Ladies and gentlemen, it's my great pleasure to welcome you to the 53rd Sigmund Freud lecture and we are delighted by the great interest shown in this program highlight at the workplace of Sigmund Freud. First, I would like to thank our advisory board members and their new chair, Ruben Gallo, For selecting Freud lecturers and submitting proposals. Thank you very much for your ongoing support. It's such a enriching working together with you all. Once again, we are commemorating Sigmund Freud's birthday on May 6th with a speaker who is a psychoanalyst. Specifically, his work incorporates approaches and perspectives
from Different disciplines, which we will learn about more today, especially in the introduction. And this is particularly significant for our Freud lecturing programming. For the Sigmund Freud Museum as an international platform for current discourse, it has always been essential to present psychoanalysis in all its facets and to open it up for discourse and discussion. So, we have had the pleasure of hearing from experts in psychoanalytic theory and practice as well as from internationally renowned philosophers, literary scholars, sociologists, filmmakers, artists, and many more. So, we can in fact look back on a diverse range of Freud's
lecturers. I would like to take the opportunity to thank also all those who made this event possible. So, our partner of the Sigmund Freud lecture, the Unica Insurance Group, the city of Vienna's Department of Culture and Association of Friends of the Sigmund Freud Museum. Now, we will hear a brief introduction to the work of the this year's Freud lecturer from Spiros Theophilos. Since Spiros cannot be here in person today, his fellow advisory board member Goa Homayounpour will read the introduction and lead the discussion following the lecture. Ladies and gentlemen, please join me in welcoming our
Freud lecturer 2026, the British psychoanalyst and author Darian Leader. >> [applause] [snorts] >> Good evening and welcome. So, I have the pleasure to read Spiros Orfanos' introduction to Darian Leader. Welcome to the 53rd annual Sigmund Freud lecture held on the occasion of Sigmund Freud's Birthday today, the 6th of May. This lecture is not merely a ceremonial tribute to the founder of psychoanalysis. It's a living intellectual event, one that situates psychoanalysis at the vital interface with the humanities and within the urgencies of contemporary debate. This evening, we're honored to welcome Professor Darian Leader, who will speak
on the theme Freud and neurodiversity. If you're wondering what the word neurodiversity means, I believe it's a movement about the challenges commonly attributed to people with different ways of relating and reacting, which often seems surprising or baffling to the so-called neurotypicals. A colleague described Joseph, a 6-year-old boy with an older brother on the autism spectrum, as saying, "Autism is like when you could just be Sitting there minding your own business, and let's say someone would come along and just chop off your nose, and the person with autism would say, 'But what about my lunch?'" Serious
theories of the etiology of autism have multiplied. What neuroscientific and developmental studies consistently show are fundamental differences in motor, sensory, motor sensory, and attentional processes, Which then secondarily impact and result in differences in language, affect, and cognition. Serious advocacy for the treatment of autism has also multiplied. I'll return to this after I offer a few selected biographical notes about our distinguished speaker. Professor Leader is a practicing analyst, educator, writer, historian of science, art commentator, and public intellectual. Those familiar with his work know that he approaches complexity with remarkable clarity, moving with ease across clinical practice,
philosophy, art, and science. His work is deeply informed by Lacanian orientation, yet remains strikingly pluralistic in spirit. He moves fluidly between the consulting room and the cultural world. Whether clinically unpacking the meaning of psychosis, depression, or sex, Or engaging contemporary art, or conversing with rock stars such as Nick Cave. Darian Leader was born in 1965 in California and came to England when he was 2 years old. He grew up in Cambridge and London where his father researched in physics and his mother lectured in modern languages. He read philosophy at Cambridge before going to Paris to
study as a Lacanian analyst While doing first a master's degree on the history and philosophy of science, followed by a doctoral dissertation on the reasons why Greek comedy changed between the 5th and 4th centuries. For some of us of Greek origin, the question is still compelling. I mean, Spiros says Greek origin. Leader has had a fascinating career having worked as a lecturer in comparative literature, a psychoanalyst, a founder of a Psychoanalytic institute, and an author who has written extensively on psychoanalysis and art. Had he been raised in America, surely someone would have said about him,
"Grass does not grow under his feet." As a founding member of the Centre for Freudian Analysis and Research, he has played a central role in fostering Lacanian psychoanalysis in the United Kingdom, where it had long been relatively Marginalized. Of particular note, and something personally meaningful to me, is his meaning Spiros is his leader leadership in developing low-cost clinical services, expanding access to psychoanalytic treatment for those who might otherwise be excluded. Professor Leader is the author of 14 widely read and influential books whose range alone gives a sense of his intellectual reach. From Introduction to Lacan
to The New Black, from What is Madness to Jouissance, and most recently Is It Ever Just Sex? His writing consistently challenges us to rethink the taken for granted, to question diagnostic certainty, and to listen more carefully to what exceeds our categories. His intellectual position, and perhaps his psychoanalytic position, is at once inside and outside dominant traditions, Translating between them rather than belonging wholly to one. He seems to embody a third perspective, not unlike what Jessica Benjamin, a previous Sigmund Freud lecturer, calls the third in relational psychoanalytic theory. Though articulated differently, this evening I expect that
rather than treat conditions like autism as fixed by a biological deficits, he might ask What function does a given symptom or mode of being serve? How does it organize the subject's relation to language, the body, and others? What is the patient's lived world, suffering, and relational embeddedness? Such questions reopen what had been already settled. Uh reopen that what seemed to have already been settled, including how psychoanalysis understands autism, psychosis, and now Neurodiversity. In this sense, his thinking resonates with, but may not be identical to contemporary neurodiversity discourse. Where neurodiversity emphasizes variation rather than pathology, Leader
would likely add a specifically psychoanalytic question. What subjective logic is at work here? In my opinion, this last question is a clue to how Leader investigates and Interrogates the concept of neurodiversity, not as pathology, but as difference. It's a clue to his phenomenological attuned voice. Returning to the concept of neurodiversity, it started as a remedy to certain misdirected thinking about autism. Psychoanalysis has had a complex and at times troubling history in relation to what we now call neurodiversity. Earlier frameworks, often psychogenetic In their assumptions, pathologized difference, at times in ways that were not only reductive,
but harmful, as is the notorious formulation of Bruno Bettelheim of the refrigerator mothers. The term neurodiversity, emerging in the late 20th century, signals a profound shift, drawing on both Greek and Latin roots. It names variation, rather than deficit, difference in the ways the mind and the Brain function. While it may sound medical, it often works against a strictly medical model, aligning instead with forms of disability activism that emphasize strength, resilience, and singularity. This shift is not only conceptual, it is ethical. It invites us to reconsider how we listen, how we understand, and how we honor
subjectivity. It is here, I suspect, that Professor Leader's work will prove specially Generative. His long-standing attention to the distinction between surface and structure, his resistance to reductive labeling, and his commitment to preserving subjecthood all position him uniquely to engage this topic. If he has an allergy to pathologizing, it is one that opens space for thought, for a more nuanced, more humane psychoanalytic listening. Leader is a distinctive voice in contemporary psychoanalysis, and we're fortunate to have him with us this evening. Professor Leader, it is a pleasure and an honor to welcome you to be our 53rd
Freud Lecturer here at Berggasse 19. >> [applause] >> Thank you so much, Spyros, and thank you, Goh Har, for transmitting Spyros's words from New York. It's a great pleasure and honor to be Here this evening in Vienna at the Freud Museum, and I'd like to thank Monika, the director, the advisory committee, and everyone at the museum who's organized, facilitated this visit. I started reading Freud when I was a teenager in our school library. It was open access. You could take whatever you want from the shelves, but there was one bookcase behind the librarian's desk, which
had the works of Freud and the works of Fraser, The Golden Bough, and That was the only part of the library where you needed permission to take the books out. So, of course, that became a focus of interest, and I've been reading and learning from Freud ever since. And I remember as well, back in the 1990s, 1998, I spent some wonderful months at the Freud Museum in London going through Freud's library, looking in particular at the footnotes that he'd added to different editions of His works, cuz I was studying the the development of footnotes in
