have happened. Both are


immersed in their own worlds, in which the presence of others is
disregarded. None the less, it is clear that the quality of the phenomenon in each of these situations is very different; therefore, the way to
approach them will also differ.
In the relationship with Mariana, the analyst shares an experience
in which the presence of emotions prevails. The environment is
intense, vivid, and full of impact. A feeling of impotence predominates in the analyst when she finds herself without means to reach the
patient who is wrapped in a mood in which prevails the phenomenon
of hallucinosis.
In the relationship with Ana, the analyst experiences a state of
affective emptiness. The contact here is with an object sensorially
present, but psychically absent, with no affective life available to
relate to others. The analyst experiences an accentuated unfamiliarity.
She does not have access to the universe that inhabits the mind of the
patient. The degree of isolation brought about by this situation is
considerable. In this circumstance, the analyst needs to develop
adequate tools in order to maintain her analytic footing and to differentiate the ongoing phenomenon. This collection of phenomena
points towards what I call autistic transformations.
The relationship established by Ana occurs through auto-sensual
activities, or with objects which she feels as physical. She tends to hold
on to these sensations to feel protected. The threat she feels when her
analyst makes any attempt to approach her mental world is exacerbated. Ana fears that her entire fragile structure might abruptly crack
and that her vulnerability will be exposed.
One point to be discussed relates to the apparent paradox
contained in the term autistic transformations. Tustin (1981, 1984,
1986, 1990) tells us that the functioning of the autistic mind is characterised by the fact that the individual is predominantly living in a
world dominated by sensations. His answers to people occur from the
sensations that arise from the contact with them. The author is referring to protomental phenomena, whose degree of primitivism prevents them from acquiring representation in the mind, making them
immune to transformation. Yet, we can suppose that any manifestation, even on a protomental level, as well as its apprehension, is a
transformation, since we do not have access to the experience itself,
however primitive it might be. These phenomena are expressed on a

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65

sensorial level, but they are certainly transformations. With this fact in
mind, and in spite of the idea that an autistic transformation might
seem paradoxical, this notion is extremely useful because it gathers a
set of phenomena linked to the protomental sphere.
The merit of this distinction is related to the possibility of including autistic phenomena within an observational methodology of the
theory of transformations. That will allow us to shed light on a common area of our practicethe autistic area. This area is not always
accessible to us, due to the intensity of the stimuli and the strong
impact they create, and mainly because of the analysts struggle to
maintain himself in contact with the situation.
It is important to emphasise that not every auto-sensual activity in
the session is associated with autistic transformations. What determines the nature of a particular transformation is the emotional experience the analyst identifies within the session. There are auto-sensual
activities that produce intense emotion in the analyst, and they are of
a different nature from those found in autistic transformations as I
have formulated them.
A further point for consideration is the need to not confuse the
impact on the analysts mind in the face of autistic phenomena with
phenomena coming from projective identification. The degree of
primitivism present in protomental states causes intense reactions in
the observer. These reactions are also disorganised, which might lead
one to consider them a phenomenon of successful projective identification. I believe this is a mistake because, in the states where autistic
phenomena prevail, the object is not considered a separate object. In
these cases, there is no possibility of a patients release of undesirable
content by projecting it on to the analyst. The patient in this state is
wrapped up in himself and in the sensation he creates, and for him
there is no difference between me and not-me. This is a fundamental distinction to be made, positioning the analyst according to the
level of mental development in which the patient is. For the analyst,
as well as the analysand, it is preferable to be aware of the unknown
brought on by these situations, as well as by the limitations imposed
by these mental states, rather than running the risk of substituting
them for some misguided approach leading to a situation that does
not progress (Korbivcher, 1999).
I will now return to those transformations brought on by the
analyst when confronted with autistic transformations. As we are

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aware, mental stimuli are powerful in this area in which the absence
of emotion prevails. For the analyst, it can be intolerable to be faced
with a mental state of affective emptiness. The way in which the analyst responds to the ongoing communication will vary according to
the interplay of movements shared by the pair.
The analyst often creates in his mind a different analysand with
whom he communicates, ignoring, in this manner, the patients
mental condition. In an attempt to reach his patient, he offers interpretations based on specific theories and does not realise the error he
is committing. The analyst uses this mechanism to free himself from a
situation the way it presents itself, replacing it with one of his own
creation. In my opinion, phenomena of hallucinosis prevail in the
analyst in this circumstance.
There are also situations in which the analyst, overwhelmed with
anguish at not finding an interlocutor with whom he can communicate, cannot contain the feelings these situations bring about, so he
tends to avoid the discomfort he feels. He often expels and projects his
own hostile impulses coming from that experience on the analysands
mind and pressures his patient to operate with resources which are
not available to him at that time. When this happens, the phenomenon of projective identification prevails. Can we then consider the
analysts transformations to be projective transformations?
At other times, depending on the degree of suffering in the particular situation, an abyss is created within the analytic pair. Each
member remains self-absorbed, analyst on one side, analysand on the
other, in a private universe, with no connection to each other. To deal
with these situations, the analyst can be caught up in activities related
to his own body, with his own mental activities, totally unrelated to
the patient. He can also be carried away by pleasure in the act of
speaking and produce long speeches which clearly address his own
needs, rather than those of the patient. I question whether the analyst
in this situation would be operating in autistic transformations.
It is also possible for the analyst to maintain some distance in relation to the experience the client presents. In this case, he can perform
a split in his mind in a way that discriminates the nature of the transformation in the ongoing emotional experience. If this occurs, the
analyst recovers his capacity to think and stays with the patient in his
isolated universe. In the event that the analyst can transform this
experience into some communication and offer it to the patient, some

THE THEORY OF TRANSFORMATIONS AND AUTISTIC STATES

67

contact might be established between the two of them. The analysands experience of sharing with the analyst his state of mental
emptiness, his lack of affective life, even of being informed about the
workings of his inner world can be extremely valuable. This would be
a rare opportunity for these patients to feel close to someone. In my
opinion, under these circumstances, the analyst would be operating
under K transformations.
The ideas I have developed in this chapter, in which I propose the
new concept of autistic transformations, are designed to unite a
particular group of mental phenomena with specific characteristics, to
limit them, name them, and fit them into an established theoretical
framework so that, perhaps, they can acquire a life of their own. I am
fully aware, however, that, in spite of the effort involved in this
attempt to unite these phenomena, I must remember part of Capras
quote at the beginning of the section Autistic states: the model will
therefore not give a complete description of the real situation (Capra,
1975, p. 41).

CHAPTER FIVE

The analysts mind and autistic


transformations*

Introduction
ccording to Chau (2000),

A scientist, in ordinary times, when confronting a fact or a phenomenon not yet studied, employs the existing model or scientific paradigm. A scientific revolution happens when the scientist discovers that
the available paradigms are not able to explain a new phenomenon or
fact. Thus, it is necessary to produce another scientific paradigm,
which does not exist at that moment and the need for which was not
previously recognised by researchers. (p. 257, translated for this
edition)

My work with patients presenting prominent manifestations of the


primitive mind, areas of non-representation, protomental states, and

* This work was presented to a scientific meeting at the Brazilian Psychoanalytic Society
of So Paulo in June 2004, with comments from Joo Carlos Braga. It was also presented
in Los Angeles, November 2005, an occasion at which it received the Frances Tustin
Memorial Prize granted by the Frances Tustin Memorial Trust.

69

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specifically autistic states (Tustin, 1981), has proved to be an effective incentive for reflection.
In our clinical practice, we frequently find ourselves working with
neurotic, psychotic, or autistic patients for whom we cannot always
find representation in our theoreticalclinical apparatus, or in our
personal repertoire, to enable us to identify the phenomenon at hand
so as to approach these patients and finally reach them.
In these situations, a chaotic atmosphere often takes over our
minds. This disorganisation is caused by the reference systems we
employ, which make it difficult to maintain the psychoanalytic vertex.
Protomental phenomena, and autistic phenomena in particular, even
when found in neurotic patients, could cause this kind of disorganisation.
When confronted with these primitive areas of the mind, what can
an analyst rely on to identify, recognise, transform, and give meaning
to communications he cannot always find in his mind to guide
himself, once the fantasies which might underlie such communications are not perceived as having any psychic reality? How can the
analyst embrace or restrain these phenomena and exercise his reverie, keeping his alpha function operative when he faces emotional
experiences for which he cannot find in himself similar experiences to
support it? How to proceed through this universe and penetrate the
autistic hideouts some patients have developed from their own corporeal sensations? And, from this standpoint, how can analysts use their
alpha function?
These questions are not looking for answers, but, rather, are
intended to present some elements to expand this reflection.
In the previous chapters, I examined such phenomena. In Mente
primitiva e pensamento (Primitive mind and thought) (Korbivcher,
1999, p. 29), I draw upon the need for an analyst to differentiate, within
the primitive mind, different levels of the patients mental development so that his communication reaches the level in which the patient
is. In The theory of transformations and autistic states. Autistic transformations: a proposal (Korbivcher, 2005b, pp. 15961600), I suggest
incorporating into Bions theory of transformations (1965) the group of
autistic transformations in which autistic phenomena prevail in the
emotional experience shared between analyst and analysand. Bion, in
Transformations (1965), proposes a theory of observation of the mental
phenomena in the analytical session. He affirms that we have no access

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71

to a phenomenon itself, only to its transformations. The comprehension of the mental phenomenon by the analyst is also considered a
transformation. Bion proposes different groups of transformations:
transformations in rigid movement, projective transformations, transformations in hallucinosis, transformations in K, in K, and in O. My
conjecture is that Bion leaves open the possibility that other groups of
transformations might be included in this theory.
The autistic phenomena (Korbivcher, 2001), as I conceive them, are
characterised by development in an autistic environment, which
implies the absence of notions of internal and external objects, and by
the experience of states dominated by sensations which do not acquire
mental representation. Some of the invariants highlighted in them are
related to the experience of absence of affective life and experience
of affective emptiness in the presence of auto-sensual activities,
observed through the relation with autistic objects and autistic forms.
In this chapter, I deepen the examination, already started in the previous chapter, of the processes that occur in an analysts mind when
subjected to the impact of manifestations of the primitive mindmore
specifically, of autistic transformations. I explore the need to provide a
framework for the autistic universe, a universe dominated by sensations. Therefore, the laws that control this universe are peculiar to it,
different from those of neurotic or psychotic universes. Within this perspective, I explore the possibility that this universe might come to constitute a new paradigm in psychoanalysis. These questions will be
illustrated, in order to widen the discussion, using clinical material
from three patients: Luis and Caio, two autistic children, and Ana, the
same patient presented in Chapter Four, who has autistic nuclei and
functions using the neurotic part of her personality.

Autistic states and the nuclei of the self


According to Bion, in protomental states, the physical and mental
spheres are undifferentiated. In these circumstances, we find
ourselves in an area in which the mind is not yet developed, and in
which predominate untransformed sensorial elements. Often, hidden
behind the neurotic part of a personality, there is a part where encapsulated and impenetrable nuclei of the self prevail. Such nuclei are
resistant to change and preclude emotional contact. These emotional

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states produce phenomena that are similar to autistic defences, the


ultimate aim of which is to protect the primordial self from unbearable states of non-integration (S. Klein, 1981; Tustin, 1986).
Autistic states, as discussed in the previous chapter, are characterised by the presence of a state of emotional withdrawal of the
individual into an auto-generated protective shell. The self retreats
from affective contact with the object, generating around itself this
protective shell within which it becomes sufficient and satisfied
through auto-sensual activities. Through this process, it avoids the
pain coming from the awareness of the corporeal separation from the
object. These manoeuvres protect the individual from experiencing
terror, which would inflict feelings of fragmentation and of unbearable vulnerability (Tustin, 1986, 1990).
In these states, there seems to be no mental apparatus capable of
inscribing and representing bodily impulses in such a way that they
can acquire psychic qualities. The individual finds himself in a world
dominated by sensation. The relations between self and object occur
through sensation-objects, autistic objects and autistic shapes. These
individuals anxiously seek sensations rather than objects. They react
to people according to the sensations they produce in them (Tustin,
1981, 1986, 1990).
Some patients who manifest these states communicate in a nonverbal way, mainly through auto-sensuality.
Lus is a six-year-old autistic child who was referred to me for
analysis. According to his parents, he does not establish any contact
with the external world. His father, a daunting figure owing to his tall
stature, says that his son only reacts when he is licked thoroughly on
the face. He notices that Lus manifests joy and pleasure when he is
licked that way, prolonging his contact with the father for a long time,
until he becomes disturbed by the amount of saliva on his face. Lus
then stops to wipe it off, but quickly returns and waits for his father
to start over again. His parents also say that they notice that Lus is
insensitive to pain. He often hurts himself but does not react. Their
paediatrician has suggested they scrub Luss entire body with a
rough sponge, in order to make his skin thinner and more sensitive.
With time, they then noticed that Lus gradually started to react. They
also mention that Lus urinates into any receptacle he finds at hand,
wherever he is, and then drinks its content. He often eats his own
faeces as well.

