Asperger’s Syndrome

 

Romeo Lucioni – Alberto Farina – Ida Basso – Alessandra Amabile

 

“… no son simplex raros”

(Murphy)

 

Almost at the same time as Kanner who presented his first cases of “autism”, in 1944, the Austrian pediatrician, Hans Asperger, was making known a group of children with tendency towards isolation, but gifted of a high I.Q.: people that started to talk of “Asperger’s syndrome”, characterised by difficulties in socialisation, deficient social faculties, obsessive-compulsive behaviour, mental rigidity and incoherence, not accompanied by trouble of language nor by psychomental and intellective blocks.

Carrying on the research, today we managed to establish that these signs appear around six years of age, accompanied also by obsessive behaviours, exaggerated reactions, giving up on a busy life and to the initiatives that had normally developed.

In these cases quantifiable biological signs were not highlighted (the normality of the reports of TAC, of RMN, of EEG etc. contrasts with expressions such as “… the A.S. is a neurobiological disorder included in the autistic spectrum, even though in latest times some researchers have highlighted structural anomalies in the frontal lobe of the brain (data that was not confirmed yet and difficult to read).

Even if the biological factors still take up space in the determinism of the personality, influencing the psychomental development and the organisation of the representational system.

Right or wrong, good or bad, useful or useless, sound or banal, convenient or inconvenient, prestigious or harmful for the image, healthy or detrimental for the body, they represent the alternatives that get learnt in relations verified in the culture, accepted in identification and expressed in behaviour.

These, that we can also define cultural forms, inspire the styles of life, but deeper, they contribute to the determination of psychomental development, to the forming of ego and to what was called the self, psychic structure that accompanies the adult and socially integrated man.

Almost all the described cases show deficient motory ability, but it is difficult to signal this symptom as primitive, because the renunciation on life, the reduction of activity and preferring to be lying on the couch and listening to music bring, already, to a reduction of the simple and complex motory abilities.

The considerable singularity of the responses to social, relational, sensorial and/or vital stimuli is a characteristic sign that drives the family “crazy” and/or the caregivers because the answers never result normal or foreseeable and besides the obtained results are always conflicting with the real and evident mental abilities of the subject.

Treating a case of “psychomental illness of Asperger” (it is therefore not a regressive process) does not result an easy task and moreover the diagnosis can call for a long observation since the subject easily withdraws in the house, is reserved towards the others, is mute, not because (they have nothing to say, but because it refuses the personal contact: tends to discredit the world (even if it is obsessive in learning generical and varied informations) and to take no interest in the relationship with other people.

These negative aspects induce a form of psychomental regression and renunciation to maintain any form of activity: the most typical expression is “oh! How tired am I”.

 

Trying to put together characteristic psychopathological signs we can say that the Asperger subject:

 

        can not answer to questions appropriately and coherently, showing not to be able to take advantage of an efficient “criterion of reality”;

        demonstrating a disharmonious psychomental development because they present parts organised after normal temporal parameters and others that are delayed or that never arrive;

        highlight trouble of adaption to tasks that often get referred to forgetfulness, superficiality, indifference or also opposition;

        the intellective abilities are disharmonic that one can find good mathematical-deductive abilities, together with big deficits to the imaginative and logical-lexical ones;

        present also difficulty, to generalise the learning (quality that gets referred to symbolical development);

        they are disturbed by informations that get presented in a caotic and/or little structured way and also when they are presented in a multiple and/or contradictory form;

        support with difficulty the frustrations and react with outbursts of rage or with sulky expressions and opposizione;

        experience sensations of inefficiency and inadequateness that bring to sudden and unjustified withdrawals (often studies get interrupted) and/or cooling of will;

        highlight the emotive incontinence, responsible for the reactions of rage, of flight and of breaking the relationship with consequent isolation (“…overload of the electric circuit”);

        often manifest repetitive behaviour that can contain crises of internal tension;

        are clumsy in complex motory behaviour, as consequence of an insufficience and/or a disaccustom but never of a deficit.