Freud's work. And also, one of the things that really, really stood out looking through the annotations in Freud's library, where he'd underlined books, where he'd made ironic comments in the margins. What was very, very clear was Freud's fascination with questions of diagnosis. And at the time, that had struck me as quite surprising Because a preoccupation with diagnostic questions is often more linked to other psychoanalytic or psychiatric traditions. It's big in the Lacanian tradition, but when you read Freud the work in the 1890s, he's clearly interested in diagnosis, but it is it doesn't really seem to
be such a pervasive theme in the later work, but it's absolutely clear from the way that Freud read, noted, annotated his books that he retained this interest in close Reading of psychiatric texts to try to formulate differential diagnoses and more often than not to contest received diagnoses. And if you look at Freud's published work, this is also something very, very clear in his work between 1892 and 1897, often referred to as Freud's kind of neurological period. He was working for 3 days a week in a child neurology clinic specializing in what's now known as cerebral
palsy. He published three substantial works on what was then called infantile cerebral paralysis, call it palsy for now. And the last of those volumes published in 1897 it it is basically 350 pages just trashing everyone else that wrote anything about diagnostic issues in cerebral palsy. Freud is interested in can you make a diagnostic category out of a collection of symptoms? Or should you make a diagnostic category Out of studying the progression of a so-called illness or disease? Should you pay attention to quantitative factors? Would these play a role in framing diagnosis? Or should you look
at the changes in a condition over time? Or should you focus on etiological factors, on causes, and define so-called clinical pictures just in terms of their causes? And Freud's conclusion at the end, he he dismisses practically everyone, Is that in the end, infantile cerebral paralysis can be diagnosed without any sign of paralysis, that it's such a wide-ranging category, it's impossible to make any definitive links in most cases between pathological anatomical lesions and clinical pictures. And even when you can identify so-called pathological agents, there's never a clear route between that and a clinical presentation, let alone
the clinical course of a palsy. Yeah? And this work is still highly rated today. He makes a few references in this work to psychical factors, not too many, but the very last paragraph of the 1897 book ends with a very brief consideration of the importance of educational methods, which Freud is quite positive about, for treating the mental factors which he doesn't link to so-called pathological processes, but he sees as co-occurring with the Pathological processes. So, he's not saying that psychical issues are consequence of policies. He's saying they co-occur and the relations between them, the phenomena
haven't yet been mapped and hopefully that's something going to that's going to happen in the future. What does he hope for in the future? He hopes for quite a multi-dimensional hierarchy of clinical pictures with at some point In what he calls its upper ranks a diverse set of causal factors. So, he's saying that we're looking here at a very, very diverse group of conditions. We're linking them all together with a name which isn't particularly accurate. But most important, he's questioning the clarity that had been claimed by many of the contemporary writers between particularities of central
impairment and clinical symptomatic pictures. Now, the other reason why this is so relevant today, apart from obviously the diagnostic question, is that it's well known that in infantile cerebral palsy, there's a very high rate of the co-diagnostic occurrence of autism. And the stats say different things. One of the most well-known Swedish studies says there's a co-occurrence of something like 30% of cases. Other studies in America tend to put it around 7%. But whichever of the figures you take, it's quite a substantial percentage of children. >> [clears throat] >> The children that Freud was seeing week
after week for more than 10 years. So, he would absolutely without any doubt have worked with children who would later have received a diagnosis of autism. And we know that in the early 1930s, an American couple traveled to Vienna with their autistic son, took him to have a consultation with Freud. Freud said he didn't know whether an analytic perspective could help him, but referred him to Edith Sterba, one of his students, who'd already published what what's perhaps the first case of what without any doubt would later be diagnosed as early infantile autism back in the
early 1930s. So, the case I Think she worked with the boy probably in the late 1920s. We don't know what happened after Freud made the referral, but it's clear that that's where he was going to send the case cuz he knew already about Sterba's very, very inventive work, the way in which she adapted technique, and I'll talk about that a little bit later on. Now, let's just go back and do a little bit of history of the term autism itself, Which is what I'm going to focus on in this field of neurodiversity cuz I think
it's closest to Freud's clinical experience and his clinical and metapsychological concerns at that time. Now, Bleuler, Eugen Bleuler, the Swiss psychiatrist, goes to America in 1913 to give a lecture about autistic thinking. And he tells the American psychiatrists in the audience, he says that Jung, Freud, Le Bon, and himself were all currently working on the question of autism. What could that have meant? Yeah, it's a bit of a surprise if you are a reader of Freud cuz there doesn't seem to be too much about autism at that time. But if we look at the Jahrbuch
published between 1908 and 1914, Bleuler and Freud were the co-editors. Freud wanted to have the kind of official psychiatric passport that Bleuler in a sense provided. And you see a kind of back and forth between Bleuler and Freud for about 3 years in the journal where Bleuler is really, you know, uh uh anti-Freud. He he he doesn't like Freud's theory of autoeroticism. He doesn't really like Freud's theory of sexuality. He doesn't really like Freud's theory of hallucinatory satisfaction at the origins of life. He he kind of Misinterpreted Freud on this. I won't go into all
the detail, but when you read through the different articles in those years of the Jahrbuch, you really see Bleuler consistently misunderstanding Freud. Freud writing him a letter saying, "You've misunderstood me." Bleuler saying, "Yes, I misunderstood you." Then writing something which again misunderstands Freud. So, you see a kind of catalog of of errors and misunderstandings. Sadly, It isn't particularly fruitful. But what's so interesting in terms of the later debates is that Freud wrote a little paper, I think seven and a half pages in the 1911 edition of the Jahrbuch, translated as the formulations on the two
principles of mental functioning. And and this is I I don't know for the readers of that paper here this evening, yeah, what what you thought when you read it. I mean, it's a very very Condensed paper. It's quite dry. It's quite difficult. And yet Freud said he felt compelled to publish it and he puts it before the Schreber case in the Jahrbuch. So, he obviously gave it a kind of importance. And it It basically his way of of correcting all of Bleuler's misunderstandings. And Bleuler's subsequent work on autism, autistic thinking, is basically his way of
responding through misunderstanding To Freud's 1911 paper on the two principles of mental functioning. Now, without going more into the history, who's going to help us read the paper? I think the best interpreter was in fact the first ever Freud Memorial lecturer here, Rudolf Ekstein, who came to Vienna from America in 1970. He gave the first Freud Memorial lecture. And there's an irony which he doesn't mention in the lecture, but Ekstein was arrested at number 20 Berggasse for his political Activism. He spent a little bit of time in jail. He then went to America, ended up
in Los Angeles, where he did brilliant work with autistic children, which I'll talk about later on. And then he came back to America, and in an interview later on in in one of the archives, he said, you know, he comments on the irony of being arrested and then returning to the house opposite to give his lecture all those years later. So, Ekstein's reading of this short and difficult paper is that Freud here introduces the difference between the pleasure principle and the reality principle. He says, let's not misunderstand it in the way that Bleuler did. It's
not that first a baby has pleasure, then it's disappointed, then it accepts reality, and the pleasure is kind of annulled or canceled. Freud's argument is rather that there's A continuum between the pleasure and the reality principle, that the reality principle factors in the pleasure principle through functions of delay, but crucially Ekstein's point that pleasure and reality principles shouldn't be seen as kind of stand alone agencies, but rather as operating mechanisms or operating principles in the psyche which can combine, merge, and operate at the same time. So, it's a kind of corrective To Bleuler. And the
other thing he picks up in Freud's paper is the idea that when the infant is confronted with frustration and disappointment, when there's this sort of hypothesized, hallucinated satisfaction of feeding, of nutrition, the child will eventually realize that disappointment can't be overcome through hallucinatory means. So, they're forced into a recognition of reality, a Recognition which supposes attention and memory, in other words, discriminatory activities, yeah? There's going to be a kind of discrimination, a choice, a judgment, again themes which are developed in Freud's later work, especially in the 1920s. And so, this relation between pleasure and reality
is supposes the function of discrimination and attention. Especially interesting when you think about the clinical picture described by Everyone 30 years later of early infantile autism, where it seemed as if one of the most obvious phenomena was an absence of discrimination. That you could walk into a room and the child wouldn't react to your presence or react to your leaving the room. You could wave a toy in front of the child and it was as if nothing was happening. It seemed as if there was no discrimination, Which again suggested to many people that there was