THE ANALYSTS MIND AND AUTISTIC TRANSFORMATIONS

73

Lus is a vivid example, almost didactic to an extreme, of the field


of autistic manifestations. Lus builds a protective shell from his
insensitive, thick skin, which safeguards him from the pain of bodily
separation from the object. He demonstrates explicitly a relation of
continuity established through the sensations he obtains from his
fathers tongue and saliva on his face. He shows that he has no need
for external things, nourishing himself with his own excrement.
Other patients, in whom the neurotic part of the personality
prevails and who present autistic nuclei, develop autistic manoeuvres
operating, as I proposed, through autistic transformations (see Korbivcher, 2001). As Braga (personal communication) suggests, it is
necessary, however, to stress that the notion of autistic transformations applies only to neurotic patients who present autistic nuclei, and
not to truly autistic patients. The mental apparatus of neurotic
patients with autistic nuclei oscillates between autistic states and
states with a functioning psyche. Thus, these patients can, to a certain
degree, accomplish transformationseven though they are autistic
transformations. However, patients with encapsulated nuclei, such as
Lus and Caio, a patient I will introduce below, cannot perform transformations.
Verbal language is the most frequent means of communication in
neurotic patients who develop autistic barriers. However, because of
their withdrawal into auto-sensual activities, and because their relationships are dominated by sensations, even their speech might
acquire a sensorial character. Its function then is to provide comfort
and, with that comfort, induce a somewhat cohesive mental state
produced by the sensation caused by the act of speaking.
Fdida (1991) also describes the presence of autistic defences manifesting through speech in neurotic patients. He says,
Autism must not be mistaken for schizophrenic psychosis. Progress
made by autistic children in psychotherapy is characterised mainly by
the discovery of strange similarities between such states and recognised semiologic configurations, especially during the psychoanalytic
treatment of adults considered neurotic. Indeed, it is not rare to document, in the course of a narrative or even of associative speech, the
emergence of truly autistic zones that evoke the image of a hole or an
enclave. . . . Such phenomena may be labeled autistic, even in the
absence of behaviour comparable to that of an autistic child. These
phenomena present, as their main singularity, their isolation from a

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form of speech capable of describing them. They produce only sensorial images. Analysts experience these in a way different from the way
one might react to metaphors. (1991, p. 157, translated for this edition)

This kind of communication, either exclusively non-verbal or


verbal with a sensorial character, causes great impact on the analysts
mind. Like the analysand, the analyst also has his own primitive
mental area of non-representation, an autistic part of the personality, as Tustin (1986) says. Under the strong pressure of these stimuli,
analysts tend to develop manoeuvres that are similar to those of the
analysand. Because the analyst often does not find in his mind representations that enable him to transform that impact into thought, he
reacts with evasion or corporeal reaction.
The analyst, when working in these areas, is constantly challenged
to reflect more broadly about the impact suffered while in contact
with these phenomena during a session, whether he remains in the
situation or evades it. In both situations, the analyst is required to
create some distance, a gap (Rezze, 2003), in relation to that impact
in order to elaborate it and, maybe then, reconstitute his thinking
process.
It is necessary to stress, however, that reactions such as these on
the part of the analyst are not necessarily due to phenomena of projective identifications that have occurred; they arise from the anxiety
entailed in the situation. In these circumstances, an abyss might open
between analyst and patient in such a way that each one of them
remains absorbed inside themselves, in their own universe, with no
connection to each other. In trying to cope with this situation, the
analyst might also get caught up in activities linked to his own body,
mental activities not engaged with the patient, or even become
involved with the pleasure of his own talk, producing long speeches
which clearly meet his own needs rather than those of the patient
(Korbivcher, 2001). Another possibility is that the analyst seeks relief
from the anxiety that these situations cause by invoking theories in
order to cling to a point of reference and, thus, minimise his feeling of
helplessness. The use of such theories in this circumstance often
moves the analyst away from contact with the analysand. Also, it is
observed that theories used in this way are often helpless.
I believe that in experiences such as these, analysts come face to
face with an unknown universe, where they lack any stable guiding

THE ANALYSTS MIND AND AUTISTIC TRANSFORMATIONS

75

references. This might stimulate the development of a privileged


condition for the analysis, requiring the analyst to operate most of the
time with his negative capability, as defined by Keats (Bion, 1970,
p. 125). In this circumstance, the analyst will be led to investigate
freely, without restriction, the material offered by that particular
system of mental functioning. As I see it, this might lead to the
absence of memory and desire (Bion, 1967).

The chaos theory


The chaos theory is a new science of the complexity of nature, created
in the 1970s by physicists, astronomers, and economists. This theory
allows us to see order and pattern where previously it observed only
randomness, irregularity, and chaos. In the words of Douglas Hofstadter, It turns out that an eerie type of chaos can lurk just behind a
faade of orderand yet, deep inside the chaos lurks an even eerier
type of order (cited in Gleick, 1987, jacket notes).
Gleick himself says,
Where chaos begins, classical science stops. For as long as the world
has had physicists inquiring into the laws of nature, it has suffered a
special ignorance about disorder in the atmosphere . . . The irregular
side of nature, the discontinuous and erratic sidethese have been
puzzles to science . . . (1987, p. 3)

This statement of Gleicks shows us the need to be aware not of what


is apparent, but of the hidden, unknown, of what is beyond appearances.
Like biologists, economists, and astronomers in their respective
areas of research, our job as psychoanalysts is to sharpen our tools so
as to keep abreast of the psychic movements present in our consulting rooms. It is not an easy task to find ways to get closer to the
patients I have been describing, and neither is it easy to reach those
mental areas which involve such a degree of primitivism that their
content often cannot be recognised as psychic elements.
We are often forced to face violent storms without having
noticed the flapping of a butterflys wings anywhere, to parody the
classical example and the often cited butterfly effect in reference to

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the chaos theory. In other words, we have no idea where these


storms come from.
Chau writes,
A scientist, or a group of scientists, begins to study a phenomenon
employing theories, methods, and technologies available in his field of
work. Little by little, he finds out that the concepts and procedures do
not explain what he is observing, nor do they lead to the results he is
looking for. According to Bachelard, they come up against an epistemological obstacle. A new scientific conception emerges: it might
incorporate previous knowledge, or it might have to discard that
knowledge. (2000, p. 257, translated for this edition)

Tustin, in experiencing isolation when treating autistic patients


completely withdrawn into their own world, noticed that within the
chaotic universe of their manifestations, these children often clung to
both hard objects and soft objects. She hypothesised that the tactile sensation caused by hard objects was related to a sensorial experience of hardness and of contact with boundaries, and associated
them to the pursuit of experiences of corporeal cohesion. She mentions that the contact with hard objects results in a sensorial experience similar to an armour, giving a feeling of protection against an
unutterable dread. Concerning soft objects, or autistic shapes, as she
called them, Tustin relates them to the sensorial impressions an object
once provided, or to bodily substances which, when touching the
patients skin, promote comforting and calming experiences. She
maintains that these are peculiar, idiosyncratic forms. Based on these
observations, Tustin (1986) proposed that object relations within autistic states are special; they are based on sensations caused by autistic
objects and autistic shapes produced in the individual, and not the
product of fantasies or meanings which they invoke .
Tustin, in my view, seems to have found a pattern, an order,
within an apparent state of chaos, as Hofstadter has suggested in the
quote mentioned above.
Clinical situations entailing the characteristics I have described
above leave us no alternative but to develop a state of mind free from
any previous knowledge and attempt to frame these patients particular universe. We can then immerse ourselves in their universe. Within
such a framework, we might be able to make out, as Hofstadter
proposes, the idiosyncratic organisational patterns of those systems

THE ANALYSTS MIND AND AUTISTIC TRANSFORMATIONS

77

and thus acquire some notion of how such patients see the world. If we
can do this, we might be able to set up some sort of dialogue with their
areas of non-representation within their sensorial universe which
seems chaotic to us.
Gleick (1987, p. 5) goes on to say,
Chaos poses problems that defy accepted ways of working in science.
. . . The first chaos theorists, the scientists who set the discipline in
motion, shared certain sensibilities. They had an eye for patterns,
especially pattern which appeared on different scales at the same time.
They had a taste for randomness and complexity, jagged edges and
sudden leaps.

In addition to Tustin, other post-Kleinian psychoanalytic theorists


such as Bion, Winnicott, Bick, Meltzer, Ogden, Grotstein, Alvarez,
Mitrani, and Houzel, have worked on protomental phenomena, of
autistic manifestations from their work with psychotic patients and
autistic children, as well as observation of infants. In their clinical
work, these analysts came face-to-face with phenomena found in
mental areas where the level of organisation precedes the
schizoidparanoid position (Klein, 1946). This has been an almost
unexplored area within classical psychoanalytic theories. (In Brazil,
analysts such as Haudenschild, Braga, Melega, Guimares Filho, V. R.
Fonseca, Lisondo, and Garcia de Barros have done research on this
subject.)
Just like the early chaos theoreticians, several psychoanalysts have
proved to be attuned to patterns, to have a taste for randomness,
complexity, jagged edges, and sudden leaps: for example, Bick (1986)
and Meltzer (1975a) in their notion of adhesive identification,
Winnicott (1986) with his formulations concerning unthinkable anxieties, Ogden (1989) with his conceptualisation of the autisticcontiguous position, Grotstein (1999) and his ideas about the Black Hole, and,
finally, Tustin. These researchers have dealt with chaos, that is, they
were sensitive to patterns . . . had taste for randomness, complexity,
jagged edges, sudden leaps . . . and, in my view, have entered areas
of chaos, or, as Gleick would say, areas where science stops. With
these formulations, they began to identify patterns and find some
order in those phenomena. Quite probably, they encountered experiences in which the prevailing phenomena could not be explained by
the concepts found in contemporary theories (Chau, 2000). It was

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probably this disposition that motivated their research. These authors


have made valuable contributions and have helped to define working
parameters for investigations, allowing psychoanalysts to come closer
to that unknown universe.
I wonder, however, whether Tustin and the other researchers
mentioned have, in their research and through their novel concepts,
identified a universe containing its own internal organisation. I
wonder if that universe, the autistic universe, might not be controlled
by its own laws, laws which are different from those found in
neuroses and psychoses. I also wonder if these laws might not elude
precepts of classical psychoanalytic theories. Could it be, as Chau
suggests, that there is a new scientific paradigm in the makinga
paradigm that will both incorporate some of the established knowledge and banish other traditional precepts?
In this vein, Green mentions, referring to Tustin, Tustin has
influenced not only those who are interested in problems specific
to autistic states, but also those who also share an intuition that
autism can represent the role of a new paradigm for the study of the
mind.
Fdida also asserts that Autism is not just a model, it actually
occupies the function of a true clinical, theoretical and technical paradigm, similar to what happened to neurosis in psychoanalysis, and
might happen with psychosis (1991, p. 153, translated for this
edition).
Eva and Rezze have also followed this line of thinking and pointed
out that the predominant phenomena in autistic transformations
belong to a particular field, peculiar to this field due to its link with
the sphere of sensuality. (Eva and Rezze cited this in a personal communication during a discussion of the paper The theory of transformations and autistic states. Autistic transformations: a proposal. This
work was presented at a scientific meeting of the Brazilian Psychoanalytic Society of So Paulo in June of 2001.) In this field, the theoretical frames of reference are different from those found in other
groups of transformations. Eva and Rezzes timely comment was
what stimulated me to think about the special nature of autism and to
develop the idea that the autistic universe
might be a universe that contains its own distinctive internal organisation that is controlled by laws peculiar to it, laws that are different

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79

from those pertaining to neuroses and psychoses. And this special


area lies beyond the purview of classical psychoanalytic theory.
(Translated for this edition)

The groups of transformations proposed by Bion, transformations


in rigid movement, projective transformations, transformations in
hallucinosis, in K, K, and in O, given the nature of the phenomena
therein, belong to the field of neurosis and psychosis. This field
comprises the consciousunconscious system, object relations, and
emotions. Bion, from my perspective, points to the possibility of
adding other types of transformations to the theory of transformations. Still, if the autistic phenomenon is to be included in this theory,
we must realise that a different area of phenomena must be posited,
which works with its own laws and in which sensoriality prevails.
Thus, my main query is how to situate autistic phenomena within
Bions frame of reference.
From the analysis of psychotic patients, Bion (1957) distinguishes
the psychotic and non-psychotic parts of the personality. He dedicates
his attention in particular to the investigation of disorders of thinking,
and to the psychotic part of the personality, often moving, as I see it,
to areas close to those of the autistic phenomena.
When Bion introduces his notion of beta elements, of the protomind, he identifies an area adjacent to autistic phenomena. However,
he neither points them out nor does he give them a name. I believe
that beta elements are not exactly the same as autistic phenomena,
since the latter belong to the sensorial sphere and contain no vestiges
whatsoever of psychic processes.
Using Bions way of thinking, we could consider that in autistic
states, beta elements coupled with innate preconceptions, form the
base for the emergence of thought (Bion, 1967). The alpha function
will then transform beta elements into alpha elements, which, in turn,
will enable them to be converted into thought. It might happen that,
for whatever reason, innate preconceptions cannot materialise owing
either to the selfs internal problems or to the objects, or to their relationship. When this happens, it might precipitate what Tustin (1981,
p. 99) calls premature psychological birth. In this circumstance, a
child forced to separate too soon from the object will develop autistic
manoeuvres. The child will form a protective shell around herself,
and within this shell she will try to become self-sufficient through the
use of auto-sensual activities.