 

The symptomatology, read with a psycho-neuro-cognitive register, is characterised for:

 

-         difficulty to conceptualise the sensory spectrum and, therefore, to organise a valid and permanent “representational system”;

-         impossibility to express with mimic, posture and attitude the own affective valencies, just because the awaying and the variability of reading emotions brings to continuous variations in the intimate resonance: love and hate, just as participation and indifference, are sentiments so close that the subject passes from one to the other in a short space of time;

-         difficulty to read with precision the coordinates that link the causes to the effects and this, above all, when it concerns interpersonal relations;

-         a great sense of fatigue, just because in front of any thing, is the psychic and moral weight that one must choose; this means indolence, the perennial “fatigue (leads them to refuse the physical exercises too which is why they result in difficulty in front of complex motricity), the frequent and irritating answering “…. Boooh!”;

-         oppositive and/or aggressive reactions that are (per lo pi) determined by a state of stress, unsustainable internal tension, even though, from the outside, it can not be justified or understood.

 

From one psychodynamic point-of-view, one can speak of “pathological structure of the Ego” linked to a disorder of the psychomental development.

The concise activity of the ego manifests in the organisation of the Genitorial Object and the affective development (that is the foundation for the representation of self and the objects of reality) and, in the borderline, the representational difficulties that are observed bring from one side not to have a shareable term of paragon and, on the other, not to benefit of the “reality” to give a sense of value to oneself.

 

In the clinical observation we find:

o       poverty of personal identity (personality “as self”);

o       scarce perception of self and the own social role and, therefore, identification with the Other through a sustained mimetism;

o       impulsiveness and emotive insustainability;

o       disturbed affective relations: anaclitic, dependent, complementary, rarely reciprocal;

o       inexistent identification caused by poor and partial relations with the internal objects;

o       depressive sentiment (that never is blaming oneself of abandonment; solitude and impossibility to organise satisfactory relation, that renews daily and does not give space to access self-satisfaction;

o       broad variety of adaptive nevrotic conduct (above all hysterical) that bring to a deformation of the Ego;

o       deficient adequateness of the sense of reality with constant sliding towards personalistic and inadequate perceptions;

o       difficulty to maintain a narcissistic “permanence”, the Ego fluctuates between being and not-being; producing an extremely fragile sense of self: a frustration is sufficient (even if lived in the imaginary) to provoke serious and depressive crises;

o       low tolerance to anxious reactions with scarce ability to self-congratulation for the own relations and for the own successes in the work (when they manage to carry it out they are obstinate and precise);

o       multiple phobias, fussy and obsessive behaviour;

o       tendency to paranoic sentiments and to hypervalorative thoughts of self (without ever reaching the limits of fake self);

o       tendency to increase in value as “young”; efficient, valid and mentally adequate (the thought of the others result valued: the value of self and of the Others result extreme result to be extreme ends of the arm of the balance;

o       dark states of refusal and isolation, charged of accuses both painful as vague and of little value;

o       the experiences of pleasure result only episodically ego-sintonic, presenting themselves foremost as ego-distonic, therefore, valorised.

 

Observations of a clinical case

 

Affa is 20-year-old young man when he reaches to the observation, requested for by serious attitudes of self-inflicted wounding.

A few months after serving in the army he started to say incoherent and little understandable sentences, that referred to “….. fear of guard duty and by the eventuality to make use of the firearm that he had”.

On request of the consulted psychiatre, the interruption of the military got rapidly arranged and the youth started a psychotherapy where difficulties to maintain a good relationship were highlighted even though a clear attitude of dependence brought to establish an environment sufficiently useful and capable to sustain a wish to “grow in self-individualisation”.

In a moment of affective expansiveness Affa said: “….. I recognise that in these meetings I learnt to think….. this is why I manage to organise my mind that now is mine…..”.

The personal history, rebuilt in the psychotherapeutic sessions, reported how the first signs  of “psychic difficulty” appeared around the age of three. A photograph helped him to re-experience the wishes of “castration” towards the father. “….. I wanted to cut his nose off”) and anguishing sentiments of shyness for “….. having such a small penis”, thought that induced the continuous request to wear the diaper as the sister (“narcissistic injury”).

Having started the school period regularly, the mother referred a lively boy, cheerfulness, capable to enjoy the company of mates and friends.

Around the age of 10 the first psychopathological signs appeared with a refusal to maintain relationships with the children of his age and to a certain tendency towards isolation; continued schools with difficulty because the commitment into study had strongly weakened. Affa reported “… I went on without studying, doing the bare minimum, remembering the explanations of the professors”.