some kind of different wiring in terms of the relation of pleasure and reality operations in the psyche. I'll come back to that later on. Now, if we then look about the kind of subsequent history, the term autism is widely used in the 10s, the 20s, the 30s, and the 40s [snorts] to refer to very simply any kind of self-absorbed activity, perceptual or cognitive, which seems driven by affects. Yeah, it's not used in a particularly rigorous way. There's misunderstanding of Bleuler's original idea and of Freud's idea, but when it becomes minted into a diagnostic category in
1943, it's taken then to refer to some kinds of self-absorption, and Leo Kanner, who Introduced the category, defined the two principal features as an insistence on sameness in the environment, and an intense desire for aloneness, both of which he thought were forms of or derivatives of problems in effective contact. And there's also a lot a long history with with many threads linking it to Viennese pediatric and psychiatric work in the 1930s that's being kind of well documented nowadays by historians. But let's move to what was happening in America, where the diagnosis is first created and
starts to snowball. There were several different centers where really everyone was inspired by Freud's work. They weren't all coming to psychoanalytic conclusions, but the work was saturated in Freudian ideas. The different sites of clinical work and research for autism were in New York at the Ittleson Center, where William Goldfarb was very interested in why distance receptors of vision and hearing seemed to be less privileged than the proximal receptors of touch, mouthing objects, smelling objects, and a close relation to services. So, a toy, rather than being played with, would be put into the mouth or sucked
or or touched intensely. Yeah? Also in New York, you had Barbara Fish and then Loretta Bender at the Bellevue Hospital doing a lot of, you know, quite dodgy things, doing ECT with children, but arguing there that the phenomena that had been defined as autism actually did not constitute a clinical categories. It's quite resonant with with Freud's perspective. They thought that the phenomena we associate with autism, like an apparent Obliviousness to the environment, stemming, rocking activity, aloneness, lack of effective contact, lack of approach behavior, all these well-known features, could actually be found right across the board
in cases of mild to more severe neurological damage, congenital rubella, even retrolental fibroplasia, lots and lots of different kinds of problems a child could encounter, genetic and medical. And Bender and her colleagues thought that autism was simply the name for a set of strategies introduced by children in order to introduce equilibrium given the maturational lag that they experience for a wide variety of medical reasons. And that's the view that is held by quite a few people today who argue that that between 70 and 150 different kinds of autism, what does that actually mean? When you
read Research, what it means is that they find between 70 and 150 different kinds of childhood illness, which then can generate what's seen as a common pathway of certain behaviors that might not actually have anything to do with the initial illness. Yeah? But that's that's the way in which that the people working at the Bellevue thought. You also had Louise Despert and then Margaret Mahler, the New York State Psychiatric Institute. I'll talk more About Margaret Mahler in a moment. In Boston, in Roxbury, you had the James Jackson Putnam Children's Center where the most amazing work
on autism was being done by Tola Rank, Molly Putnam, Eleanor Pavenstedt, Gregory Rochlin, and their colleagues. And what they argued there, they were quite worried by the pathologization of autism and the way in which it was lumped together at the time with Childhood schizophrenia and other forms of psychoses. And they thought that this didn't really have a great effect on work with children because not only would it be bad news for families to be given such a bleak prognostic outlook, but also it could influence people working with autistic kids because they'd assume that the prognosis
was bleak. And so they argued it with with real prescience for the later category of Neurodiversity specifically to contest the dominant category of early infantile autism. They argued for the category of atypicality and the atypical child, which someone who could be diagnosed as autistic or schizophrenic or psychotic in other places. They thought if you just use the word atypical, you can look at each individual case, see what can be done, see what the structure the history is in each case without introducing a Diagnostic category which risked creating looping effects where everyone would behave as if
things were going to be difficult or it would progress in a particular preset way. So basically as a as a way to try and challenge prejudice. Unfortunately, the category didn't really take off so well. Then you had Kanner and his colleagues at Johns Hopkins. On the on the other coast, on the West Coast, you had Stanislas Szurek and his Team at the Langley Porter in San Francisco who were again doing very, very psychonetic work with autistic children. And then you had Rudolf Ekstein from Vienna who went to LA and worked at the Reiss-Davis Center with
colleagues like Elaine Caruth again doing remarkable work with autistic children. And one of the things, the most striking things about the work of these pioneers Is that they were all steeped in Freudian theory. Most of them belonged to quite hierarchized institutions where you basically everyone had their place and you had to follow the rules of what to do when you receive an analytic patient. But at the same time, they were all quite radical in innovating new ways of working with children. So there there much less emphasis on interpreting to the child. Rather, it Was about
initially trying to gain trust through attunement, helping the child not in getting rid of what was seen as autistic defenses, but rather in working with the interests that the children had and moving them towards different ways of inclusion, of perhaps being able to allow a little bit more of otherness into their worlds, and trying to help them to find ways to navigate the particular social Geographies which they inhabited. Yeah? Now, of course, you can find horror stories of, you know, brutal Freudian interpretations being given to children, but really much of the work was very, very
sensitive and different from classical work. Analysts would sing interpretations to the children at Landly Porter in Boston. They would sometimes, when they were talking to the children, let's say using, you know, Freudian vocabulary, they would turn the vocabulary into a nursery rhyme. So, they'd use rhythmical patterns, prosodies in order to convey something to the child. They'd sing, they'd lie on the floor. People complain about getting their nice clothes dirty. Eric Schopler, very influenced by by the psychoanalytic scene at the time, writes in an article about how awful it was to have his brand new sports
jacket Destroyed when he let a kid smear candy all over it. So, you have a lot of this stuff, but what you see is analysts getting on the ground, you know, not using the couch or anything like that, not even using traditional play techniques and, you know, traditional child analytic techniques, but trying to find ways with which to engage children, and at the same time to rethink what's happening in early infantile autism. And this is where we find the first Really big development of classical Freudian theory, and it happens between 1945 and 1949. In 1945,
if you read what people are writing, a lot of it is quite traditionally drive-based, oral, anal, phallic, genital. Child development is seen much more in terms of an endogenous program that's unfolding in the child. By 1949, this is all changed, and Especially by the 1950s, it's becoming clearer and clearer. And the extraordinary thing, when you read through the texts that people are publishing then, is that people are becoming much more aware, first of all, of the fact that an infant is always part of an engaging unit with the mother. Again, not necessarily a new idea,
Freud refers to it himself. But rather, what's new is that the way In which that unit is characterized is using the new vocabulary and concepts of the communication sciences. And Erik Erikson was particularly influential here. He taught a seminar, probably the first child analysis seminar in Boston. And he argued that what happens in the early baby-child-mother relation Is not so much the gratification of biological or even drive-based needs, kind of classical drive theory, but rather the creation of the very idea of meaning and communication. So, when a child is feeding, the mother might respond to
slight changes in the rhythm in which the baby is sucking. She might respond by jiggling the baby a little bit, or she might say something to the child, or she might move the Nipple a little bit. And in this process, which was pretty soon studied in great detail by early analysts and infant researchers, it was hypothesized that what's going on from really day one of life, and and later research pushed it even back to in utero, was the idea that in these early interactions between infant and mother, primitive structures of dialogue, proto conversations, are being
established. Spitz called them Proto dialogues, and Catherine Bateson called them proto conversations. So, that the child might, let's say, move its mouth a little bit around the nipple, and the mother will respond maybe by moving the child's body. But through these tiny, tiny, tiny little changes in the interactions between mother and child, the mother is transmitting to the child the idea that the child's movements, whether it's a cough, a burp, a shiver, whatever it Happens to be, a movement of the mouth, are sending a message to the mother, which the mother is then responding to.