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Within the horizontal and vertical axes of the Grid, where shall we
situate the group of autistic phenomena? As Bion suggested, we might
need to provide a new Grid for this sort of phenomena. This would be
a negative Grid (Braga, 2004, personal communication). Or we may
need a Grid for beta elements, or perhaps a gradation of beta elements
(Korbivcher, 1999).
Bion introduces the emotional links L, H, and K to represent the
three basic types of emotional experience susceptible to alpha function. He also proposed the negative links L, H, and K, and he pays
particular attention to exploring the minds activity in K.
Green (1998, p. 658) says, K symbolizes not only ignorance but
a trend to remain actively in ignorance with the adoption of an attitude in which there is advantage of avoiding awareness or a disadvantage of approximating truth. He defines this situation as one in
which the patient wants to actively preserve his ignorance, believing
that there is some advantage in avoiding conscious awareness. For
Bion, these patients have to show that they are superior to their
analysts. If this is the case, it seems that such states entail a notion of
object, which means that K would not belong to the autistic area.
I wonder, however, whether the L, H links would be related to
the autistic sphere, or whether we might conjecture that emotional
links might be imperceptible in the autistic scope, or if such links even
exist.

Case study: Caio


I now present the clinical material of Caio, a four-year-old autistic boy
who has an important developmental lag, mainly in his ability to
speak. I will then delve further into Anas case. I intend to use Caios
material to show how the contact with an autistic mind in an analytic
session can affect the analysts mind. After dealing with this material,
I then present similar phenomena in someone with a developed
mindAna. My work with her will expose readers to what I call
autistic transformations.
Caio was a beautiful, dark, and well-built child, who sometimes
expressed through his eyes sparkle and presence, at other times,
absence and distance. His parents brought him to me because he was
severely delayed in his language development. None the less, they

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81

thought of him as a clever child because he could read words in signs,


which made his parents very proud.
Caio insisted that his mother be near the consulting room. I would
invite her to sit just outside, next to the door. Caio showed some
interest in the toys in his box and would become quite excited with
them. He made unco-ordinated movements with his arms and at the
same time bit his index finger, which bore an enormous callus. Caio
communicated through words uttered one at time, with no connection between them. These words were the names of people and television programmes; he would name them appropriately. He would
call the toys: Rro, minho, lelo, zul. He seemed like a wind-up
doll which, when its string is pulled, starts to perform. When he
came up against any difficulty, he would grab my hands as if I were
part of his own body to make me solve his problem. At other times,
Caio would curl up on the couch like a baby and stare off into the
distance. He would often be totally absorbedeating faeces he pulled
out of his anus, picking his nose and eating the mucus, or eating
pus from a sore on his skin. I understood absolutely nothing about
Caios behaviour or about his mental world. I began my work
with him with no notion about any area in which we might come
together.
Once Caio entered the consulting room, he would open the box of
toys, examine them, name them, and immediately thereafter he would
put a pencil in his mothers hand. Using some of his particular movements and his personal language, Caio would quickly make his
mother understand that she should write the words he would utter on
a piece of paper. He would say, Mame [mummy], papai [daddy],
vov [grandma], beb [baby], bala [sweets], bambalalo [a made-up
word suggesting bouncing], curumim [a folkloric character represented by a young boy], Caio, Clia. His mother would write them
down on a piece of paper taken from her chequebook. When she had
finished, Caio, in an atmosphere of intense excitement, would then
read those words. His mother, it seemed to me, would control her face
so as to show no emotion. She would obey Caios commands automatically. Frequently, Caio would try to grab on to her body, he
would pull her hair, put it in his mouth, but his mother would not
react. She seemed totally frozen. She could decipher Caios sounds
and speak and act for him when he was unable to express something.
For example, he would say bank, toy, and she would pull out the

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car keys and ask, Would you like to buy a toy at the shop near the
bank after we leave?
I felt as though witnessing a universe that was totally alien to me,
but little by little I became attuned to Caios eccentricities. I would
often think of a colour-blind friend of mine with whom I used to play,
asking what colour he saw when he looked at a green object. His
answers would never clarify anything for me, since his frame of reference for colours was different from mine. Often, I would liken my
experience with Caio to my prior dealings with colour-blindness. By
that time I had intuited that the frame of reference organising Caios
universe was totally different from that of other patients.
I had innumerable experiences similar to the one I have described
above: Caio would say words, his mother would write them, and Caio
would read them. Although I was puzzled by that strange game, I
noticed that Caio would refer to proper nouns over and over again in
his lists: Daddy, mummy, uncle X, curumim. These words seemed
like bunches of sounds thrown together to form words devoid of any
meaning and unrelated to any apparent fantasies. They seemed to be
empty signs, signifiers devoid of meaning.
Caios remarkable ability to read words seemed incompatible with
his difficulty in using speech to communicate. Likewise, his inability to
engage in simple activities, as well as his involuntary twitches, similar
to a babys movements, accentuated that discrepancy. Together, these
symptoms made a very unusual picture, especially because we had
discarded any possibility of Caios being neurologically impaired. In
view of Caios peculiar form of communication, which seemed devoid
of symbolic content, I devised the following game: right after his
mother wrote down Caios lists and he read them, I would get a doll
out of his box that would correspond, from my perspective, to that
name. I would then start a dialogue that gave some life to his words. I
would say, Hey, Caio, how are you doing? Uncle X is here, do you
want to play? This game interested and excited him. And that was
how I began to introduce some affective meaning into his utterances.
Each figure began to be associated with some living person and began
to acquire some existence for the two of us. I have my doubts as to
whether these figures actually became symbols for Caio, but, as time
went by, Caios vocabulary grew somewhat and he was able to put
short phrases together. He would pronounce each word one after
another and communicate a little better.

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Case study: Ana


I shall now describe my experience with Ana in a recent session. I had
seen Ana in the waiting room when I called a patient who was coming
for her session before her. Ana was comfortably ensconced and
involved in an activity of her own. When it was time for her session,
I invited her in. She was chewing gum. She came in slowly and
performed a lying down ritual, straightening her skirt and purse and
crossing her legs. The slowness of these movements caught my attention. After a long period of silence and total immobility, she began to
speak in a low tone, as if she were talking to herself, seeming to have
just woken up. I became aware that her deportment bothered me, both
with her body and with her way of speaking, and also when I saw her
immersed in a withdrawal state, lifeless, clinging to her rituals, with
no apparent contact with me.
Ana tells me that she forgot to bring my payment. I suddenly remember
that the previous patient had come in carrying an envelope and perhaps
Anas mention of the payment was somehow related to that. Ana ponders
a bit and says that if I want, she could write the cheque and pay now.
I tell her she should do what is most convenient for her. She sits up and
writes me the cheque. She lies down once more and then begins a long
narrative in the same tone of voice as before. I am tempted to stop her and
bring up the situation that we had just experienced, but, without realising
it, I give up and go along with her, immersed in her narrative.
Ana gives me a detailed account about some sores she has had on her
face for a long while. When they become inflamed, she applies some antiinflammatory and anti-allergic cream, but the sores do not go away. She
tells me that she has been to several doctors and gives detailed accounts
of her experience with each one. Finally, she adds that the last doctor told
her that there is no cure for her sores. She has chronic dermatitis, which
is emotionally induced and caused by stress.
I realise that I am becoming exasperated with all these details in her narration. I remember her last session, during which she spoke for a really long
time about her relationship with the umbrella she had brought with her.
Little by little I feel very sleepy and extremely listless. Because of the
somewhat stereotypical way Ana expresses herself and because of her
withdrawal, I find it all very tedious. During her entire narrative I have to
struggle with my lethargy and the strong impulse to fall asleep.

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Ana ends by saying, If what I have on my skin comes from stress, if it


has to do with emotion, then here is where I should be dealing with it.
She goes on to say, I dont know why Im stressed out because I just came
back from my vacation. And, actually, even on vacation I had these sores.
Maybe its because of my separation, although even before we separated,
I had these sores.
The concrete nature of Anas declaration is so overwhelming that it makes
it hard for me to ask myself what mental content there might be behind
it all.
From within my sedated state, I tell her, in a well-meaning tone, So what
you are saying is, if your sores are emotional, youre the one who needs
to deal with them! Further, I tell her that I am aware of her difficulty in
establishing any link between her inner world, her emotions, and the
sores on her skin. I also let her know that she is asking for my help to
make this connection. I repeat that she has learnt that her stress shows up
on her skin, but she cannot relate it to her inner world.
In a somewhat resentful tone Ana says, Thats the way it is. I dont have
the slightest idea, I dont know how to go forward with this. I note that
when she says she doesnt know how to go forward, I get quite upset,
because neither do I.
Ana withdraws once more and remains silent. She is so still, so lifeless,
that I feel as if I have a corpse on my couch.
Even though I am still somewhat woozy, I am fully conscious of my
discomfort with her withdrawal and with not having anyone to talk to in
my consulting room. All of a sudden I see that I am at a crossroads. I can
either give up and abandon her, or I can seek her out. My drowsiness is
suddenly gone, and I regain my ability to think, and my ability to get
closer to her emotional state.
I tell her that she probably would like me to make the connection that she
cannot make on her own. She would like me to connect her sores to her
mental world. I add that she might just live in a state of fear, of terror. She
might not know what she is afraid of, and she has no name for it. I go on
to say that perhaps she might be very afraid of what we could find in her
inner world if we dig deep, down through the skin.
She quickly answers, in a somewhat more friendly tone, I agree. I know
that my fear is palpable. But I have no idea what Im afraid of. Could it be
life?
I say that she might be right. She is afraid of being a living person, of being
alive. She is afraid of her own emotions.

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85

She withdraws once more. She is perfectly silent, practically immobile.


She chews her gum and fiddles with the cloth of her dress. I wait. A bit
later I ask her what shes thinking about.
She answers, thoughtfully, Im thinking about emotion. But how can I
find out? How can I get to know what I dont know?
I tell her that she seems distressed to find out that the sores on her skin
have something to do with mental pain, but we have not found out what
that pain is about.
I feel I am extremely empathic concerning Anas suffering, but as yet I
have no way to help her. Right after that, somewhat perplexed, I realise
that I had suppressed from my mind the entire beginning of our session.
I recall the scene in which I saw Ana in my waiting room when I called
the patient before her. Ana was there, busy with something, way before it
was time for her appointment. I remember how upset and how queasy I
felt seeing her waiting there, and when, rather than Ana, I had the other
patient come in. At the same time, I am surprised to realise that my mind
had become paralysed and that the whole scenario had momentarily
disappeared, and I had let go my analytic self and got wrapped up in
Anas narrative.
I try to transform this realisation by telling her that I had noticed that she
had come early, that she had found someone else in the waiting room, that
she had waited a long time for her session, and that, as far as I could tell,
the whole affair had made no mark on her, no sign of any emotion.
Beyond this, I add that for some reason she needs to freeze her experiences, her emotion, and her entire being.
She replies that she had let all that go by the wayside because she thought
it was not important, and when she saw me she remembered she had not
paid for that months sessions. I ask her how that came to mind. She
answers, saying that when she opened her appointment book, she saw
that it was the tenth day of the month, and she felt it was not right that
she still had not paid.
The extreme concrete nature of her response makes me give up my
attempt to find some fantasy she might have about the other patient, who
had an envelope in her hand, or about any emotion she might feel about
paying. Still, I mention that I had seen her with someone else in the waiting room, and I ask her about that experience. She replies that I might
have been distressed by her early arrival, that she might be in the way,
and that she should not stay . . .

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At that point, I can see that the emotional climate in the session has
changed. Her emotions had defrosted somewhat and, a bit more trusting,
she begins to talk about her fears.
I let her know more or less what I have seen, and I venture that she probably felt sheltered and protected in my waiting room because she was
near me. I also wonder whether she feared that I would know that and be
uncomfortable with her being there.
She answers emphatically and in a bored voice, For Gods sake, Clia!
Thats too much! I dont think of our relationship in terms like that!
I tell her that she seems afraid to think that I might have become an important person in her life. And this idea makes her feel emotions she cannot
deal with so she works things out in such a way that she avoids these feeling all together.
To my surprise, Ana answers sarcastically. I might be a bit boring, but
you analysts are funny: if the patient arrives on time, he is obsessive. If he
arrives early, he is anxious, or he wants to be there longer. If he gets there
late, its . . . You know that I come here because my daughter sees her therapist at the same time, so I wait for her. Its true that I could wait in her
waiting room, but . . .
In view of Anas response, I feel that I have been cast far away, and this
makes me feel useless. Quickly, however, I understand her reaction as
being the consequence of the previous movement.
I say that she experiences a lot of emotions that she cannot handle, and
that is why she needs to keep me far from her. I go on to say that she needs
to find ways to protect herself from her emotions and to protect herself
from being a living person. I remind her that, just as she had said, she is
afraid of life. She is afraid of acknowledging that we are separate people,
that I see other patients.