This was an important sign because it had structured a sentiment of inadequateness and guilt to not deserve the obtained results.

She interrupted the studies at the third year of secondary school, without reaching the corresponding diploma; closed at home where he passed long hours in the cellar reading old newspapers.

For a short period he worked as assistant-macellaio, then he left, waiting to be join in compulsory military service.

 

The psychological investigation put in evidence sentiments of depersonalisation linked to a deep sense of impossibility and inadequateness; the psychic world of the self was experienced as dominated and lead by a brain (interior to the self, but of another nature) that managed to convince him, that in order not to suffer moments of anguish linked to interpersonal relations even occasional ones, it was better to stay at home peacefully.

The Rorschach characterised for incapacity for the identification and impossibility to structure valid objects of reference; the test gives evidence for a psychopathological picture with:

        deep phobic-obsessive anxieties, little controllable, that determined a destructuring of perceptive capacities;

        big difficulties to perceive a reality configurated in objects difficult to recognise so that the images doubled allowing the appearance of confabulating thoughts.

        Deep anxieties of destructive-oral type that resulting little contained by primitive adaptive systems (narcissism and flight into a phantastic reality), were inadequate to defend the structures of ego.

 

The therapeutic relation got structured in the research for valid interpersonal links and, above all, of adaptive hooks to allow the structuring of a sense of self founding and free of anguish. The patient started to make himself available for group-activities that in the impossibility to use verbal methodologies (Affa did not express himself if not through sporadic monosyllables mixed to spaces of absolute silence).

After a few months of this occupational therapy (accompanied by weekly sessions of individual psychotherapy) the boy also started hippotherapy with excellent results, that he could not continue longer than seven months for an explicit and still refusal. This experience got experienced as a “too strong stimulus to grow, to assume a decisive identity, capable to make independent”.

In the work with autistic children Affa reported to feel like an “executor of directions and of orders” and, therefore, free from precise responsibilities.

The affective link with the children became pi sicuro, and, sometimes, also expressively characterised by hugs and by an aspect of mothering (putting on shoes, bringing to the toilet, offering drinks).

 

After approx two years Affa is a good collaborator, precise in engagements and respectful of rules, a “status” was built between the psychology of the Centre and, sometimes, by their indications of how to behave to overcome difficult moments.

He still does not manage to decide to take on his studies to complete his education, which would induce a necessity to “officially” assume responsibilities, even if in the conversations with strangers he declares “ …I like my work also because it is unbearable not to have anything to do”.

 

◊ ◊ ◊ ◊ ◊

 

The analysis of this case brings it into the middle of a long nosologic disquisition because many researchers put the accent on the fact that not many differences can be found between the Syndrome of Asperger, Autism at high functioning and borderline Syndrome.

 

In those three psychopathological pictures we can find:

 

         Medium-high intelligence quotient;

         Psychomental attitude dominated by egocentrism and by megalomaniac referred most-of -all to intellective abilities;

         Emotive coldness accompanied by critical responses of tension to stimuli of little meaning;

         Incapacity to structure good interpersonal relations for a special affective sideration that underlined incapacity to organise sentiments of reciprocity and of recognition;

         Disenhancement of the Other that can be “abandoned” without regrets;

         deep sentiments of incapacity and of inadequateness that bring to the refusal of the interpersonal relative and/or to isolation;

         psychic instability due to the incapacity to clearly report the experiences to the perceptions that so fluctuate, dominating incomplete interpretations, linked to marginal aspects, poor and devoid of value, absolutely personalistic;

         incapacity to structure good objectual relations with tendency to give up;

         great difficulty to “navigate in social rituals”, due to the fact of taking into account the conventions, the rules and, above all, the reciprocity.