So, there's the creation of a dialogue. So, the infant is learning the actual concept of meaning and of agency, with the idea that the infant is able to affect the way the mother relates to him or her. Yeah? So, this is a kind of an amazing idea. And it was even claimed at this point that the object of the oral drive is not The nipple or milk, but communication itself. So, what's happening in the these these early days and weeks of life is that commu- signaling systems are being established between the mother and the child.
And this is where the research the early psychiatric research on autism is so fascinating and sadly it was forgotten until relatively recently. What Tola Rank and Margaret Mahler and Loretta Bender and others, despite having quite different views and not always liking each other or getting on with each other, what they noticed was that very, very often these children were in pain, were in physical pain, which wasn't an effect of bad parenting, but could be linked to a gastrointestinal issue, could be linked To a colic, could be linked to a respiratory issue. It could be linked
to problems in the effects, the feeling of gravity, which Bender and Paul Schilder from Vienna emphasized as being the first kind of intrusive phenomenon in the life of an infant. And a lot of later research has kind of backed that up. Anyway, so what they argued was that if, let's say, [snorts] a parent is trying to feed a child and the child is In physical agony, but can't say that, they're naturally going to focus their attention, their bodily attention, on the pain in their abdomen, for example, rather than trying to suck on a nipple or
on the teat of a bottle. And the parent who's trying to feed them might not be aware of what's going on with the child, cuz often early infantile pain isn't clearly localized. This is something that Temple Grandin also pointed out. That if a child is in pain in their stomach, they're not necessarily going to be holding on to their stomach to show that they're in pain, sometimes they might try and clutch their head. Yeah? And these phenomenon of the way in which infants deal with internal pain has later on became much more widely studied. But
what the early analysts pointed out was that you have the presence in a lot of cases Of internal pain, physical [clears throat] pain for whatever reason. And this will then affect these nascent dialogues, these tiny micro dialogues between the infant and the mother. So that the child might turn away from the breast or the bottle. The parent might not understand why the child is doing that, yeah? Or if a child is sitting on a chair, in many cases of early infantile autism, It's a very difficult thing to sit without the trunk and the feet being
supported. And the infant might be putting all their attention, all their energy into trying to stabilize their body, which means they're obviously not going to be interested in someone waving a toy in front of them, for example, or someone trying to feed them. So the argument was that the early experience of pain or discomfort could create Problems in the synchronization of signaling systems that would otherwise be developing primarily with the mother. The mother or the parent might then feel that the child isn't responding to them in the right way, and then they might feel that
they need to try and do something different, generating even more inconsistency in the relation to the child. So So what you see basically in the model Boston, San Francisco, Los Angeles, in all these models is a kind of two-tiered to early infantile autism. On the one hand, you have physical problems for any reason, a genetic reason, neurological reason, stomach, GI, respiratory, whatever it's going to be, yeah? No no specific etiology. But then you have the effects of that in The signaling system that's being developed between the infant and the mother, yeah? And that will then
create a de- desynchronizations, which generates the clinical picture of early infantile autism. Now, the obvious question is how does it do that? And this is where another Freudian text was very very important For everyone. The the two texts that everyone talks about at the time were the 1911 paper, the two principles that I mentioned earlier on, and Beyond the Pleasure Principle. What was so interesting about that text to everyone? There there were two things that were taken from Beyond the Pleasure Principle, the notion of a stimulus barrier and the notion and Freud's description of the
Famous game of fort da, which if I have time, I'll talk about a little bit later on. What was the stimulus barrier? The stimulus barrier was an idea that Freud develops in chapter four of Beyond the Pleasure Principle, that there's an initial organic He sees it in the sense as as as alive, yet at the same time somehow not alive, layer or rind in the psyche, The main function of which at the beginning of life is to protect the infant from too much stimuli overwhelming them, which would basically cause a psychical catastrophe for the child.
