Annual Research Lecture 2021

Annual Research Lecture

The Role of Early Anxieties when Emerging from Autistic Pathological Organizations: The Dilemma of Cure

1 December 2021

Delivered via zoom
This is a live event only
 

Lecturer: Joshua Durban, Israeli Psychoanalytic Society

Introductory Discussant: Gillian Ingall, British Psychoanalytical Society

Joshua Durban, M.A., is Training and Supervising Child and Adult Psychoanalyst at the Israeli Psychoanalytic Society and Institute, Jerusalem (IPA) where he also teaches. He is on the faculty of the Sackler School of Medicine, Tel-Aviv University, The Psychotherapy Program, Post-Graduate Kleinian Studies. He is a member of the IPA inter-committee for the prevention of child abuse. He has a private practice in Tel-Aviv and specializes in the psychoanalysis of ASD and psychotic children and adults.

In this presentation I will describe some theoretical and clinical findings concerning the development of child patients with autistic and autisto-psychotic features into adulthood in the course of intensive, long analyses. Using detailed clinical material taken from the five-sessions -per-week analysis of a young man, I will describe the process of emerging from the autistic pathological organization as depending on working through the constant interplay of paranoid -schizoid anxieties, autistic anxieties-of-being and of osmotic/diffuse anxieties. The patient's journey passed through three main stages: autistic encapsulation; autisto-psychotic defensive organization and, finally, autistic-manic-perverse pathological organization, with severe obsessive-compulsive defenses that help him ward-off the pains and anxieties of otherness and dependence.

Central to this patient's journey is what might be called "The Dilemma of Cure" namely--accepting the analyst's offered "cure" over his own autistic self-generated, bodily and omnipotent one. This dilemma can often deteriorate to a standstill that might even result in a negative therapeutic reaction. However, if we have the patient's deep anxieties concerning change in sight while, at the same time, we relate to his aggression, destructivity and omnipotent-perverse need for a new protective structure, some further, benign object-related changes might emerge. This calls for the analyst's open acknowledgement of his or her responsibility for the inevitable anguish and pain he or she is causing the patient with their analytic "cure".

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