 

For the borderline the beginning of the symptomatology, although it explodes between the 14 and 20 years, has its warning signs starting from the three-four years with memories of experiences that regard:

 

      anxiety of castration;

      deep desires for castration of the father;

      sentiments of shame that will subtend those of incapacity and of inefficiency;

      almighty use of the thought (I know…;my father knows…) that inhibits the necessity of communication and to establich relationships;

      tendency towards isolation (after the three-four years abandonment from all his friends);

      opposition and hate towards the father that however is also saved and protected, never abandoned (they do not manage to stay away from home);

      tendency towards subordination (when an own idea needs to be defended, one prefers to give up and/or change air, retreat);

      crises of opposition that however flow always into personal renunciation;

      ambiguous link with the mother of whom one accepts benefits and kindness, but that is always devalued (Macco, another borderline subject, said: “…my mother is stupid, she can not reason …she is not capable to direct the house … my father is right to always moan and not relying on her.

 

These psychopathological characteristics are difficult to evidence in the Asperger children, but it would be worth to investigate specifically with the adolescents to verify the presence; in this way it would be possible to verify the superimposition of the two syndromes. Our experience brings us to suppose that the Asperger (child that since the age of 3-4 years shows a relevant psychopathology) goes structuring an extremely accentuated dependence of the paternal figure and that conditions the development of the phenomenological characteristics.

Taking into account these observations we can also speak of a common etiophatogenesis because the three pictures highlight disorders of affective development (mood) referable to a partial reference to Oedipus: the symptomatologic characteristics links the Asperger’s syndrome to a special problem on the stopping place of the separation-individuation development and, therefore, in relation with the bond with the mother and, especially, with the father.

We can postpone to other works that regard the structuring of the Genitorial Object and to the development of the self through the dynamics of the “Name of the Father”, but it is clear that the symptomatology that links the sense of self, oral needs, sentiments of dependence and self-liberation that results the founding background of these psychomental trouble.

 

We can speak of an unusual cognitive profile, that is to bound the guiding lines for the psychomental development of the subjects that, although having good intellective abilities, do not manage to express them or to use them for a precise and above all shareable end.

 

1.     First of all we can reveal that their emotive-affective mechanisms acquire a significant and personalistic profile that brings them to not be able to establish a common platform with the people with which they come in contact.    

Egocentrism: their world is definitely egocentric and tends to leave out the others that are experienced as less intellingent, less capable to “see” the more real side of the reality, anchored to a life without values, without ethica, materialistic and useless.

Affa expresses these sentiments saying that his intelligence brought him to choose a life without illusions or wealth, but “sure”, while all the others (stupid) “tear each other to pieces“ to obtain things, foods, travels, objects, homes.

These words underline the oral dimension of the psychopathology that was evidenced also by the “famished” and “greedy” behaviour in the relationship with food.

2.     A contradictory aspect present in psychopathology is of a very low sense of oneself. Almighty sentiments hide senses of incapacity, of inferiority and inadequateness, that upset the psychomental flow, allowing explosive, instinctive, uncontrolled and exaggerated behaviours that induce responses of refusal and alienation.

In front of difficulties, the Asperger-borderline tends to renounce, putting forward the little value of what one risks to loose and the indifference in front of need.

The negative sentiment dominates the approach with reality and limits the cognitive abilities, blocking them in a sort of inanition. It is surprising to discover in every story how many goals were reached and then abandoned, how many opportunities were dropped, how many stupid justifications were invoked in order not to do, to relinquish at the last minute, to close the eyes in front of evidence.

In this sphere inhibition is important and the renunciation in the sexual sphere: these subjects do not dare to look for a girl (“…I take her if I do not need to make an effort, no sacrifice, but in the end of all, she is too different to me, never understands, for her I am worth nothing”), they prefer to be above, do not behave adequately and fail.

 

Egocentrism has a deep psychoanalytical meaning linked to an almighty-father figure, castrating, violating and inaccessible; therefore this megalomaniacale sentiment derives from taking possession of a “lineage” and an inborn quality that brings to putting oneself intellectually above the Others. The intellect is the true “weapon” with which one should defend oneself, finding therefore the barrier that isolated the world “degraded” and “inferior”.

Affa says “… I do not speak to the others because when I hear them express their ideas I realise that they are ignorant and faint-hearted; Macca too says “… I am from another planet, because I do not support superficiality and stupidity of my fellow’s!”

Naturally this psychomental position has delirious characters (they are however not a delirium) that do not manage to become ego-sintonic just because the others acquire a “value” of “… owning all that I do not have, all the characteristics of mental agility, of safety, of adequateness that I miss and that make a person incapable to maintain a valid relationship”.