So, the stimulus barrier is like a shield, which protects the child and only lets in certain amounts of stimulus. Now, what does that mean in practice? Well, you could say It's reflected in the fact that in the early days and weeks of life, babies spend quite a lot of time in sleep. Yeah? There's a stimulus barrier which involves a raised threshold towards stimuli coming in. Now, why was this This might seem absolutely obvious to anyone today. I mean, it's not rocket science to imagine that there's some kind of barrier that protects you from everything flooding
in From the outside, but it was kind of big news at the time just because the people doing analytic research in the 1930s and 40s had been kind of brought up on the idea that problems children have that move them away from a kind of typical neurotic future are to do with impairments in the function and constitution of the ego. It's the the quality of the ego that's The problem. But this focus, which was really introduced by people like Sibylle Escalona and Mahler as well, on Freud's notion of a stimulus barrier changed that. Again, it
might seem obvious now because what it meant was that you no longer had to look at the constitution of a baby's ego to try and understand why they might experience Difference or difficulty later on, but rather you could look at this early rind, the psychical rind as Freud called it, of the stimulus barrier, and you could see it as being perhaps unduly thin or porous in some cases for whatever reason. Yeah? And that porosity might mean that the infant from day one was flooded with stimuli. Again, Creating these circular patterns. If a child is trying
to breastfeed, let's say 2 hours after being born, if they're being flooded by noises in their ears because the stimulus barrier isn't robust enough, it's not thick enough, or light is burning into their eyes, they're obviously not going to be that interested or even able to feed in an expected way cuz they'll be so busy trying to defend themselves against this influx of excitation. Yeah. So, again, You have a problem at a sensory level which will then generate problems at the level of the signaling systems between the mother and the child. Again, beautifully described by
Erikson. Now, with this idea of a stimulus barrier, it then seemed to explain a lot of the phenomena of early infantile autism. If the child didn't seem to hear or see, it wasn't because they were deaf or had [snorts] problems with vision, it was because they'd had to raise the thresholds of the stimulus barrier. And again, what the analysts showed here went really in the sense quite against a lot of the other views at the time because what it showed, it wasn't that the infant was born with some kind of congenital deafness or problem with
vision, it rather showed that autistic infants were born not with a hyposensitivity But a hypersensitivity that they were acutely aware, they were too aware of everything that was going on around them. And this then necessitated the raising of thresholds in order to protect the child. Yeah? Now, what did this mean? Clinically, it meant that if you raise thresholds, a lot of stimuli that you might otherwise want Would no longer be available, would be blocked. And crucially, it also meant that if so much was being blocked out, there was a strange a kind of temporal gap
that some of the researchers had noticed at the time that they couldn't really explain. It seemed as if in the first 3 weeks of life, the stimulus barrier was more or less maintained through sleep and Through biological mechanisms which kept the baby protected. But between 3 weeks and 10 weeks, again, it seemed to researchers at the time that there was a kind of opening of the stimulus barrier, which was then becoming in a way more more mastered by the child from about 10 weeks, where which was linked to various operation physical operations that the children
were able to do. So, Without going into the details of that, Mahler's brilliant deduction from all this, suggested by Sibylle Escalona, was that if Freud had suggested that there's a psychical barrier that blocks stimuli coming in to flood the world of the child, and that problems with this can generate some of the phenomena we see in early infantile autism, Mahler suggested that maybe the stimulus Barrier in neurotypicals is actually not in the child's body, but outside the child's body. That the stimulus barrier isn't isn't linked to the cortex, but it's actually embodied not in the
child's brain or body, but embodied in the parent, in the mother. That the mother is becomes the child's stimulus barrier in the sense of a differentiating organ outside the child's body. Cuz what Does the mother do on Mahler's model? She protects the child. And not only protects the child, but also gives a route for the child to access the differentiation of reality that Freud had seen as so central in the 1911 paper. Let's look at that. Isn't that interesting? Is that too noisy for you? Does that taste good? Oh, no, you don't like that. Through
this process of daily Amplification, commenting on, helping, administrating to the child, the child is introduced to a world which is divided up into meaningful units. This is good. This is bad. This tastes good. This doesn't taste good. This is dangerous. This is safe. All the things that a parent can transmit to a child. And so in Mahler's view, the mother is a kind of living, breathing semiotic system outside the child's body That gives the child in in a way you can say that for Mahler, the child outsources its relation to reality to the mother. Yeah?
And then later on this is all internalized and the child has a greater autonomy. That's another story. But you see this this brilliant idea that Mahler had, that you move the stimulus barrier outside. And then the consequence in terms of the clinical Picture of early infantile autism for Mahler was again very very simple. That due to these problems in synchronization, which could be due to any reason. It's got nothing to do with bad parenting. Marla was actually very impressed with the devotion of the mothers of autistic children. If for whatever reason these signaling systems are
out of sync or are not working, they're not entrained in a typical way, The child is then unable to use the mother as their external differentiating organ to outsource the construction of reality. And so, the autistic child for Marla has to invent the world for themself. Yeah, exactly what so many autistic subjects describe in in memoirs and in clinic and on the web, you know, the these descriptions are very, very ubiquitous. The idea and the lots of different ways of formulating this thing about it that there's a a difficulty in linking experiences to previous experiences
or what some people call priors, which means that everything has to be thought of anew, which generates both difficulty and brilliance and creativity. There's a the lovely story that Lorna Wing told to Francesca Happé of a little autistic kid who was asked To name the parts of a toy bed set, and he named the bed very well, and he named the mattress very well, and he named the quilt very well, and then when Lorna Wing pointed to the pillow, he said, "It's a piece of ravioli." It's brilliant. And and as Happé comments very nicely, she
said, "The The kid assumed less and was hence able to see more, whereas neurotypicals assume more and hence are able to see Less." And I've got to say that ever since reading that anecdote, I can never look at a pillow or a piece of ravioli in the same way. You know, you you you see this this extraordinary, you know, creation that that invention of the world allows. And again, without going into the the history of theories of autism, you can see many many many theories of Autism as versions of that basic [snorts] idea of outsourcing
and then invention. Now, how much time have I got left? 10 minutes or so? >> Yeah. >> Yeah, okay, great. So, let let's just move very quickly. Great, lovely. So, Beyond the Pleasure Principle, the which was really the most commented on text in the early autism literature, So, the notion of the stimulus barrier was very popular, but also what people went back to again and again and again was the famous fort da. The story that Freud tells of his grandson Ernst, who, when he was 1 and 1/2 years old, took a cotton reel, threw it
into his cot, his curtained cot with a fort, and then pulled it back with a da. Freud says he he threw it away more than he pulled it back. And this was a game, he thought, that Allowed the little boy to turn the experience of his mother leaving him into something less passive and more active, cuz he was now in charge of the process. He could make the cotton reel come back just as he could make it go away. And he linked it also to the opposition between the phonemes fort and da, so linking it
to a symbolization, again something that that analysts have been very very interested In little Aaron. And Freud notes as well that when the mother came home, he greeted her with an "Ooh." Like as in the fort and are. And he links this to the fact that during her absence, he had been able to make his own image disappear in the mirror. And Freud says, if I can find the the quotes, Yes, it's a footnote. One day the child's mother had been away for several hours and on her return was met with the words "Baby Ooh."