Discussion
Both Ana and Caio provoke a strong impact on the analysts mind
because they confront her with phenomena of a primordial nature.
They both develop autistic manoeuvres as a form of protection. However, it is necessary to recognise that Caios and Anas levels of mental
development are quite different. Caio operates on a level typical of
pathological autism. There is no sign of a developmentally operant

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87

mind where transformations might exist. In Ana, a neurotic part of


the personality prevails, even though one can see evidence of pronounced autistic nuclei, which make her, at many moments, operate
with autistic transformations manifested by the autistic part of her
personality.
As I have described, in Caios case, the analyst finds herself in a
universe replete with phenomena that, as far as she can tell, undermine any frame of reference known to her and in which she could
operate. Through successive experiments in her contact with this
patient, the analyst perceives a certain pattern in this communicationan order within the chaos, as Hofstadter would say. Finding
this pattern is possible if analysts discard their prior knowledge of
how communication between people usually takes place. The analyst
must employ his negative capacity (Bion, 1970) and proceed without memory and without desire (Bion, 1967). And, if he can contain
the impact brought on by these states and transform them, he might
be able to set the stage for immersing himself in these patients
universes. In this case, he can become familiar with these mental universes and the laws which govern them.
Using this point of view, the analyst can observe that the words
Caio pronounces have none of their habitual symbolic meaning. They
are mere sounds, probably imitative, and they seem devoid of any
sense or any affective meaning. They are, as the analyst said, only
sounds. They function as sensorial stimuli that provide to the
analysand some comfort because they guarantee him a minimally
cohesive mental state. For Caio, names are sounds in search of a mind
that can turn them into words with psychic content and all their
emotional and symbolic content. Such a mind would transport these
sounds from the protomental sphere into the mental area. The analyst
has been finding her way little by little into his chaotic universe by
using dolls and associating them with the names Caio utters and lists
so as to give these utterances some emotional content. She emphasises
that what guides her in this approach is the quality of the emotional
experience as it occurs. The analysts discovery of Caios inanimate
universe has made her want to get inside it and give life to those
words which, up to now, have been bereft of affect, so as to populate Caios mental universe with living beings.
It is worth repeating that, as said above, the prevailing phenomena
that Caio exhibits do not fit into psychoanalysiss classical frame of

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reference. The patterns evinced in Caio are totally unknown to the


analyst. It seemed to the analyst that Caio had turned himself into an
almost inanimate being and that he needed to build a mental world in
which his concrete language could be transformed into symbolic
language. For that to happen, Caio needed to experience a relationship with another living being, and that is why the analyst made up
the name game.
Ana, from the beginning, presents non-verbal manifestations: for
example, actions such as coming earlier and staying in the office,
ritualistic movements, and the payment issue. Her non-verbal
universe seems to help her to keep tabs on herself. The episode in the
waiting room had a strong impact on the analysts mind. Anas subsequent overly detailed stereotypical speech functions to protect her
from any contact with her mental world. With these patterns of behaviour, she is operating with autistic transformations. The analysts
mind becomes sluggish; however, she can manage to break out of her
lethargy and go on thinking. She goes from transformations in K to
transformations in K. Concerning the content of Anas speech, we can
see that Ana requires explicit help so that the analyst can turn sensorial elements such as sores on her skin into psychic elements. In
other words, she must use her alpha function and turn beta elements
into alpha elements and help her build a mind. The analyst
empathises with Anas pain when she feels she cannot do anything,
and becomes aware of her own difficulty in helping Ana. Drawing
back a little, the analyst perceives that the entire experience they
shared at the beginning of the session had been cast aside. She then
suspects that that episode could tell her something about Anas
mental processes. As the analyst says, For some reason, we dont
know what, she needs to freeze her interactions, her emotion, her
being, and her fantasies. This perception provides an opening for
some investigation. From there, Ana timidly exposes her fears. In this
chain of movements, I suppose that the analysands experiences are
projective transformations, and the analysts are transformations in K.
Concerning Ana, the impossibility of finding a way to enter her
universe elicits psychic states in the analyst which range from despair
to irritation, avoidance tendencies, and even profound lethargy. Ana
uses sensations she obtains from chewing gum, from fiddling with her
earlobe and her dress, and from her speech as the means of protecting
herself from the helplessness she feels in dealing with the analyst, a

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89

living being who is separate from her. In this clinical description, due
to the transformation of the ongoing emotional experience, I believe
one can see autistic transformations both in the patient and in the
analyst.
With this patient, the analyst finds herself confronting a universe
in which autistic transformations predominate. For Ana, the experience of coming early to her session and staying in the waiting room is
apparently turned into an action belonging to the concrete world, with
no perceptible link to any emotion whatsoever. Her inner world
seems inaccessible. What the analyst experiences is lack of emotion,
affective emptiness, isolation, which permeates the field. All this
has a strong impact on her mind, and makes her hypothesise that she
is dealing with autistic transformations. Given these circumstances,
the analyst can do nothing more than ride out the situation, waiting
to find some way of penetrating Anas autistic barrier. These stimuli
exert so much pressure that, at various times, her mind submits to the
analysands movements: During her protracted narrative I am
tempted to interrupt so as to deal with the entire situation we had
experienced up to that point. But, without my realising it, I give up
and go with the flow . . . The analyst mentions that she has bodily
discomfort, lethargy, and is tempted to avoid the situation. At this
point, it seems to me that she is operating predominantly with autistic transformations.
Subject to Anas drawn-out narrative, the analyst shares with her
the experience of all emotions seeming to be frozen, which is how she
protects herself from the vulnerability she feels owing to her
conscious recognition that the analyst is a living being corporeally
separate from her. Beginning with the transformation of the current
emotional experience, the analyst tells Ana that her need to withdraw
might be a protective measure brought on by terror, by fear of life, by
fear of existing, as she herself has acknowledged. The analyst tries
to help Ana make her protective manoeuvres more permeable and to
encourage her to become closer to being alive. One can consider
Anas request to turn sores into emotion as proof of her interest
in becoming someone with a psychic life, in escaping her mental bidimensionality (Meltzer, 1975b). At this point, she begins to use
projective transformations.
The analyst, by operating a splitting in her mind, can break out of
her mental lethargy and rescue her analytic function. Beginning with

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the emotional experience she has described, she can make out the
nature of the phenomena at hand and try to approach Anas mental
world. Ana, perhaps because she no longer feels alone, becomes less
inaccessible. Now her autistic barrier is more permeable, and Ana
starts to function on a different level. She is in a different state and
feels encouraged enough to defrost, or perhaps humanise, her
inner world. She can acquire an existence without feeling vulnerable.
She starts to explore her fears when, for example, she says, I thought
that you might be upset by my coming early . . . I wondered if I might
be in the way and that I shouldnt stay. The relationship between the
analyst and analysand has been altered. Now they experience
phenomena associated with projective identification, projective transformations. But one can also see elements of hallucinosis, transformations in hallucinosis. We come together in a different sphere, that is,
in psychosis rather than in the autistic sphere. Since Anas state of
terror is so intense, she wavers between being more or less alive, as
when the analyst suggests that perhaps she enjoys being there close to
her, which causes Ana to react violently and once again seek refuge in
her autistic state.
I point out once more that in my clinical practice I have adopted
the emotional experience as my working vertex. I also rely on the
development of thought, and the theory of transformations is the
observation method of the phenomena in this field. As far as autistic
transformations are concerned, autistic barriers are erected in this
field to protect the primordial self from states of terror brought on by
the threat of non-integration. In their clinical work, analysts are often
confronted with autistic barriers within which patients withdraw and
satisfy themselves through auto-sensual activities. The analysts task
is, then, to get as close as they can to their patients autistic universe
so as to become living company (Alvarez, 1992) and add some
humanity to these patients inner world. Put another way, the analyst
tries to help these patients go from a protomental to a mental universe
by using his or her alpha function to transform those concrete, sensorial elements into mental elements; alpha elements full of emotional
life and fantasies that become capable of being thought. If we think in
terms of the theory of transformations, we could suppose that the
patient abandons the field of autistic transformations and begins to
operate using projective transformations, or transformations in hallucinosis, in K, K, and in O. One must also keep in mind that one often

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91

finds that autistic barriers can become more permeable, or more


impermeable. As soon as the patient ventures out of his withdrawn
state and exposes himself, he immediately generates another protective barrier and withdraws once again. They can constantly waver
between states of existence and non-existence.
Considering that the autistic universe is a peculiar universe, I
wonder whether we should develop specific instruments that might
be compatible with this type of manifestation so as to deal with autistic phenomena in our clinical practice. That is, I wonder whether we
should start by actively (Alvarez, 1992) trying to help patients
emerge from their autistic refuge and then try to help them turn sensations into emotions while favouring their development of alpha function and their ability to think. In both Caios and Anas cases, the
analyst had to be more active in the sessions. In dealing with Caio,
she introduced the name game with the intention of conferring on
those sounds some life, so that, with this patient, she could help him
build a mind. In Anas case, once the analyst realised that both she
and the patient had suppressed the episode at the beginning of the
session, she also adopted an active and direct attitude. With this
patient, the analyst tried to explore what she had experienced at that
moment. The analysts intent was to establish the emotional connections that, up to that point, had been missing.
I end this chapter by going back to Gleick and his position on
chaos, in which he says, Ever since physicists have inquired into the
laws of nature, they had not begun to explore irregular side of nature,
the erratic and discontinuous side that has always puzzled scientists.
This thought reflects my state of mind as I finish a text that has
opened for me a limitless area of investigation in which I dared to
venture into the functioning of the primordial mind.

CHAPTER SIX

Bion and Tustin: the autistic


phenomena and Bions referential*1

Introduction

orin (1990) states that

The complexity of the orderdisorderorganisation relationship arises


when it is empirically proved that disordered phenomena are necessary in certain conditions, in certain cases, for the production of organised phenomena that contribute to the increase of order. (p. 91,
translated for this edition)

Analytic experience with patients who operate in areas where


autistic phenomena prevail is a constant challenge for me, owing to
the enormous complexity encompassed by these phenomena. The
dissonance which is created between the functioning of the analysts
and the patients minds is largely responsible for this challenge.
* This chapter was presented to a scientific meeting of the Brazilian Psychoanalytic
Society of So Paulo in June 2005 as well as at the 23rd Brazilian Psychoanalytic
Congress in Porto Alegre, where it was awarded the Durval Marcondes Prize for work
by a training analyst. The version presented here is an expanded version, which was
published in the International Journal of Psychoanalysis (2013, pp. 645665).

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These are ordinary patients who experience the separation


between self and object so abruptly that they need to develop extraordinary protective manoeuvres (Mitrani, 2001). According to Frances
Tustin, the manner in which the individual deals with the awareness
of bodily separation between self and object is the core of human existence and, in her opinion, the experience of bodily and psychic separation is what will determine the development of an entire
personality. Tustin mentions that from birth, there are fluctuating
conditions of awareness of the separation between self and object.
Such conditions are the basis for mental fitness throughout life
(Tustin, 1986, 1992).
The uniqueness of each particular psychic organisation may be
found in this area. If we create a scale of these modes of organisation,
we shall find at one end thought, knowledge, and areas of symbolisation. At the other end, there will be a range of possibilities of mental
functioning, entailing areas of projective identification and hallucinosis as well as autistic areas.
In the previous chapters (Korbivcher, 1999, 2001, 2005a), I focused
on the examination of autistic phenomena, particularly the autistic
manifestations found in neurotic patients (Tustin, 1986, 1992). In
these chapters, in order to obtain some guidelines within this apparently chaotic universe, I tried to develop a metapsychological reflection with regard to the parameters that delimit the area of autistic
phenomena.
After discussing with several colleagues the ideas I have developed, their contributions enabled me to outline some points more
clearly, encouraging me to go on with my research. In 2001, I began
to reconcile Bions frame of reference with my understanding of the
autistic universe (see Chapter Four of this book, in which I propose
that autistic phenomena might constitute a different group of transformations to those proposed by Bion: the autistic transformations in
which autistic phenomena prevail. These transformations characteristically develop in an autistic medium, which implies the absence of
any notion of either internal or external objects. The relationships
between me and not-me are dominated by sensations. The relation is established through sensorial objectsautistic objects and
autistic shapeswhich have no mental representation. Some of its
invariants are associated with the absence of affective life, the experience of affective emptiness, and the presence of auto-sensual