The relations with these patients, although characterised by many difficulties makes them deliberately feel like strangers, as normal people that “play” to be egocentric, irritating, mute, indifferent, opposed, hysterical; just for this reason their disability gets often denied, their “sickness” and, therefore they provoke sentiments of refusal. Often even in the centres of psychopathological help they get referred and wish to be an outcast.

Their way to do is, in other words, always little conciliatory, opposing, pretentious and spiteful, as though they should all stay at their dependence.

The continuous wavering between almightiness and idle annihilation, between being able to do everything and never reaching the goal, between the tendency to always give the blame of ones insuccesses to others, the attitude of victims even if this derives from the own personalistic model to read the world, all cases result capable of turning away friends, acquaintances, relatives, parents, that reached a level of desperate exhaustion, decide to assume negative, accusatory and, therefore repulsive attitudes; the life in the family becomes unbearable and “one must be a saint” to bear their inconsistencies, their “malice”, their incapacity to gratify and be fond of others.

 

The egocentrism, sustained by the “sentiment of mental superiority”, becomes a defence against the “discovery” of the real dependence and incapacity to face up to the needs.

The decrease in value is a defensive way to bear the fear of loss; the almighty sense of superiority brings to say “… it does not matter that I depend from my father because if he should die it would be easy for me to commit suicide since “things” have no value”.

The phrase underlines dependency from a huge and almighty “Being” that can make me live and makes me live even if I do not love him.

This particular sentiment, that closes in itself hate and love, is really characteristic and justifies the behaviour of these subjects that never manage to show reciprocity and gratitude.

 

The reasoning that subtends this lack is fine:

1)     If you give me something it is because you want it and not because I ask you;

2)     If I would ask you I would show my weakness and my need, instead it is you that give it to me because you want: you have something that you do not need and you want to give it to me and you do not have in abundance or a thousand other reasons;

3)     You should not expect though that I thank you, that I feel in debt towards you, that I must repay the gesture;

4)     If I would accept this principle I would go against my FREEDOM, of choice and of decision, that is the irrevocable foundation of my life. (Macca, already 10 years old, reproaches inside herself the father that never brought him to see a game in the stadium, but never managed to ask him, he never expressed his desire);

5)     If you get angry for my behaviour, it does not interest me in any way because I can do without of what you want to give me (even if I do not need) and I do not need you either: I am I, even if the world ends.

 

This affective problem is the deep nucleus of psychopathology of the Asperger-borderline because it justifies the behaviour that appears always inadequate, anti-social, pushed to isolation. The hypervalorisation of Self that, how we saw, is the expression of an almighty and violent Super-Ego, brings to behavioural choices that seem paradoxical. From one side there is the hate towards the Father (that can do everything and gives me nothing because he is a pervert: he knows that I would like to, but pretends not to know) and, at the same time, the impossibility to detach from him is caused that gives the possibility to live and would kill me if I would abandon him. This is why the Asperger, like the borderline, do not know how to “love” anybody: the link with the Others would spark off the violence of the Master-Father would not let them live.

As Arnold Modell says, the Ego of these patients is split,  compound of two parts:

         A first one, deep and instinctive that would result weak and incapable to protect;

         Another, stronger, that it provided with destructive almightiness and is capable to give libidic energy for separation and isolation.

 

The objects wander in the psyche blocking all the possible linking-bridges between the outside and inside and a psychic world derives from it, intimate and folded on itself, incapable of validating through the confirmation of the “real” and the eye of the Other, that anyhow, remains persecutory, unreliable and “unsincere”.

The objects get seized and abandoned without affective scruple and regretted, so the Ego, inaccessible to structure as Self in the relation and in the dynamism of the “Name of the Father”, remains battered by a permanent storm that pulls down the little obstructions that bit by bit one tries to erect and melt the affective-valorative components of any relation.

The Ego, extremely weakened and devalued, can not even understand the recognition structured with notable sacrifices and great difficulty in the everyday life, does not manage to cross or to save the affectious approaches that get whispered to him, all the psychic picture is dominated by anguish and by anaclitic depression, without objects and without hope.

 

In the therapeutic relation these two “souls” live together, producing benevolent aspects and others that are destructive, both almighty; at the same time, however, they will emerge desires of flight and acting-out together sentiments typical of an undefenceless subject, whose identity is lost in the object: the therapist made auxiliary-Ego.