Which was at first incomprehensible, but it turned out that during this period of solitude, the child had find had found a way of making himself disappear by playing with a mirror where he could make his image appear and disappear. Okay. Now, you can interpret that In a slightly different way because he says it to his mom, he's telling her, he's conveying to her this message that the baby has disappeared, which I guess would presuppose the fact that he has disappeared for her cuz he's telling her that the baby's gone, that the baby can disappear for
her. It's not just about the mother disappearing or being able to disappear. And this brings us to the interesting Aspects of the fort are cuz presumably when Ernst threw away the cotton reel, he made it disappear, it was symbolic in some sense of the mother. It was representative of the mother. Yeah? Everyone seems to agree. You could also argue it was representative of himself if you link it to making his own image appear or disappear in a mirror, but his own image as present or absent for the mother. But this again presupposes Is that there's
some registration or symbolization of the mother as the mother. Yeah? And what the early autism researchers were especially interested in was the possibility that in some cases of autism, maybe this process hasn't happened or has occurred in a slightly different way. And that for the mother to be constituted as an object, there needs to Be the establishment of a certain confidence in her reappearance. Yeah? Little Ernst throws the reel into the cot and pulls it back, but I guess you've all seen cartoons where someone throws a fishing line into a pond or a lake and
pulls it back and there's nothing on the end. The hook isn't there anymore. There's no fish there. There's nothing there. What would happen if the child threw a reel away and had no confidence that the Reel was going to come back? Yeah? And this was suggested was perhaps resonant with the experience of some uh autistic children where due to these early problems in entrainment and in synchronization, there was a lack of what Therese Benedek called the confident expectation in the mother. This was a point she made in 1937 in a very, very nice paper where
she argued that when children have a problem for Whatever reason in establishing a faith in what's going to happen next in parenting that could be for any reason, yeah? That meant that they will then pay more and more attention to the non-human aspects of the environment, temporal sequences, order. This has to be done after this. Certain objects used in care that the peripheral phenomena of the environment, the non-human objects, and The time sequences will become more important than the person because the sense of a reliable expectation, what Benedict called confident expectation, and what Eric Erickson
called basic trust haven't been built up. Again, something very, very resonant with the clinical picture in autism where there's so much of a premium on sequences being followed through. That plans have to be well mapped out in advance, that objects and routines have to be kept the same. Remember Kanner's insistence on continuity and sameness rather than difference and change. Yeah? So, with the four die then, you have a kind of example of the confidence in an object that's symbolic of someone else with a situation where there might be little confidence that the real is even
going to come back, and a problem in making the real symbolic of the mother. The real might The cotton real might be Put in the person's mouth, it might be touched, it might be smelt. It would have more of a value perhaps as a physical object with sensuous properties rather than as a symbol. Yeah, and and you can think about the sort of Winnicottian developments of that and so on. Now, Marla noticed something very interesting. She noticed that when therapy advances Well, what you often see with autistic children is that they might take an object
and throw it. But, this is a little bit different from what you see with, you know, babies in a pram. Don't know if you've had this experience where they they throw all all objects out of the pram, and then you have to gather them up, and then they throw them out of the pram again, and They might be angry, might be taking revenge. There might be, you know, a kind of storm of emotion there. It's very, very common. But, what Mona noticed was that it seemed in these instances as if it was less a kind
of aggressive or violent act, but rather the beginnings of a kind of game, where the child was creating its own fort da, but using not simply itself, but outsourcing part of the process to the therapist. So, the therapist would then Be expected to bring the object back to the child. Yeah, which is something for her that you wouldn't see in [music] the early moments of the therapy. It's something that could only happen later on. It's May the 6th, right? Freud's birthday. Freud hated birthdays. I think you'd probably agree, you know, Freud experts here. Freud was
never comfortable with birthdays. He didn't like all the gifts. He didn't like Having to reciprocate. He didn't like having to say thank you, and and he didn't like being made, you know, having a big song and dance made about him. He didn't like all this stuff. He says to Abraham at the time of his birthday in 1919, he think he said the time is now ripe to abolish the celebration of birthdays. Now, in German, you don't have this expression, but in English, we say Almost automatically when someone has a birthday, we have it on cards,
we say it, we say many happy returns of the day. But, why do we say that? Why do we say happy returns? What's What's the returning? Yeah. Traditionally, it means the return of a feast day or a religious festival, or a day which has a value in usually a religious or sometimes a profane calendar, and you are hoping that the Day will return again. When it's when it was then historically applied to birthdays, obviously means, you know, we want the day to come back so you get to live another year. And Freud says again in
the correspondence with Abraham, he actually says, cuz the expression isn't used in German, he says in English, "Many happy returns." Yeah, so he was aware of the the resonance perhaps of the term. And let's just conclude with that. This Detail linked to Mahler's clinical observation around the idea of a happy return. What makes a return happy? Cuz what you so often see working with with young autistic children is that there's more of a kind of desperate and sometimes frantic activity to make an object match or to return things to the same place. So, Kanner had
noticed that a kid would go into his office, Pay no attention to him, look at the books on on a bookshelf, or look at the objects in the room, be preoccupied with that perhaps. They'd come back two years later or a year later, and they'd they'd go straight in and they'd show that they were disturbed by the fact that the objects had been moved. Yeah? And and this was such a well-known thing that many parents of autistic children in the 1950s and 60s, without any therapist telling them what to do, they they Decided themselves to
do things like change all the furniture in the house to force their kids to accept difference and change. And it even became the principle of a very unfortunate kind of therapy called implosive therapy. Yeah? And you can read the accounts of parents at the time. It's It's very sad to see what they were doing and you imagine the violence done to the child with the idea that these kids didn't accept difference And so you had to make sure that nothing was returned to the same place to kind of force an acceptance of change on them.
And then, no doubt, that wasn't always particularly successful. It must have been very painful for for those children. But, something we see in the course of an analytically oriented therapy, or or even a non-analytically oriented therapy that's recognized that, Is that if early on there can be a kind of desperation to make certain objects or sequences match, to make them exactly the same as they were before. Sometimes you find later on that there can actually be a joy in finding the same thing again. There's a very nice uh vignette in a book by Bronwyn Hocking
called Little Boy Lost, which is a a kind of in a way an analytically inspired account of her Bringing up her autistic son. And there are moments when he's absolutely desperate and frantic to make sure that certain elements in his environment match each other. And then there's a moment when he's absolutely delighted to find that the shape of a little toy Christmas tree matches the silhouette of some rooftops in a TV program. And there's also an absolute joy he Experiences at a certain point in realizing that the puddle of piss that he made on the
floor in one room one day that he'd been reprimanded for matched a little puddle of water on the kitchen floor that he found the next day. And doesn't that suggest perhaps that that what matters is not so much the return, but the happy that you see the joy in the re-finding? Yeah? But, what allows that re- the joy In the re-finding? Isn't it precisely the fact that there has to have been in the meantime some kind of registration of absence? Yeah? Exactly what perhaps didn't operate in the way it had operated for the neurotypical playing
the fort da, where because there isn't >> [clears throat] >> a straightforward symbolization of maternal absence, the child again is left to create for themself Structures where there's an emptiness or an absence. The way in which autistic children very often will empty containers. A container has to be either totally full or totally empty. They'll pour things out of bottles and cups and containers to create an emptiness that perhaps hasn't been established. And so, what we see there is the way that for a re-finding to have that positive, perhaps joyful, nuance, it supposes a certain framing
or creation or marking Of absence or loss, exactly what the work inspired by Freud has suggested to many analysts and therapists since then. Today, thank you for listening. >> [applause] [applause] [applause] >> Thank you very much for this wonderful lecture. Besides the fantastic context, I have to say I'm impressed that you can just Say all of these things without reading. Thank you very much for that. Um I think we have about 20 minutes and uh I because we only have 20 minutes, I like to open it up for the audience. Usually also our board members,