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95

activities.) Among the types of transformations highlighted by Bion,


I suggested the inclusion of autistic transformations, in other words,
transformations in which autistic phenomena prevail. I continued
with this subject in 2005 (Korbivcher, 2005a), attempting to define the
area that comprises the autistic universe and pointing out that this
area might become a separate universe which is organised by specific
laws different from those of the neurotic or psychotic universes. As
we know, the autistic universe is dominated by sensations that might
not acquire mental representation. An absence of emotions prevails
and the notion of object, if it exists at all, is not accessible.
The purpose of this chapter is to continue my attempt to move the
area of autistic phenomena into Bions frame of reference. I begin by
relating the phenomena contained in the autistic transformations to
certain concepts used by Bion, for example, emotional links and beta
elements, present in Transformations (1965), as well as to the Grid. My
intention is to examine the possibility of introducing in Bions referential the area dominated by sensations and to check the coherence of
the autistic transformation proposal with the entire theory of transformations.
With that in mind, I raise the following questions. How would the
L, H, and K emotional links and their negatives operate in the autistic
area? More specifically, what would be the connection between autistic phenomena and the K (minus knowledge) area? In which of the
dimensions of the mind are autistic transformations located?
I question further: how are autistic phenomena and the beta
elements related, and where could we locate them on the Grid?
It is important to take into account that the attempt to insert the
autistic universe into Bions frame of reference could cause a major
disorganisation in that system. This disorganisation is due to the fact
that in his theories, Bion predominantly explores the development of
the mind and the area of emotions, whereas the autistic universe,
being a sense-dominated universe, does not present a constituted
mind and, therefore, one has no access to any emotions. Clinical practice has shown that the manifestations of the autistic phenomena are
more frequent than we suppose in neurotic patients. The question
then remains: how should these phenomena be considered within
Bions frame of reference?
Perhaps Morin (1990), with the ideas he developed concerning
complex thought, could be of help. He ponders what complexity is:

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What is complexity? At first sight, complexity is a fabric (complexus:


that which is woven together) of heterogeneous, inseparably associated constituents: it raises the paradox of the one and the multiple.
When closely examined, complexity is, in fact, the fabric of events,
actions, interactions, feedback, determinations, uncertainties, which
constitutes our phenomenal world. But then, complexity appears with
the disquieting features of confusion, inextricability, disorder, ambiguity, uncertainty . . . Hence, the need for knowledge, to bring the
phenomena in order by repressing the disorder, to depart the uncertain, that is to say, to choose the elements of order and certainty, to
disambiguiate, clarify, distinguish, prioritise . . . But such operations,
necessary for intelligibility, may cause blindness if it eliminates the
other characters of the complexus; and indeed, as I said, they have
blinded us. (p. 21, translated for this edition)

In this passage, in referring to complex thought, Morin


expresses the need to include in our field of work all kinds of phenomena that are part of it. According to him, psychoanalysis is a
complexus, in other words, a field made up of . . . heterogeneous,
inseparably associated constituents. I understand, therefore, that
those phenomena that apparently cause confusion, disorder, ambiguity, and uncertainty should be included in our field of work. If these
phenomena are excluded, we will mistakenly leave aside important
elements and, through this, inadequately identify the phenomena
present in the analytical session, possibly confusing them with others
of a different quality.
It must be emphasised that the inclusion of autistic phenomena in
Bions referential will produce a complex universe full of incongruence, restlessness, and ambiguity. However, in spite of this, I am
convinced that it is important to continue this attempt because these
phenomena are part of the complexusthat is, a part of the field of
phenomena through which the mind expresses itself.

Bion and Tustin


Bion studied the development of thinking and its disturbances. He
differentiates the psychotic from the non-psychotic part of the personality (Bion, 1957), with emphasis on the psychotic aspect. In his clinical work, he examines in detail the phenomena that interfere with the
capacity to think. Bions main focus of interest is the subject of thinking and non-thinking, or, in other words, knowing and not knowing.

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He expands his ideas in Transformations (1965) towards what he called


O (being). He explores the area in which negative links predominate,
particularly K. Bion confirms that, in these conditions, emotions
caused by envy and rivalry are important factors which actively affect
the process of knowing.
Bions theory deals with the development of the mind and with
emotions and links that bring them together. Bion starts off with beta
elements, sensorial elements that did not undergo transformation
through the action of the alpha function at the psychic level. He examines the processes involved in the genesis of thought, beginning with
beta elements and going on to stages in which abstract thought occurs.
Learning through emotional experience shared between the analytic
pair is the means by which thought can be developed and the theory
of transformations (Bion, 1965) is the method used to observe the
phenomena in the session.
Frances Tustin underwent analysis with Bion for fourteen years.
She comments that throughout her analysis, she became aware of
encapsulated nuclei that protected her from deep depression, and it
was then that she was able to come closer to the terrors of the black
hole, experience them, and penetrate the autistic capsule which
protected her (audio recording, Squiggle Foundation, 1986).
Her interest in, and her important contribution to, the research of
phenomena in the primitive mind, in the autistic area, have proved to
be extremely valuable for the clinical work with patients; not only
autistic patients, but also neurotic patients who present autistic nuclei.
Tustin (1986) proposes that some patients, despite operating predominantly with the neurotic part of the personality, present impenetrable autistic nuclei, making contact inaccessible. She mentions that
if these nuclei are not approached, the process of analysis might be
delayed to a certain extent. Paraphrasing Bion with regard to his claim
concerning the psychotic and non-psychotic parts of the personality, Tustin suggests that these patients are operating with the autistic part of their personality. (I must point out that in the autistic
realm, according to Tustin (1981, 1986), the relationship between me
and not-me comes about through the use of sensation objects, in
other words, autistic objects and autistic shapes. They are relationships that are established through sensations brought on by contact
rather than by fantasy or an affective meaningful relationship between
the self and the object, as is the case among neurotics and psychotics.

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Through contact, individuals can achieve a feeling of corporeal continuity with the object, and this allows them to attain a minimally
cohesive psychic state. Their awareness of the corporeal separation
between self and object oscillates according to a particular individuals ability to tolerate the pain entailed in separation).
In a different way to Bion, Tustin engages in an area in which
sensations prevail, the autistic area. In this area, sensations are not
mentalised and do not achieve mental representation. Individuals
wrapped in autistic states recoil inside a protective shell, where they
remain absorbed in auto-sensual activities through which they
become self-sufficient. Through that, they protect themselves from
unbearable experiences of non-integration and states of great vulnerability. If these areas are expressed in clinical work, I wonder how it
would be possible to consider them in our clinical practice in order to,
in Morins words, prevent analysts from becoming blind to some
features of the complexus they are analysing.

Autistic transformations and emotional links


In his work, Bion abandons the central ideaobject relationsthat
until then was the main approach in psychoanalysis and begins to
focus on working with emotional links which connect the objects,
according to him (Bianchedi, 1997).
According to Bion (1962a), emotional links permeate any relationship. Bion points out the importance of distinguishing the different
qualities of the links between self and object. These links represent the
three fundamental types of emotional experiences to which the alpha
function can be applied: love, hate, and knowledge, L, H, and K
(Meltzer, 1978). Bion introduces the idea that these links can become
negative, L, H and K, that is, that there can be manifestations of
attack from the self against the links which unite the objects,
expressed through violence and hate. In this sense, Bions central idea
is that it is not the objects that are attacked, but what links them to
each other (Bianchedi, 1997).
Within this perspective, I wonder how the emotional links and
their negatives operate in the autistic area.
If we agree that there is no notion of object in the autistic area or,
if there is, it is inaccessible, how can we think of positive or negative

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links joining objects? I wonder whether that would be an area in


which the absence of links prevails: an area of non-links.
I understand that autistic transformations and autistic phenomena
contained therein, owing to their characteristics, could be considered
as belonging to the domain of K, non-knowledge (Braga, 2004,
personal communication; Rezze, 2004), or as a kind of expression of
transformations in hallucinosis (Braga, 2004, personal communication). In my opinion, this approach to autistic transformations merits
discussion.
The patients who function in K actively want to remain oblivious
and believe it is advantageous in avoiding awareness.
The most important characteristic is its hatred of any new development in the personality as if the new development were a rival to be
destroyed. The emergence therefore of any tendency to search for the
truth, to establish contact with reality and in short to be scientific in
no matter how rudimentary a fashion is met by destructive attacks on
the tendency and the reassertion of the moral superiority. This
implies an assertion of what in sophisticated terms would be called a
moral law and a moral system superior to scientific law and a scientific system. (Bion, 1962b, p. 98)

Bion (1962b) maintains that


In K the breast is felt enviously to remove the good or valuable
element in the fear of dying and forces the worthless residue back into
the infant. The infant who started with a fear he was dying ends up
by containing a nameless dread. . . . The violence of the emotion that
is associated with Envy, can be one of the personality factors in K, is
in evidence, affects the projective processes so that far more than the
fear of dying is projected. Indeed it is as if virtually the whole personality was evacuated by the infant. (pp. 9697)

My understanding of this explanation of Bions is that K phenomena, for him, imply the functioning of a mind capable of splitting and
of projection. There is also the expression of violent emotions and the
presence of a breast into which the feelings awakened by envy are
projected. It is important to explain further that Bion uses the notion
of envy as Klein (1980) applies it in Envy and gratitude, which is
that the notion of object exists from the beginning of life and that this
object is a target of envy. Thus, we can presume that the phenomena

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belonging to the K area, as conceived by Bion, are full of emotions


and that the notion of object is present.

Autistic transformations: a transition


between existing and not existing
Barros (2004, personal communication) offers an important contribution with her insight into autistic phenomena. She mentions that the
state of non-existence of the patient wrapped in autistic nuclei stimulates analysts to obliterate their own existence in the session. She adds
that the difficulty of the analyst with these patients is to be able to
tolerate their non-existence. According to Barros, it is necessary for
the analyst to put up with their own condition of non-existence.
This comment led me to consider the possibility that autistic
phenomena are related to the dimension of non-existence in the mind.
For that matter, Tustin, in her paper To be or not to be (Chapter
Two in Tustin, 1990, pp. 3360), mentions that autistic phenomena are
intimately linked to a lack of awareness of mental existence. For her,
their consciousness of being happens only at the sensorial and
physical levels. They seem half dead, trapped, as they are, in a limbo
of to be and not to be.
Tustin maintains that
When autistic children are studied in the psychotherapeutic situation,
we find that they are in a state of limbo, teetering between being and
not being. This paper seeks to study how their early sense of goingon-being as Winnicott so well called it, has been put in jeopardy . . .
(1990, p. 33)

She also says (p. 39),


The feeling of being outside the body seemed to be an elemental panic
reaction to the frightening awareness of bodily separateness from the
mother, which threatened him with a psychical loss of being. By this
means an unbearably frightening situation was avoided. It seems
possible that, in situations of acute bodily terror, the psychic sense of
being can be protected by seeming to be separated from the physical
body. This preserves the sense of being and guards against the dread
of not-being.

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In this paper, Tustin also proposes that the loss of the sense of existence is much worse than the threat of death. In death there is a feeling that the body remains. In the loss of the sense of existence, nothing
remains. The threat of annihilation is the worst threat of all because it
represents the extinction of the psychic sense of existing.
The autistic mind will then provide, through auto-sensual manoeuvres, protection against the terror arising from the threat of not
being. It is, in fact, through these auto-generated bodily sensations
that the autistic individual ensures some feeling of existence and, at
the same time, guards against the experience of terror with which the
non-existence threatens him.
At several moments in his work, Bion deals with the phenomena
of non-existence. He differentiates no-thing from nothing. According to him (1970, pp. 1920),
The emotion aroused by the no-thing is felt as indistinguishable from
the nothing. The emotion is replaced by a no-emotion. . . . Nonexistence immediately becomes an object that is immensely hostile
and filled with murderous envy towards the quality or function of
existence, wherever it is to be found.

In Cogitations (1992, p. 134), Bion also discusses this issue. He states


that when a child hates or is angry, she wishes the object to be dead
and, consequently, the object becomes non-existent. He says that the
characteristics of these objects are different from those of live, real, and
existing objects. For Bion, the child submitted to mental pain remains
surrounded by dead objects, destroyed by her hate. The fact that the
person cannot tolerate mental pain makes the objects non-existent.
He elaborates (1992, p. 134): The dead, non-existent objects are
products of murderous hate; guilt invests them with attributes akin to
those associated with consciousness, omnipotence, omniscience, but
not the qualities necessary for employment in dream-thoughts.
In defining the characteristics of the phenomena found in the nonexistence sphere, Bion considers that these are full of emotional
expressions. A range of feelings with negative qualities is observed
in these phenomena as, for example, feelings of hate linked to nonexistent objects. I think that the characteristics of the autistic phenomena found in autistic transformations are of a different nature from
the ones mentioned before. In them, the emotions, if any, cannot be

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perceived, and there is also no indication of the notion of the existence


of an object to be attacked. There is, however, evidence of an encapsulated state in which the individual remains immersed in autosensual manoeuvres with which he satisfies himself. I presume that
the autistic phenomena contained in autistic transformations are
located in a developmental area apparently prior to the one considered by Bion with regard to the phenomena of non-existence.
As we can see, to exist and to not exist are different from to
know and to not know. However, the question remains as
to whether the awareness of to exist and of to not exist would precede to know and to not know, and whether the urge for knowledge and its opposite would demand a previous, minimally constituted awareness of the existence of a being. Should we presume that
the constitution of the individual would imply a continuous transition
between to exist and to know?
Summarising the thoughts developed so far, with the proposal to
incorporate autistic transformations to the theory of transformations,
as already mentioned, a new area of phenomena is being introduced:
an area dominated by sensations, in which mental representation is
inaccessible and the relations through sensation objects prevail (Tustin, 1986). The dimension of the mind to which these phenomena
belong is linked to the sphere of being and not being. In this area,
the phenomena of non-existence are expressed through auto-sensual
activities, which apparently do not acquire mental representation. I
dismiss, therefore, the idea that autistic phenomena are related to the
non-knowledge area (K).
However, it is necessary to point out that, when considering autistic transformations, one is dealing with mental configurations containing autistic characteristics and not with autism as pathology. In the
same way that Bion highlights the phenomenon of hallucinosis constituting the transformations in hallucinosis and differentiates hallucinosis from hallucination, in my proposal of autistic transformations,
the autistic phenomenon contained in these transformations is different from autistic phenomena characteristic of autism as pathology
(Korbivcher, 2001).
We should also note that the proposal to incorporate the autistic
universe into the theory of transformations by adding autistic transformations expands the observation of mental phenomena beyond
that of classical psychoanalysis.