 

These observations bring to well differentiate Asperger from an “abandonic personality” and from the anal and obsessive-compulsive problematics.

 

Abbandonic: the hypervalorised objects such as the good brest, capable of giving and of letting live and, therefore, is dangerous loosing him because death could follow: the dependence and the symbiotic structure towards a concrete object (the breast). On the contrary for the borderline the valorised object is the “phallus“ that is a sentiment a “strength”, is intellect with subdole and vindicative activity: it would kill me if I would not submit.

 

Obsessive-compulsive: the almightiness is prerogative not in the object, but of the subject, that, therefore can understand everything and live the own superiority, even if it does not succeed to free himself of the valorised object without the one, however, he can not assert his almightiness, express his superiority.

 

The Relationship with these subjects is particularly unstable, confused, contradictory,inconstant; their affective coldness, emotive instability once the particular and personalistic disposition to read reality are the elements that make the relationships difficult.

In front of these qualities the relation with them tends to fluctuate between:

         Unconditional acceptance of their peculiarities;

         Refusal and emargination from the others;

         Control of perceptive and behavioural disorders to induce an improvement of the adaptive components of the Ego, fundamental step for the structuring of the personality.

 

These three relational models influence up to today the educational and formative choices and those therapeutic-rehabilitative, so we find  such as “… accepting and trying to speak on the behaviours and the situations…”, “… things go well, it means that we have set up a valid procedure”.

This modality of approach, deeply comfortable, is certainly not the most useful to solve the problematics of the Asperger and what gets underlined is that the psychopathological subtended trouble requests always a therapeutic-rehabilitative intervention lead by a specialist.

 

Therapy

The therapeutic approach to these boys usually marked on cognitive-behavioural modalities (TCC), just because the good intellectual level stimulates to “bring to understand”, “teach”, “condition”.

The results obtained with these techniques are though always reductive and also dangerous; one speaks of psychotising effect because the introduction of rigid, prejudice , illiberal modalities brings yet to contain the crises of anguish, the outburst of rage, the self-injuring attitude, but induces also closures in the social sphere.

We find children treated for many years that have learnt to communicate through the facilitated communication, to converse through the computer, but that also became grumpy, solitary, grumblers, incapable to adapt to the needs of the others, always inclined to ask, uncapable to bear the frustrations.

 

More open relational and psychodynamic therapies find the major difficulties in the incapacity to structure and to accept the affective dynamics and a good therapeutic rapport, in the facility of the establishing to acting-out, in the push to renounce because the personal growth and the indipendence are experienced always as aggression and directed towards the “phallus”, against that wonderful Super-Ego, that, almighty and vindicative, prevents any type of identification, of introjection, love and solidarity.

With all this, however, it is these therapeutic models that are the only capable ones to bring to results turned to overcome isolation and, therefore, to restructure the socialising forces.

The TCC brings to contain sensations of anxiety, anguish, sadness, but through a meccanism of intellectualisation (that on the other side is facilitated, however we saw, from the mental attitude characterised of these boundary forms), insisting on the cognitive strengthening, the controlled relaxation, the adaption of predefined modalities, the utilisation of “behavioural indicators” and of rigid schematisations, self-referred and egocentric.

 

These applications, together with the well-known instrumental techniques of biofeedback (EMG-auditory electromyogram); CRS-galvanic response of the skin) bring to emphasize the loss of the psychomental agility, the social withdrawal, the restringimento of the interests.

 

It concerns choosing:

a)     Restoring the adaptive functions of Ego through the psychoaffettive development that contains emotive incontinence and enriches the relationships bringing to a harmonic and global psychomental development;

b)     containing emotive instability, anguish and consequent disactive reactions through hypercontrol, intellectualisation, the narrowing of the social optic. When one speaks of “affective education” one makes a precise cultural choice since it’s a question of containing with “thought” everything that is instinctive, exuberant, personal, immediate.

 

Self-reflection, the concepualisation, examination of the evidence tend to give confidence through a reduced cognitivism, while the psycho-affective development tends to enrich, to push out, accepting the Other, developing that vision of oneself that structures in the eye of the Other organising values and affects that result the true motors of the relation and the socialisation.