if they like to make a comment, um it's welcome and then we take it from there. We want to hear your thoughts in this 20 minutes that we have together. >> Yeah, there's a question. >> Thank you so much for this talk. I had a question that was um hope it's not annoying. It's a little bit like a expansion of something that you just touched on very briefly, which was this idea of gravity. Uh and and gravity is this um initial uh sort of external um force acting upon the infant body and and you mentioned
two thinkers that I Didn't have time to write down. I wonder if you might have a note. >> Yeah, sure. So again, this is something that that is is in in most of the mainstream analytical research, it's quite peripheral. But it was developed by Paul Schilder from Vienna, who went to America and and joined Johns Hopkins in the same year that Kanner was there, 1928, and they wrote articles together. And he married Loretta Bender, This well very influential New York psychiatrist, and both of them, again, they co-authored papers on the on vestibular sensations in infants
and children. And they argued that again, you know, this was quite quite far out at the time, that the ego in the Freudian sense is constituted first of all through the vestibular dimension. Yeah, so through the relations of the infant to the Effects of gravity. Yeah? Again, you know, this is like quite a radical idea at the time, and I I think in many ways it still is. They developed those Schilder, unfortunately, was hit by a car and and died in 1940 just after going to meet his newborn baby at the hospital. Um so his
whole research program was shut down and wasn't really developed by by anyone afterwards as far as I know. I mean, There's a a fair amount of literature since then on autism, vestibular sensations, gravity. Um but not with the kind of analytic inspiration that Schilder and Bender had. Um but again, you know, you you see these things very very clearly when autistic infants, when they get a bit older and are able to transmit their experiences, um you know, they can explain that just Sitting in a chair without having their back supported or their feet touching the
ground can actually make them feel totally totally dizzy. Whereas, you know, you wouldn't expect that. You think the the baby's sitting comfortably, what more do they need? But they may be feeling so giddy and disoriented that all their attention is focused on trying to gain a bodily equilibrium, which obviously means that other aspects Of their social situation will be neglected. And that can then create these circular processes that that Mahler and and and Rank and everyone had been so interested in, whereby the parents and and the the adults and perhaps children around the baby, the
infant, think that they're being ignored or that something else is going on or that there's, you know, there's some kind of failure of contact when it isn't necessarily that there's a Failure of contact. It just means that the kid is prioritizing feeling safe. So, yeah. >> Lisa. Uh go ahead. Thank you for a brilliant lecture, Darian. It's really, really interesting. I wanted to go back to the first part of what you talked about, which was the process of diagnosis. And autism now has become a kind of imperializing diagnosis. It takes in More and more kinds
of children and indeed people. Um And I was wondering whether you thought that in the current situation or maybe not, uh what you thought in the current situation analysts might be able to contribute to perhaps slightly deering de-imperializing it and giving it uh more balance. >> Uh thanks. That's a very good question. Um I mean, for I guess a lot of you will know this, but for those of you who who who don't kind of follow what's happening in the autism world at the moment. So, for the last few years, about two or three years
now, many of the people who forged and popularized the category of autism spectrum disorder are now arguing that it should be basically got rid of and replaced by new segmentations of Autism, which they argue will allow for better care and parity. But all of these views are in the service of of health and insurance um structures. So, but they're basically uh to a certain extent financially motivated because bills for care are and support have just increased exponentially. Now, in a way Analysts, you know, I don't think we're in a great position here because you know,
we might find it very interesting to differentiate different structures within the so-called autism spectrum. And this is, you know, personally I I find this very interesting, but you've got to ask the question, who does it really serve? It really just serves our own interests. Yeah, you know, I can be Very happy writing a paper, you know, trying to produce new segmentations, but it's not going to help anyone because the most important thing that that advocates, autistic advocates, and disability advocates have been trying to show for decades is that someone can function brilliantly maybe for an
hour and then not so brilliantly or not at all maybe for another day. You know, a kid in the classroom might be able to Focus on a task for 5 minutes and then they'll be totally incapacitated right after that. And narratives about spectrum diagnoses and autism often, you know, create looping effects where the person is expected to behave in a particular way and so they don't factor in the reality that there'll be massive variability both between individuals and within the same individual. You know, Someone could could be, you know, you know, brilliant at some task
at one moment and then they'd have to, you know, stay in bed or or retreat away from the world for the next few days. And you can't really fit that nicely or easily into current segmentation system. So, so I think in the end you know, my view is is is closer to to Freud's view on on infantile cerebral palsy that the question isn't is the diagnosis Scientific, but it's rather is it helpful? And ultimately although we can all recognize it's not scientific at all, it I think it is more helpful to stick with a vague
and quite woolly multidimensional diagnostic area and then try and evaluate things in terms of what care people need case-by-case, what support people need case-by-case. But I mean we might see, you know, a huge backlash that's already beginning against the idea of spectrum diagnoses. I think you you had a question but >> you had a question. Yeah. >> Thank you so much. This was really fascinating and it's still occupying me and will for many days, I'm sure. Um I have a a brief association or comment and then I wanted to follow up on this question about
diagnosis that that you Began with as well. My association is with um Winnicott's description of emptiness. And well, he has two seemingly contradictory descriptions of something like emptiness or nothingness. One negative and one positive. And you know, the negative is his notion of the primitive agonies including a sense of falling forever which I was reminded of when you described the situation sitting without A connection to the floor, a sense of a loss of feeling of real. Um that's my favorite. Um and and he he describes them as behind, underneath, preceding, more primal, whatever you want
to say, any kind of psychotic symptoms. So, that that's sort of what can happen if that if that uh outsourcing, I think, it doesn't happen in the earliest stages. But, he also says that we start with un as un Integrated, and that's crucial. And that um uh a sense of disintegration can only happen if there's been integration. And so, I was I was really reminded of that when you talked about the creation of an absence, because you need the absence in order for something to be able to happen. But, my question has to do with
um diagnosis Um the relationship between diagnosis and identity that is uh becoming very strong in the US uh academic world that I dwell in. Um and I'm I'm just curious about your sense of uh the embracing of neurodiversity as a as an identity. Um >> Yeah, I mean >> [laughter] >> thank you for that. And and thank you for um evoking Winnicott's who you know who had made some comments in the early '50s about autism and trying to separate that from from other kinds of diagnostic category. I think the the the key to situating the
the Winnicottian thoughts about those experiences It it it brings us back to the idea the Freudian idea of the stimulus barrier, because what the early autism researchers who were using Freud's ideas found or what they argued was that we're not dealing with defense mechanisms here because for a defense mechanism to operate something has to have passed to the level of a representation that you can then defend against or project, yeah? And yeah, so so what what you're arguing with Winnicott is a state prior To that where bodily sensations, bodily processes haven't attained that status of
representation and hence can't be defended against. And so rather than talking about defense mechanisms many of the early researchers said we need a different vocabulary threshold mechanisms for example, boundary creations for example. Nowadays we have the sort of vague category of regulation, yeah, which in a way has Kind of taken the place of those those early concepts. Um I mean in terms of identity um I mean you know some people have found it life-changing to reread their their biography in terms of a diagnosis, other people find it profoundly alienating. And I think you have to
respect different people's relation to it. You Know, if it's helpful for one person, great. If it's not helpful for for another person, well, what else can be done? One of the things we have in in the UK is that um children between 10 and 11 years old in the state education system are taught diagnostic categories. And so I see kids in my office who's you know 10 11-year-olds who say you know, I don't want to have depression or anxiety cuz that's not worth you know. They literally say that this is totally worthless as a diagnosis.