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Autistic phenomena and beta elements


Green (1998, p. 651) said that both Bion and Freud suspected there
was something primitive in the mind that was not entirely explained
by the first stages of the object relations in a babys development.
Green mentions that Bion considers the beta elementthe elements
which do not undergo transformation at the psychic levelas the
minds most primitive component.
Based on this idea, I believe we can propose that autistic phenomena lie in an area quite close to that of beta elements. The characteristics of both autistic transformations and beta elements are fairly
similar, but I admit that there might be a difference in quality between
the two. I do not intend to explore in depth the concept of beta
elements. I develop some assumptions with regard to my understanding of the difference between them, each of these concepts
restricted to the scope proposed herein.
As defined by Bion, beta elements are sensorial elements that did
not undergo transformation at the psychic level through alpha function and, therefore, are not likely to be used for thought (Bion,
1962a). They are sensorial stimuli that have not been digested and are
discharged and expelled with the intention of freeing the mental
apparatus from the accumulation of tension. With her capability for
reverie, the mother, gathering and containing these beta elements in
her mind and exercising the alpha function, will attempt to transform
them into psychic elements, making them available for the baby for
the development of thought. When this does not happen, a barrier of
beta elements is formedthe Beta Screen. The contact barrier is
destroyed by the inversion of the alpha function, so that the elements
that make up the contact barrier disperse and become alpha elements,
incremented by remains of the ego and the superego. These might
become bizarre objects, which need to be evacuated or projected.
In contrast, autistic phenomena are characterised by their static
nature because they belong to the inanimate world. They are mainly
characterised by their protective function, which counters the pain
entailed in facing the threat of psychic non-existence. Through autosensual activities, autistic phenomena are used to cover up the
absence of the object, thus preventing the awareness of bodily separation from the object. These phenomena do not seem to acquire
mental representation and, unlike bizarre objects, they do not

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present any vestige of psychic life. We can suppose that autistic


phenomena, when grouped together, produce a protective barrier,
the autistic barrier, similar to alpha and beta elements which, when
grouped with one another, give rise to the contact barrier and the Beta
Screen. Individuals use this autistic barrier for protection and, based
on their auto-sensual activities, they generate their own object, an
object with autistic characteristics (Tustin, 1984, 1986). Autistic
phenomena differ from beta elements in that they do not have a
discharge or relief function, but, as already mentioned, they exist to
provide protection.
The analysts function, when facing a patients autistic barrier, is to
attempt to penetrate his inanimate world in the form of a live and
active element and provide psychic life for those autistic states. For this
to happen, the autistic barrier must have some vulnerable points in
order to allow the analysts communication to reach the patient. In
other words, there should be a transition, an oscillation between autistic states and states in which the mind operates in a more developed
way. As a result, it might make sense to the patient when the analyst
tells him that his autistic isolation is the result of a state of terror
brought on by becoming aware of his bodily separation from the
object. In finding himself outside the autistic barrier, the patient can
perhaps feel accompanied by the analyst, which will mitigate his experience of being threatened. This experience will eventually make the
autistic barrier more permeable, allowing the patient to transit through
mental areas without feeling so vulnerable and terrified. Thus, the
mental phenomena previously locked behind the autistic barrier,
whether they are beta or alpha elements, will become more accessible.
Beta elements is a concept used by Bion to represent a wide range
of phenomena related to different levels of mental development. Both
in transformations in hallucinosis and in projective transformations,
beta elements prevail. As previously mentioned, it is important for the
analyst to identify the nature of the phenomenon he confronts because
there is a specific clinical approach for each of these phenomena. I
have suggested establishing a gradient of beta elements so as to
recognise the different nuances of these manifestations more easily. In
2004, I even proposed the importance of devising a Grid for beta
elements.
Within this scope, I continue to attempt to differentiate beta
elements from autistic phenomena.

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Autistic phenomena, tropisms, and the Grid


Mion (2003) quoting Bion in Cogitations, suggests that the area of
psychic tropisms represents the area in which the matrix of the mind
is constituted. (Mion says that when Bion spoke of the matrix in which
all mental life comes to be, referring to tropisms, he asserted that they
not only need to be rescued from vacuity, but they must be communicated as well. He also mentions that beyond the search for an object
to murder, or by whom to be murdered (before or along with that
object), or of whom to be either a parasite or a host, one also seeks an
object to create or seeks to be created by an object. Mion suggests that
in the absence of such objects, we could find autismin other words,
the rejection of all objects and of ones own psyche.) She associates
autistic manifestations with the reactions of the individual in the
absence of an object that rescues and transforms tropisms with autistic manifestations.
Beltrame (2004, personal communication) also relates autistic
phenomena to the notions of tropisms presented by Bion in Cogitations. (Beltrame, in a personal communication in 2004, said that Bion
mentions the basic tropisms: to be killed or to die, to be a parasite or
a host, to be created or to create. He wonders whether autistic transformations might not be a consequence of an overwhelming fear of an
individual to live out a tropism and, thus, try to lodge himself as a
parasite in order not to be killed and/or not kill someone.)
The meaning of the word tropism, found in The Heritage Illustrated
Dictionary of the English Language (1973) is The turning or bending
movement of an organism or a part toward or away from an external
stimulus such as light, heat or gravity.
In Cogitations (1992, p. 34), Bion argues that
Tropisms are the matrix from which all mental life springs. For maturation to be possible, they need to be won from the void and communicated. Just as a breast, or its equivalent, is necessary for the infant
life to be sustained. The vehicle of communication the infants cry,
tactile and visual senses is engaged in order not only to communicate but also to control the tropism. If all goes well the communication, by projective identification, leads (as Melanie Klein has
described) to the deposition in the breast of the tropisms that the
infant can neither control, modify, nor develop, but which can be so
controlled and developed after they have been modified by the object.

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If this breaks down, then the vehicle of communication, the contact


with reality, the links of every kind of which I have spoken, suffer a
significant fate. This applies particularly to the communicating particles that are felt to lie with their enclosed tropisms, rejected by psyche
and object alike. . . . the tropism . . . is enclosed within the vehicle of
communication itself, be that sound, sight, or touch.

Bions contribution to tropisms has led me to think that he might


be pointing to the existence of an area of primordial phenomena prior
to the beta elements, an area in which there are only movements of
approximation and withdrawal of the organism towards the source
of a stimulus. It is an area in which a state expects that an object will
modify the tropism. According to Bion, this area constitutes a matrix
from which all mental life springs and from which personality is
organised. Thus, it is supposed that when individuals are born, or
even before that, they bring with them the willingness to seek an
object. I wonder whether this tendency corresponds to the idea of a
preconceived breast, but at a stage of biological development prior to
the appearance of psychic life.
According to Bion, a person who operates using tropisms needs to
find an object that will turn these tropisms into psychic elements. We
know that plants need light to grow. We can see that their leaves
move naturally towards the light. When deprived of it, they often fail
to develop and might even die. I wonder whether we might draw an
analogy between autistic states and plants that can find no light.
Bion (1992, p. 34) affirms that for those individuals who fail to find
a breast on which to project their tropisms, the result is disaster
which ultimately takes the form of loss of contact with reality, apathy,
or mania.
This consequence, in my opinion, might be related to what Tustin
(1981, 1992) has called premature psychological birth. This is a situation in which an especially sensitive child is forced to a precocious
separation from its object, which will make her pseudo-independent.
Using autistic manoeuvres, such a child will try to protect herself from
the threat of having no psychic existence by developing a protective
shell (Tustin, 1986, 1990), or a second skin (Bick, 1986). We could,
therefore, wonder whether this apathy and this loss of contact with
reality that Bion refers to would not be manifestations of a state in
which an autistic barrier was developed because the infant had no
object on which to project its tropisms.

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Still in the realm of tropisms, Bion, in Transformations (1965), proposes that the properties of what he calls conscience, as well as the
beta element, belong to the nature of a tropism which has been transported into the field of mental phenomena. He says,
This consciousness is an awareness of a lack of existence that demands
an existence, a thought in search of a meaning, a definitory hypothesis in search of a realization approximating to it, a psyche seeking for
a physical habitation to give it existence, container seeking contained.
(1965, p. 109)

Meltzer (1975b, p. 300) also deals with tropisms. He says that


It was at that time that we began to think about dimensionality and of
the autistic phenomena proper as a kind of mindlessness in which
there was only a sort of tropisms relationship, with direction. For
instance, a child would come in and run right up to the window and
suck on the latch or run between two doors, one door which he
smelled and the other door which he licked.

At this point, I question: where can we fit the autistic area on the
Grid (Bion, 1963)? Where can we locate autistic phenomena?
When one ponders this matter, one must face right from the start
the following contradiction: if the theory of transformations and the
Grid are instruments to examine mental functioning and the genesis
of thought, how can we include in them phenomena in which the
psychic dimension is either not accessible or is, even, non-existent?
How can this theory accommodate the area dominated by sensation,
the area located on the border between the minds early stages and a
non-mental area? Furthermore, where can we fit the autistic area?
As a mental exercise, I suggest we insert a space on the Grid just
before Line A (beta elements). This would be the area for tropisms,
autistic phenomena, and corporeal manifestations. This space would
be located on line A0, which would come immediately before Line A
(beta elements). It is necessary to explain that, by making use of the
A0, I am referring to the line just before line A. I added the zero just
to indicate that this line comes before line A. The 0 (zero) bears no
relation to what Bion proposed concerning the notion of O.
In the event that tropisms cannot find an object capable of harbouring them and modifying them, we would, consequently, end up with

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what I propose we call autistic elements. If tropisms find an object


that can modify them, they would produce beta elements (Line A) and
even alpha elements.
I understand that my proposal to include in the Grid line A0 for
tropisms allows the autistic area itself to be present. From my point of
view the tropism area would be located on the border between what
we call the primordial mental states and the non-mental states. As I
have said, tropisms are accompanied by an expectation that an object
will modify them and make them evolve into elements with psychic
qualities. I wonder whether such an expectation might be considered
a manifestation of the primordial states of the mind. As we know,
autistic elements arise whenever an object that can modify tropisms
cannot be found. In these cases, tropisms continue to be encased in the
vehicle of communication, be this vehicle sound, vision, or touch.
To continue with this exercise, as defined in my hypothesis, autistic phenomena would only be represented on Line A01 of the vertical
axis of the Grid and, I believe, in no other column. The use of tropisms
would be represented on Lines A01 and A06. Neither tropism nor
autistic phenomena would appear in any other column.

Case study: Paulo


I will now present the clinical material of Paulo, a four-year-old child.
This material illustrates many of the questions brought up during the
work, which will help us start the discussion. Paulo is a fraternal twin.
His mother came to see me at the request of his school. Paulos teachers found him very slow in his activities, and complained that he did
not obey orders and only did what he wanted to do. In addition to
that, his mother was worried because Paulo and his brother had been
neglected from an early age, owing to their parents separation and
because she worked during most of the day. She also mentioned that
they were very close to one another and extremely similar.
First of all, I shall relate some situations that occurred during the
first few months of analysis, which seemed significant to me, and then
some parts of the sessions.
Paulo is a small child. At first, he appeared to be lively and talkative.
When we met for the first time, he immediately said to me, But my
brother didnt come!

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Then, after exploring the toys in the box and going back and forth to the
waiting room where his mother was sitting, he picked up a piece of paper
and a pair of scissors, made two cuts and said, Its hurt.
He pointed to his abdomen and said, Im hurt here. His words made me
think that he wanted me to know that he felt a pain, that he was hurt by
something, so I said that to him.

This manifestation was followed in the next few sessions by


communications that contained intensely violent characteristics. He
very insistently stuck the tip of the scissors into a toy car until he
finally broke it. He did this with great interest. After experiences like
this one, he was often very anxious and tried to put the pieces together
again, tying them tightly together with a string, or fastening them
with tape. With time, Paulo replaced this game with situations in
which he seemed very distant and completely withdrawn. He would
either lie on the couch or go to a corner of the room. There he would
carry on an endless conversation in a low tone, as if he were speaking
to himself. Whenever I tried to get close to him, Paulo would push me
away forcefully, as if I were bothering him. He came to the sessions
with his mother, or, more often, with his nannyhis auntie, as he
and his brother, who always accompanied him, called her. Even
though Paulo and his brother are fraternal twins, they are, in fact,
identical. They were usually similarly dressed, one as Superman,
the other as Batman. Both had dummies tied to a nappy in their
mouths. It seemed as if they were joined by a kind of cord.
When I went to the waiting room to call Paulo for his sessions, I
could not recognise him because I could not tell him from his brother.
I waited to see who answered and came towards me. Just like Paulo,
I was very confused with this situation of not being able to tell Paulo
from his brother.