 

Our experience brought us to highlight how:

         cognitive-behavioural techniques induce rapid improvements, regarding the containment of critical responses and/or behavioural disorders;

         only through the relation and the restoration of “bridges of love” through offering spaces of not knowing, spaces of welcome and acceptance with a psychotherapeutic work that is certainly longer and more demanding, one can reach results of stability, of spontaneity, of self-satisfaction and of global recovery of the Self and the person.

 

The important problem in treating these limit cases that have as substratum:

        a disorganisation of the adaptive strengths of the Ego;

        a deficit of the structuring dynamics of secondary narcissism and above all,

        a psychomental disorganisation that prevents the settlement of the oedipus conflict that in fact results permanent in the

        impossibility to self-define oneself, to find an identificatory model for which the Other is the reality, taken into the vortex of indeterminacy, do not help to a qualification of truth and of ethical, moral, cognitive and relational validity.

is the one to open the armour of the Ego and take outside those mechanisms that did remain “included in the depth of the psychic structure”, staying internal and unmodifiable, dominating the behaviour and the answers, conditioning the “representational scheme” in such a way as to result completely personalistic and not shareable. The relational psychotherapy becomes fundamental because, as it happens in psychodrama (Roja Bermudez), the action on the concrete experience structuring inequivocal representational deductions.

For, the closeness, the corporal dynamics, the concomitance of the group experiences, although they bring about emotive tension, conduce to learn “in the eye of the Other” (and one another the truth of one’s own sensations.

 

The lack of the word blocks the channels of flight and of prevarication or hiding-places, proposing the possibility to “look into each others eyes” and to “create bridges of love” (G. Andreis) where to meet to exchange experiences and sentiments.

The psychotherapeutic work of E.I.T., when carried out in group (small 2-3 components; or big (6-8) to which a variety of therapists participate (for a relation of maximum 2/1 patient) is particularly important to reach the true goal of the operation which is socialising; results fundamental for the development of the process of personal growth in the relation and for the organisation of postures, actions, mimics and motivations that intervene in the feedback.

Naturally the group is the most appropriate place for the subject to verify the level of one’s own compatibility and the ability of self-containment; observing the possibility-ability of the others developing a “healthy” competitiveness through emulation; increasing the dynamics of reciprocity, of generosity and gratitude.

Parents accuse strangers  (friends, acquaintances, teachers and also psychologists, psychiatrists, therapists) not to manage understanding their children, not accepting their “being different”, and their disabilities. The others are accused to allow being dominated by frustration and rage just because; towards their children, they got “used” to accept and bear everything.

The parents accuse strangers (friends, teachers and psychologists, psychiatres, therapists) not to manage to understand their children, of not accepting their diversity, their disabilities. The others get accused to allow being dominated by frustration and rage just because, towards their children, they got used to accept and bear everything.

The parents try to “explain” the situations, of the why the relations and the experiences end badly; of how one should behave, …, but everything results useless because the Asperger, as the borderline, is incapable to use the experience, to find alternative modes, to place oneself in the other, to decipher the own sentiments and those of the others, to give a right meaning to perceptions.

The answer to difficulties is always the renunciation, the irrationality, sometime, the aggression  (foremost verbal), isolation, mutism, closing up in the room, not participating to family-life, creating an own isolated way in one’s home (steal, run away, do not show themselves, using things in hiding, without taking responsibility). Macca used the car  of the father, but if it paid, she would stop using it until the father would solve the problem and justified him/herself saying: “… it is not mine; it is him and he should look after it, I never asked him anything.”).

The mental attitude is the one that establishes with the mind one can find always a way out to prevent the relation, to prevent the anxiety of a closeness.

In this attitude shame is hidden and the sense of inadequateness, this is why they watch themselves for asking the waiter to bring something, the others should do it: they can also prevent it.

In the same order of things, the difficulty to choose enters of choosing: “… what do you want to eat? They are asked and always say Boooh!” Affa was almost ridicule when in the restaurant he said “… I eat nothing” and then he stuffs himself with what he “stole” of the palate of the other full of a double position, ordered with right providence!”

The parents tell of annoying behaviours, unforeseeable, infantile, unjustified that though have little of the pathological, but they tend to refuse the requests and/or the advice of the psychiatre or psychotherapist.