Um Can can I can I get bipolar or um autism is is respected, but everyone knows that people will behind your back if you have an autism diagnosis, so people are less keen to get that, yeah? But there's still an absolute, you know, that there's a currency in diagnostic labels, which you didn't have before. And of course, you know, you you you could link that to the whole history of especially the between and and teen years where people gravitate towards labels at the same time as gravitating away from labels. You know, part of the the
the the difficulty and the confusion of the teen years is that you want and you Don't want to label. But culturally, of course, you know, as many philosophers have pointed out, one of the characteristics of of of the last 30 or 40 years is the increasing medicalization of difference. And although, you know, people say that, you know, spectrum and and autism have now left medicine and you can proclaim, you know, your own diagnosis, this is just nonsense because medicine Still remains almost everywhere in the world the gatekeeper of diagnostic categories, and you still need to
have your diagnosis legitimized. So, you know, I think, you know, great if it's helpful for people, but it's it's worrying that it's become so much of a currency among kids. Um and yeah, I mean, I don't think it's going to be going away soon. Yeah, you had one. >> Yeah, what? >> Go on. >> Go ahead. >> Excellent. And may I ask just very quickly, um thank you very much. I was like Gohar, I was amazed that you were able to speak for more than an hour without taking a sip of water. And then >>
[laughter] >> and detailing the the whole history as well. I have a couple of questions. One is my question was where you'd place the Work of Tustin and and Anna Alvarez who I think were just important analysts to continue to even uh consider and speak about autism from an analytic point of view. That's one. And then how would you describe leaning on on Alyssa's and Gail's question about um the the place of autism now because it was for so long in the hands of behaviorists. And uh long before uh psychoanalysis Maybe returned to it and
now it becomes sort of as you say and you confirmed the diagnosis to have and is often mixed up matched up with other diagnosis. And last thing I want to I thought that this um concept of the you know that you brought up with Ford the concept of the the confidence in that the mother is returning and when that is not there um in to what extent It there might be also a connection to the very prevalent addictions right now particularly addictions to um telephones and and objects. I mean I've I've just seen an incredible
in my patients incredible increase in kind of this addictive behavior to to objects that are always available. So. >> So that's a lot of questions. I don't know if I'm going to be able to respond to all of them. But but um so Tustin what's the amazing thing about Tustin is that that she went to Boston. She went to work with Tola Rank in 1953 to 1954 and then took all that stuff back to the Tavistock. She brought all that stuff back to the UK. Now, her theories, I didn't really have the chance to go
into them. She has a slightly literal theory of autism, but if you make it a bit more abstract, it becomes much more powerful and resonant. Her idea was basically that following Spitz, although I don't think she quoted him much, she has the idea that with autistic children, there's been a primal, very, very early experience of separateness from the mother, but before the mother has been constituted as an object. So, before the mother has been has been created into a libidinal object, which implies both the Confidence in her and a recognition of symbolization of our absences.
And what that means is that when the child is confronted with experiences such as weaning or loss of the nipple from the mouth, because the mother hasn't been constituted as a separate object, the infant will experience that as a loss not of the mother, but of a part of themself, which they then desperately have to plug. Again, You see it also goes in the direction that therapeutically it'll be helpful for some kind of framing or symbolization of absence to make that experience less painful and more bearable for the child. Her her later differentiations between encapsulated
and confusional forms of autism is basically just a rehash of Margaret Mahler. Um And it's interesting reading her case histories, they're always a little bit more complicated. And again, you know sorry to go on about this because I think we are better at just left with the under really undifferentiated category. Tustin, Frances Tustin for those of you who aren't familiar with her work, so she was in Boston in '53 and she was working seeing kids all day long, supervising kid Adult therapists all day long from then until the mid-1990s. She said in her whole life
she'd only ever seen four pure cases of autism. What the hell? Leo Kanner, famous for creating the diagnosis, he said he saw more than 20,000 children in consultation. He'd only ever seen in 30 years 150 cases of autism. I mean, you know, what? What does that say? Doesn't it mean that You know, either this is a sort of real mythic category or or perhaps it's better to be talking about something else, yeah? And maybe to have sort of more impure, unscientific category is often many more helpful. Anne Alvarez has done some of the most subtle,
brilliant post-Klinian work and really encourage you to read her books Live Company and the the sequel to that. Um And um and she gives she talks about the four doors as well in relation to autism and she gives five different versions of the four doors. Again, absolutely fascinating building on Tustin's work, but introducing Alvarez is a much more subtle thinker than than Tustin. Some very, very you know, fascinating nuances and differentiations of Klinian concepts to help us understand stuff. Um The question of behaviorism, again, I hate to say it, but you know, a lot of
the behavioral therapies today are much less rigid than they used to be. A lot of them are softer. A lot of them are much more inclusive and a much more child-led than simply imposing, you know, blindly a kind of grid onto the child with punishments and aversives. A lot of them have really evolved. What I think you see nowadays is that non-analytic therapies and analytic therapies are often very, very similar in what they do to support the child's defenses, to help them follow their interests, and allow their interests to become more inclusive towards others, more
more, you know, reaching outwards, and to help them create and define bodily boundaries. You know, we have our own analytic ways of thinking about these Things, but, you know, other people think about it in a slightly different way, but clinically when you look at their accounts, very often it's it's it's very, very close to what we do, although, you know, I'm not saying there aren't extreme forms of behaviorism that that do something very, very different. But, yeah. >> Mhm. >> So, I think we take one last question. Yes. >> Thank you very much. If we
pay attention to the terms we use, for example, autism, autoerotism, narcissism, so we can see that autism is the autoerotism without errors. What do you think of it, and what is the relationship between autism and errors, and maybe tenacities? Thank you. >> Okay, that's a great question. So, Bleuler Bleuler and his wife, they they came They came to [clears throat] dinner here in October 1908, and the Freuds laid on a nice dinner for them. And it seems that the the main part of the dinner conversation didn't Freud didn't like it, because Bleuler and his wife
were trying to persuade Freud to change the term autoerotism to the term autism. And apparently the the evening went badly. And And what you see afterwards is Bleuler in a series of footnotes, in one footnote to the his 1911 book on the group of schizophrenia, he says, "By autism, I I mean something like autoerotism." In another footnote, he says, "By autism, I mean autoerotism." And then he then says, "When Freud talks about autism, he actually means autoerotism plus symbolism plus taking reality into account." So, he's Describing, again wrongly, a theory of autism to Freud. Now,
Bleuler's point was that for him, he he couldn't accept that autoerotism was a developmental phase, which was never really a concept in Freud. And he thought that the the inclusion of Eros would be off-putting to some people, but again, the paradox, Bleuler himself often, you know, signposted the importance of sexuality in in psychical life, in his Own life, and and in what he called autistic thinking. He preferred the idea of a return not of the libido to the person's body, but rather a reconfiguring of affect, which he preferred to libido. And he thought that Freud's
theory of autoerotism, which implied a a return of libido to the actual body of the person, was misleading because in his clinic, what what he he saw again and again was that when people were Governed by what he called autistic thinking, so affect-driven thoughts, where wishes were realized, impossibilities became possibilities, there wasn't just a kind of retraction of the person into a self-absorbed state, but there could be a movement outwards. So, in his example, a schizophrenic person who has a a delusional idea of reforming the world, they're not going to be just in a Self-absorbed
state, but they're going to be going outwards, talking to people, meeting people, trying to change the world. So, that was one of his main disagreements with Freud. And he thought autoerotism implied something that was just linked to the body, rather than an outgoing, more socially directed, um, effort. >> You said something when you were giving the wonderful example of the child autistic child naming the pillow as a Ravioli. You said he assumed less and saw more. >> Yeah, Francesca Happé says that very nicely. >> which I thought it's a fantastic line, also. If I would
unfairly want to summarize your lecture, I think you're trying to tell us to assume less about autism, hopefully to see more. >> Yeah, to see the ravioli. >> To see the ravioli in the >> [laughter] >> autism. So, I want to thank you for being here and wishing you many happy returns. >> Thank you. >> [applause] [applause]