A session
This is the first session of the week. In the previous session, Paulos
mother had warned me that he would stop coming to analysis in a few
weeks because they were about to move to another city. There are
some points worth mentioning in this session.
Paulo does not want to leave his mother to go to the consulting room. She
comes with him and sits near the door. Paulo throws himself on to her lap,

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but falls on to her legs, giving the impression that he cannot stand up. He
gets up and falls several times in succession, as if his body were falling
apart. He repeats this activity insistently, until he gets some support and
manages to stand up. This behaviour attracts my attention and shows me
how fragile Paulo is.
Then, once on his feet, he hangs on to the door handle and pretends to
open and close the door. These movements turn into a tactile exploration
of the texture of the surface of the door and the wall.
He questions whether the door is rough or smooth and does the same
with the wall. This manifestation impresses me because of its primordial
nature. For a moment I have no guiding references, since I do not perceive
any fantasy associated with these activities.
I ask him whether he likes smoothness. He says yes.
I ask whether he likes roughness, he says no.
I tell him that smoothness is related to a situation he likes and roughness
to a situation he does not likein other words, to situations which are
good or bad. I go on, saying that perhaps the bad experience is linked to
the interruption of our work and the good one to the fact that the three of
us are there together.
Paulo becomes enthusiastic as a result of the conversation and goes on
with his exploration of the surfaces in the room and ends up rubbing his
own skin. At the end of the session, after having explored and named the
different parts of his body, he asks his mother what skin is and what it is
good for.

In the session I describe next, Paulo is in the waiting room with his
brother and nanny. I am again unable to tell him from his brother.
Both are excited and have dummies tied to nappies. They are sitting
on the floor with several toys scattered around, including a doll. As
soon as they see me, Paulos brother says to me, Auntie Clia, I want
water and bread.
I do not know which one is Paulo, until he walks towards me,
takes out his dummy and says, I want water and stale bread.
As soon as we go to the consulting room, we hear his brother echoing, I want stale bread and water.
The whole situation made me very uncomfortable, not only
because I was unable to distinguish Paulo from his brother, but also
because I could tell how confused they are.

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111

On entering my office, Paulo leans back against the wall and remains
standing as if he needed firm support in order not to collapse. Standing
in this position, he whiningly repeats his request for stale bread and
water. I ask him what stale bread is and why he wants it, and he says that
he likes stale bread.
I am intrigued by the fact that he likes stale bread. It occurs to me that stale
bread means old, hard bread (in Brazilian Portuguese the expression po
duro, translated literally as hard bread, is used to designate stale
bread), but I do not know what to make of it. I notice that his apparent
privation and his look of helplessness are like that of a street child, an
abandoned beggar. The expression hard bread echoes in my mind.
After some time, I think of telling him that he seems to be thirsty, hungry,
that something seems to be missing inside him. I tell him that perhaps
those days we were apart since last Friday made him miss what we have
here, made him miss Clia.
Paulo calms down, opens the box, sees an entangled string and says, Its
a spider. He asks me to help him disentangle it. I thought that perhaps
this movement was a reply to my previous statement, in which I began to
unravel a little of what was going on between us.
Then he asks me to roll the string around his hand. I do that slowly, until
he asks me to help him put his hand in a cast. He walks proudly around
the room with his hand in a cast.
I ask him what that spider and the cast are all about.
The spider disappears from the scene. The cast seems related to some injury.
He then asks me to bandage his other hand and to take some string to his
brother. He tells me that he brought his Barbie doll.
I notice that these stimuli take my thoughts in several directions. I guess
that the hand in the cast and the Barbie doll could be contents suggesting castration and masturbation fantasies. I try to find my way using
these ideas, but I soon realise that they do not have much to do with what
is happening at that moment. I then notice that Paulo seems to feel intense
pain and the threat of collapse, insistently asking me to help him protect
himself.
I tell him that perhaps he needs stale bread and water inside his tummy
and a string to tie him up, to apply a cast, to hold, to cover a wound. I tell
Paulo that his wound seems to come from being far from Clia, far from
mummy, and from stopping coming here because of moving to another
city. All these things hurt a lot. The cast helps to cover and protect this
wound, to hold together all that has been undone.

112

AUTISTIC TRANSFORMATIONS

At that point his mood changes. He becomes excited by the game. I help
him put his other hand in a cast. He asks me to meet all his needs. He
is in high spirits, making plans for the next session, when I should bring
him even more string and we will go on playing this game.
This persists until he asks me very insistently to tie up his whole body, his
legs and arms. I follow all his movements with a certain perplexity, without being able to work out what he is proposing to me. I am only aware
of his satisfaction with the game and tell him that he seems to really
enjoy the fact that I am doing everything for him, instead of him doing it
all by himself. I then mention that the stale bread and the water he had
asked for at the beginning of the session could perhaps represent the relationship established between the two of us in which he is being attended
to and cared for by me in everything he needs.
He then says, I want you to wrap me up like a mummy!
I ask him about the mummy.
He says, My auntie at school said that mummies are all bandaged up,
and he points to different parts of his body, saying, the legs, the arms,
the tummy, nipples, eyes, mouth, head and only a small hole remains in
the nose to breathe. Our game gets very intense.
The tenor of this communication touches me because I realise he is
desperately trying to have his body strongly wrapped to keep him
together. He asks for help to unroll the string around his hands and I
pretend to use it to wrap up his legs and arms. He emphatically orders me
to wrap his head as well. This extremely primitive form of communication characterises the entire session. I then remember the previous session,
in which he asked a question about skin.
I tell him, This string you ask me to wrap your whole body with is like
the skin that will cover, bring together, and protect everything you have
inside. When you are hungry, when you feel something is missing, you
seem very upset. Its very disagreeable. Everything is all mixed up,
confused, like the spiders web you talked about before. . . . I tell him that
he needs this bandage to be very tight, just like stale bread, so that all parts
of his body stick together. I add that when he is all tied up, he seems to
feel that he is who he isPaulo.

The session ends. Paulo takes quite a bit of the string with him, and
as soon as he gets to the waiting room, he tells his brother what we
did and says that I will bring more string for the next session.

BION AND TUSTIN: THE AUTISTIC PHENOMENA AND BIONS REFERENTIAL

113

Commentary
Paulos material exemplifies some of the proposals I have made so far
in this book. He is a child in whom a neurotic part of the personality
prevails, but who presents important autistic nuclei and who operates
from time to time using autistic transformations.
At our first meeting, Paulo introduced himself and proclaimed his
emotional state of affairs by saying, But my brother didnt come! He
told me how he experiences bodily separation from his brother: he tore
the paper and pointed to the wound in his belly. His pain due to bodily
separation seemed to be the central concern. He experiences separation from his brother as if parts of his body had been yanked out and
torn (Tustin, 1981, 1984, 1992). He might feel that he had been
yanked from his brothers body when he found himself apart from
him.
Paulos manifestations oscillate between states of withdrawal, in
which autistic transformations prevail, and other states in which projective transformations are dominant. His requesting help to develop
powerful protection in the face of experiencing threats of crumbling
and his state of tremendous vulnerability can be seen as projective
transformations. These experiences seem to come from early situations
in which he was bodily separated. They happen now with the prospect
of having to end his analysis and be separated from his analyst.
In the first clinical fragment, Paulo used his body to show his fear
of crumbling down. That is, he presented himself as a body that could
not stand alone. In search of some support, he leaned on his mothers
legs. Once he felt supported, he tried to develop some early stages of
mental organisation by exploring the rough and smooth surfaces of
the door and the wall. While this was going on, the analyst was confronted with an unknown universe dominated by sensations. She had
no inner repertoire capable of conferring some meaning on that experience. Little by little, beginning with the emotional experience she
was sharing with Paulo, and with the theoretical references she
normally relies on, she realised that Paulo, by exploring those sensations and by differentiating good smooth situations from bad
rough ones, was trying to create some sort of internal organisation
to guide him. By doing this, he transformed the sensations obtained
from his contact with surfaces into rudimentary but thinkable psychic
elements. Paulo seems not to like rough surfaces/separations, but

114

AUTISTIC TRANSFORMATIONS

he seems to like smooth surfaces/non-separation. Once he achieved


a more organised mental state, Paulo went on with his investigation,
leaving the door and walls behind and going to his own body in order
to ask, What is skin good for? It seems that, at that moment, he had
acquired a tenuous notion of cohesion, a tenuous awareness of existing, perhaps some notion of me and not-me.
Examining that sessions movements, the analyst observed that,
when she first saw Paulo, he was caught up in a state of continuity
with his brother. Both of them seemed physically and mentally fused
with one another. To show that they could separate one from the
other, they even produced a sort of counterpoint in asking for stale
bread and water. This entire interchange affected the analyst because,
without a notion of what she was witnessing, she had no way to transform that experience and attribute a meaning to it. In spite of all this,
and knowing that Paulo has shown himself to be emotionally withdrawn and to feel helpless, she stood fast in the face of this unknown
situation, having only the idea that when Paulo finds himself away
from his brother, he manifests a state of helplessness and withdrawal.
She then hypothesised that when Paulo saw himself bodily separated
from his brother, he felt as if he would crumble; using the wall for
support, an external element made of concrete, structured him and
kept him upright. It seems that both the wall and the stale bread
made him feel internally sustained.
Once Paulo felt a little stronger, he went on with his search for
something that would sustain him even more. He chose the entangled
string, which he referred to as a spider. He asked the analyst to
unravel it and use it to put a cast on his hands. This went on until
Paulo told her that the cast was to cover and protect his wound.
Even though she had realised that Paulo was asking her to help him
contain his suffering, she found herself once more in an unfamiliar
setting. The words spider, hard bread, and Barbie echoed in the
analysts mind, and she felt tempted to seize this content suggestive
of sexual fantasies, including castration. She realises, however, that
the emotion they were sharing was from a different level. Paulo
seemed to have a wound, a pain that came from his awareness of
bodily separation. The analyst realised his need to develop some
means to cover his wound and anaesthetise that pain, because his
vulnerability was so tremendous. The cast, another hard element,
seems to function as a shield against his vulnerable state, preventing

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115

the crumbling that threatens him. Paulo showed that he had received
the protection he needed at the beginning of the session, an armour to
protect his wound, allowing him to feel some cohesion. It becomes
more evident that the hardness of the bread, the wall, and the cast are
what Paulo needs to feel minimally sustained and, thus, reduce his
feeling concerning the threat of non-existence. His comfort and enthusiasm once he felt protected are manifested. He then asks the analyst
to wrap up his whole body like a mummy. This wrapping would
have the function of a strong second skin, which would keep him
together and maybe even allow him to acquire notions of his shape,
with which he could gather some rudimentary notions of his existence. Perhaps, as Bick (1986) suggests, Paulo was searching for a
psychic skin which would contain his corporeal and mental
contents. In his interaction with the analyst during this session, Paulo
communicated what he lacked, and the expression stale bread
evolved into his search for the shape of his entire body as a mummy
with its skin as a container.
Paulos movements in these sessions generally fluctuate between
states of greater and lesser withdrawal. His major anxiety is linked to
his need to devise powerful protection that can attenuate the constant
threat of psychic non-existence felt by him.