 

This way, talking taking into account the experience, results a damage to these children, that will then be youths and/or adults. The psychotherapy can straighten these situations, can really cure, but must be undertaken percociously, when the children start to present the first signs, before the age of five.

It is not worth “bearing” their strangenesses because they are only the first signs of a block and/or of a psychomental alteration, what one should really do for their good, is starting as soon as possible an adequate and consonant therapy.

 

Let’s resume our clinical case that can bring us to better understand what happens in the growth and structuring of Self process.

Affa certainly is a rich, deep, controversial, but “spectatular” in his approaches with reality. Having been closed for years at home, in the cellar, to “save himself” from anguish, for not facing the uneasiness of finding himself face to face with another person and being now a good therapist (although under the strict surveillance of the psychiatre) represents a life that should be known from inside.

1.     Oral anguishes: the ideation was rich of images referrable to oral destructivity. In his stories he saw himself on top of a desert hill, only and happy inhabitant that “… sucked the drops of water that could maintain alive”, while on the hill nearby (metaphore of the two hills) the more tore to pieces each other to be able to azzannare the rich products of the earth.

This scene says everything but we must add that Affa lived as estreme sign of intelligence the choice to have very little (only the bare minimum not to die), but without taking a risk … or without making an effort.

2.     It was not worth  with people that are ignorant and it gives no satisfaction to keep up a sialogue between deaf. Affa dedicates to study anything, has an encyclopaedic preparation, eclectic and can talk of any subject, but in the meetings he shuts up “… I am afraid to cut a bad figure”,  he says and his mutism becomes an aggressive act because critical, unfriendly reproaching.

3.     He experienced himself as a “wood-puppet”, uncapable to feel emotions, icy like a statue … uncapable of affection, to express a kind phrase, to feel gratitude, altruism and, even less, sentiments of reciprocity.

4.     The terror of failing brought him many times to give up to do something (for example, he left to sign up for driving lessons, but came home without even  crossing the threshhold).

Being around him was a long way of disillusionment (he always seemed to be on the point of giving up on everything), but also of renewed hope, of certainties (diluted over time, almost impercettibile. Affa manages today not to run any more, not to give up in caution, risks and reaches the possibility to sustain chatting on the most various themes; allows himself to make comments, to express criticism and or to say the own opinion.

He started to choose and to desire to go to dinner in some fashionable restaurant; good dishes … even though, every time, before going in he says that a plate of potatoes is sufficient.

The relation with the other sex has always been conflictual and remissive, but today Affa accepts the hug and the kisses of the psychologues that work with him other than, naturally, the one of the younger patients.

 

The relation with autistic children (or severe disabled) is really moving; the patients have learnt to appreciate and to be fond of him; the tender hugs that they exchange are the clearest demonstration of how much the affectivity of Affa has cleared and of how much the work with him is rich of experience, of growth, of liveliness of certainty.

This creativity is always source of surprises and every day creates therapeutic situations capable of melting knots of who can not do something, his strength of  will is always a spur to go on.

When he had to work with a child diagnosed “autistic” at the age of two and a half, he commented “… I am sure that he will pull him out of this!”.

Certainly Affa still shows some strangeness:

-         He is incapable to contain libidical pushes, therefore he eats with greed and, sometimes, in an uncontrolled manner;

-         He is emotionally unstable and does not always manage to contain tensions;

-         Does not bear new people and, in those cases, retreats;

-         He does not experience situations with coherence, in fact he does not manage to study to obtain a diploma;

-         He is uncapable to accept a joke … not even to go asking for the conditions;

-         The only activity is the one based on therapy and when he digs in his heels it is impossible to renew;

-         He is rigid in his choices and when he does not like something it is the others that have to give in.

 

The therapeutic work with Affa has been completely indirect this is how he would leave isolation, accept life, abandon self-destructive nihilism, to establish good affective relations. It has been phantastic seeing him elegantly dressed and chatting with women that attended at a concert organised in an elegant  villa!

Today Affa is a completely normal person, able on the “job”, “able” in choices, self-confident, not blocked anymore in interpersonal relations. His creativity brought him to write poems and a few science-fiction stories but nobody read them: … he is still afraid of being judged.