Discussion
Paulos clinical material allows us to discuss the points brought up
throughout this book. Let us begin with the first fragment I described.
When the analyst asked Paulo to come into her consulting room,
he does not want to leave his mother, so she comes in with him. He
presents himself in an apparently disintegrated state. He immediately
rests his body on his mothers legs in order to find support for his
state, giving the impression that he might crumble. He repeats this
movement in which he falls on his mothers legs and quickly gets back
up several times. I hypothesise that these movements might be manifestations of tropisms. There is a movement of the body and an expectation that some object will rescue that crumbling body. The analyst
remains present and might also have been a container for Paulos
mother, who, in turn, supported Paulos manifestations by letting him
lean on her and go on trying to support himself. It is worth noting

116

AUTISTIC TRANSFORMATIONS

that, beginning with this experience, Paulo was able to support


himself and to stand on his own. We might now conjecture that this
tropism has changed. I wonder, if Paulo had not found an object capable of taking him in, would he have withdrawn into some autistic
refuge? At this level of tropism, Paulos contact was purely sensorial.
It is necessary, however, to clarify that what was going on was a
phenomenon different from what Bion called beta elements. In this
sequence of movements, we have seen no discharge, only the corporeal movements towards an object which will receive this tropism and
modify it.
After leaving his mother, Paulo went on to explore the surface of
the door and the wall, starting an investigation and asking questions
concerning rough and smooth tactile sensations coming from the door
and the wall. This movement reveals a better mental organisation,
perhaps beta elements expecting to be given some meaning that might
associate roughness to bad situations and smoothness to good
ones. Here, we foresee the presence of a fantasy, which points towards
alpha elements. Paulo widens his exploration by examining his body
parts, ending up by asking, Mum, what is skin good for? The
sequence of emotional movements throughout this session is touching. In the beginning, Paulo presents in a state in which his body
threatens to crumble into pieces but, in the end, he achieves a state of
some internal cohesion manifested by his question about the usefulness of skin. Paulos notion of the purpose of the skin to some extent
provides him with a bodily shape and, perhaps, with a tenuous sense
of his own psychic existence.
In the following session, Paulo appeared to be undifferentiated
from his brother, perhaps a mere extension of his brother. When the
two of them separate after Paulo moves to the consulting room, he is
once again threatened by his fear of crumbling. He leans his back
against the wall so as to stay upright. Once again, it seems that we
have come face-to-face with tropisms. For Paulo, both the experience
of being part of his brother and the support he got from the wall seem
to show how, on a bodily level, he needs to be in contact with objects
which, through the sensations they provide, can give him some
protection against his fear of non-existence. In this context his request
for stale bread and water can be understood as his need to have a hard
object inside him that would give him some inner strength. After
asking for stale bread and water, Paulo asks the analyst to put casts

BION AND TUSTIN: THE AUTISTIC PHENOMENA AND BIONS REFERENTIAL

117

on his hands. The cast can be thought of as substitute for the skin he
lacks, a second skin which is thick and hard and which will protect
him from his state of extreme inner vulnerability and from the threat
of crumbling. I am suggesting that Paulos manifestations in this chain
of movements could be thought of as autistic transformations.
Later on, Paulo asked the analyst to wrap him up like a mummy.
He wanted his whole body wrapped up with only his nostrils exposed
so that he could breathe. Here, it seems that Paulo at least wants one
part of himself to be open to the world outside him. He needs to have
one point open (the holes in his nose) in that bodily armour so that he
can have some contact with the outer world. His nostrils might represent the permeable part of Paulos autistic barrier, a part that is still
alive and allows him to have some give-and-take with the living
world (I owe this interesting observation to Bianchedi, 2005, personal
communication). These movements demonstrate Paulos oscillation
between existence and non-existence. The analysts experience with
Paulo indicates that these are autistic transformations.
Now that we are at the end of this book, it should be perfectly clear
that my proposal to incorporate autistic phenomena into Bions frame
of reference is not a simple matter. To do so, it is necessary to widen
the area of phenomena within the mental sphere so as to include an
area that does not yet count as mental. This expansion will change the
system Bion devised, constituting a complex system which entails
imprecision and incongruity (Morin, 1990, p. 20).
To further this investigation, we need to be able to contain this
imprecision in our minds. Otherwise, I do not see how we can go
forward. Or, as Morin said, We shall have to tolerate the non-scientific within science . . . which does not mean dispose of the scientific,
but rather, allow it to be expressed . . . (1990, p. 91, translated for this
edition).

Note
1.

I thank my colleagues Alcia Dorado de Lisondo, Carmen C. Mion, Cecil


Jos Rezze, Joo Carlos Braga, and Olivio Beltrame for their valuable
contributions during the discussion of this chapter. I especially thank
Elizabeth Bianchedi and James Grotstein for their attentive reading and
their detailed comments and contributions to the final text.

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INDEX

affect(ive), 87
contact, 54, 72
emptiness, 64, 66, 71, 89, 94
experience, 17
genealogy, xvi
impression, 17
life, xv, 5556, 64, 67, 71, 94
meaning, 82, 87
relationship, 97
Alvarez, A., 53, 77, 9091, 119
anxiety, 23, 28, 36, 40, 42, 49, 52, 72,
74, 77, 86, 109
intense, 26, 31
major, 115
separation, 59
autistic (passim)
barriers, xii, 55, 62, 73, 8991, 104,
106, 117
-contiguous position, xiii, 77
defences, 54, 7273
elements, 108
environment, 71
isolation, 104

manifestation, xvii, 73, 77, 94,


105
manoeuvres, 13, 46, 48, 55, 79, 86,
106
mind, 64, 80, 101
nuclei, xiv, xxxxii, 56, 71, 73, 87,
97, 100, 113
objects, 30, 54, 7172, 76, 94, 97
pathological, xiv, 86, 102
phenomena, xviii, xxxxii, 48,
5355, 61, 65, 7071, 7980,
91, 9396, 99105, 107108,
117
psychogenic, 11
shapes, 30, 72, 76, 94, 97
shell, xv
sphere, 30, 55, 80, 90
transformation, xivxv, xviixviii,
xxxxii, 48, 5557, 6167,
7071, 73, 78, 80, 8790, 9495,
9899, 101103, 105, 113, 117
universe, xxixxii, 71, 78, 9091,
9495, 102

123

124

INDEX

Baranger, M., 16, 119


Baranger, W., 16, 119
Barros, M. E., 16, 100, 119
Bianchedi, E., 98, 117, 119
Bick, E., 30, 53, 77, 106, 115, 119
Bion, W. R. (passim)
alpha
elements, 28, 4243, 79, 88, 90,
103104, 108, 116
function, 1, 16, 28, 4143, 45, 59,
70, 7980, 88, 9091, 9798,
103
beta elements, xxii, 28, 4345,
7980, 88, 95, 97, 103104,
106108, 116
cited works, xxxxi, 1617, 27, 31,
45, 4853, 56, 5859, 62, 70, 75,
79, 87, 9599, 101, 103,
105107, 119120
H, 80, 95, 98
H, 80, 98
K, xxi, 51, 6263, 67, 71, 7980, 88,
90, 95, 98
KO, 63
K, xxi, 51, 71, 7980, 88, 90, 95,
97100, 102
L, 80, 95, 98
L, 80, 98
O, xxi, 51, 62, 71, 79, 90, 97,
107
on transformation, xvii, xxi, 22, 44,
4852, 58, 7071, 79, 95,
102
on tropisms, 105107
PSPD, 18, 27
referential, xx, xxii, 9596, 117
Braga, C., 69, 73, 77, 80, 99, 117
Capra, F., 53, 67, 120
case studies
Ana, xi, xvi, 4446, 5657, 5961,
6364, 71, 74, 80, 8391
Caio, xii, 71, 73, 8082, 8688,
91

Lus, xii, 7173


Mariana, 5658, 6364
Marieta, xi, xvi, 24, 611, 15,
1921
Mrio, xi, 2627, 29, 3745
Paulo, 108117
Pedro, xi, xvi, 2627, 3137, 4143,
45
Chau, M., 69, 7678, 120
conscious(ness), 10, 2830, 41,
4546, 55, 59, 79, 84, 100101,
107 see also:
unconscious(ness)
awareness, 80
recognition, 89
development(al), 2829, 31, 4546,
49, 71, 75, 86, 94, 96, 99,
102103
biological, 106
emotional, 22, 55
lag, 80
language, 80
mental, xxi, 13, 22, 2527, 41,
4344, 51, 65, 70, 86, 95, 97,
104
normal, 12
of alpha function, 91
of thought, 90, 103
symbolic, xvii
theoretical, 15
Duchamp, M., 49
ego, xiii, 29, 103
body-, 29
super-, 28, 103
envy, 29, 52, 97, 99, 101
fantasy, xix, 40, 42, 54, 59, 70, 76, 82,
85, 88, 90, 97, 110111, 116
characters, xii
life, 31
oedipal, 42
sexual, 114
world, 45

INDEX

Fdida, P., 73, 78, 120


Fonseca, V. R., 77
Freud, S., 16, 27, 29, 51, 103, 120
functioning, 56, 64, 91, 93, 99 see also:
symbol(ic)
mental, xiii, xviii, 2, 17, 2627,
4446, 75, 94, 107
psychic, xiii, 73
Gleick, J., 75, 77, 91, 120
Green, A., xii, 1518, 2223, 27, 46, 78,
80, 103, 120
Grotstein, J. S., 49, 53, 77, 117,
120
Habasque, G., 49, 120
hate, 34, 29, 98, 101
Hofstadter, D., 7576, 87
Joseph, B., 16, 120
Klein, M., 12, 16, 18, 27, 47, 5253, 77,
99, 105, 120
Klein, S., 53, 72, 120
Korbivcher, C. F., xviixviii, 11, 65,
7071, 7374, 80, 9495, 102,
120121
life, xvi, xxii, 12, 44, 56, 59, 84, 86,
89, 99 see also: affect(ive),
fantasy
daily, 44
emotional, 90
everyday, xv
experiences, 25
infant, 105
mental, 810, 31, 43, 60, 105106
psychic, 4, 89, 104, 106
traumas of, xiii
McDougall, J., 12
Meltzer, D., xiixiii, 30, 53, 77, 89, 98,
107, 121
Mion, C. C., 47, 105, 117, 121

125

Mitrani, J. L., 77, 94, 121


Moore, H., xx, 12
Morin, E., 9596, 98, 117, 121
object, xiv, xxi, 34, 10, 13, 1718, 22,
27, 2931, 41, 43, 4546, 52,
5455, 58, 6165, 7273, 7980,
9495, 97108, 115116 see also:
autistic
absence of, 30, 56
actual, 54
analytic, xxi, 13, 15, 1718, 21, 23,
42
psycho-, 1718, 2223
auto-sensual, 46
bad, 10
bizarre, 28, 42, 45, 103
concrete, 30, 41, 43
dead, 101
external, 9, 39, 54, 56, 61, 71, 94
good, 910
hard, 76, 116
internal, 9, 12, 54, 94
lack of, 54, 103, 105
non-existent, 101
of investigation, 23
real, 52
relations, 3, 76, 79, 98, 103
sensation-, 30, 72, 94, 97, 102
separate, 65
soft, 54, 76
transitional, 46
Ogden, T. H., xiii, 77, 121
Petot, J. M., 16, 121
Prat, R., 31, 121
primitivism, 48, 6465, 75
projection, 2830, 45, 52, 5859,
6566, 99, 103, 106
mental, 29
projective, xxi
identification, xiv, 16, 27, 30, 45,
5253, 59, 6566, 74, 90, 94,
105

126

INDEX

processes, 99
transformations, xiv, 5152, 5658,
66, 71, 79, 8890, 104, 113
psychic see also: functioning
absence, 64
activity, 28
apparatus, 12
balance, 55
content, 26, 87
dimension, 107
elements, 75, 88, 103, 106, 116
impairment, 28
integuments, xv
level, 44, 54, 97, 103
life, 4, 89, 103104, 106
loss, 100
movements, 50, 75
non-existence, 103, 115
organisation, 1213, 25, 94
pain, 10, 31, 49
phenomena, 4748, 52
processes, 79
qualities, 22, 72, 108
reality, 70
representation, 43
sense, 100101
separation, 61, 94
skin, 115
state, 88, 98
suffering, xiii
transformations, xiv
tropisms, 105
Rezze, C. J., 74, 78, 99, 117, 121
self, 22, 30, 4143, 4546, 52, 5455,
61, 7172, 79, 94, 9798
-absorbed, 66
analytic, 85
-awareness, 51
-generated, 46, 54
-knowledge, 10
-observation, 55, 61
primordial, 54, 72, 90
-sufficient, 79, 98

splitting, xiv, 4, 10, 21, 45, 63, 66, 89,


99
symbol(-ic), 2123, 26, 31, 80, 82, 94
capacity, 41
content, 82, 87
development, xvii
formation, 13
functioning, xiii
language, 43, 88
level, 21
meaning, 46, 87
Symington, J., 51, 121
Symington, N., 51, 121
The Heritage Illustrated Dictionary of
the English Language, 105, 121
transference, 16
classical, xiv, 51
total, 16
transformation, xivxv, xxi, 9, 2122,
36, 4142, 4445, 48, 5053, 56,
5859, 6267, 71, 73, 7879,
8789, 9495, 97, 102103
see also: autistic, projective,
psychic
in hallucinosis, xxii, 45, 5152,
5658, 62, 71, 79, 90, 99, 102,
104
rigid-motion, xiv, xxi, 51, 71, 79
theory of, xviixviii, xxxxi, 4850,
53, 5556, 61, 65, 70, 7879, 90,
95, 97, 102, 117
tropism, 105108, 115116 see also:
psychic
Tustin, F., xiixiii, xvixxi, 11, 13, 27,
2930, 4647, 5356, 64, 6970,
72, 74, 7679, 94, 9798, 100102,
104, 106, 113, 122
unconscious(ness), xiiixvi, 28, 45, 79
see also: conscious(ness)
Viderman, S., xvi, 17, 19, 23, 122
violence, xi, 3, 9, 20, 26, 33, 37, 40, 42,
58, 75, 90, 9899, 109

INDEX

Winnicott, D. W., xiii, 18, 53, 77, 100,


122
world, xvi, 60, 64, 72, 7577, 117
closed-off, xiv
concrete, 89
external, 72, 117
fantasy, 45
illusory, 49
imaginative, 10

127

inanimate, 103104
inner, 3, 910, 18, 22, 40, 64, 67, 84,
8990
living, 117
mental, 41, 62, 64, 81, 84, 88,
90
perfect, 52
phenomenic, 96
primitive, 8, 43