Cito tute iucunde : A Clinic with an Autistic Subject

I would like to bring out the questions on the clinic with children called autists that preoccupy us in the institution. I will set out from two references: the inaugural text by Leo Kanner on autism and a suggestion made by Jacques Lacan in his conference on "The Symptom" in Geneva, October 4th, 1975¹ I will add elements from a more developped work we are writing in the institution²

Leo Kanner

In his text, "Autistic Disturbances of Affective Contact", Leo Kanner proposes the category of autism in defining it as the "inability of a child to establish relationships with people and to react normally to situations from the beginning of his life"³. He also says, "There is, from the outset, an extreme autist solitude which always, whenever possible disdains, ignores excludes everything that comes to the child from the exterior." Leo Kanner is extremely rigorous in the description he makes of eleven cases of children he qualifies as autist, and he tries to extract the categories, the constants which come up in each of these eleven cases.

If on the one hand we are astonished to discover in these cases, rigorously presented, the children with whom we work in the institution (in effect, he describes them well), on the other hand we are struck by the opacity that haunts what Leo Kanner calls stereotypes, repetitions, ordered and rigid constructions, the construction that make up the daily bread of our clinic with these children. This opacity concerns the underpinning logic and the function of the repetitive constructions. It is Lacan's axiom, "The unconscious is structured like a language," which, like a sunbeam, allows us not only to pierce this opacity, but also to discover the unsuspected, the unforeseen: these subjects, called autists, are already at work when they come to us.⁴

Subjects Already at Work

What does that mean? What Leo Kanner, in 1943, called manias, repetitive movements, stereotypes, verbal rituals, operations of opening/closing or turning on/off, are all operations which have a structure and a function from a Lacanian point of view. They have the structure of language and the function of treatment.

Didi, for example, ceaselessly turns on and off the lights, You-You kicks one wall, then the other, Tano makes a mouth noise in rolling a little, red truck before his eyes, Fred cuts to bits his excrement, Isma cuts to bits her food. What are these children doing? They realize a pantomime the structure of which has to do with language in that language is made of a (+) and a (-).⁵ They realize constructions made of a pure combinational, a pure signifying opposition. What for Kanner is stereotypic comes in fact from logic. They are constructions logical to the architecture of language, the function of which is precisely to treat the jouissance of their ill Other. They try to treat this jouissance through a construction made of (+) and (-) which, insofar as new knowledge, decompletes the absolute knowledge of the crazy Other.⁶ It concerns a purely imaginary beat which is not supported by the symbolic order. Through their pantomime, these children already treat the Other. It's the hypothesis we support.⁷

On this point, I will pose two questions: primo, do they succeed? Secundo, if they succeed, what should we do?

My response to the first question is this: they certainly succeed in treating the Other, but, on the one hand, at the price of absenting themselves from any sign of the presence of the Other (gaze, voice, request, desire), and on the other hand, at the price of never letting up. Even at night, Victor sleeps while holding his cup balanced on his head. How can we understand that? We might think that these subjects try, with these constructions, to "add on an organ (for example, for Victor with his cup, and even in the simple fact that for Didi turning on and off the lights).⁸ This organ would come to substitute for the missing phallic organ. Jacques-Alain Miller, with a graph, proposes to write the jouissance in entry with a (+) and the jouissance in exit with a (-), insofar as effect of the substitution operated by the Name-of-the-father, which gives a law to the Other.⁹ In autism, because of foreclosure, the operator of substitution is missing from this intermediary place.

 

Jouissance (+)         NF                   Castration (-)

-------------------------------[]------------------------------>

 

Jouissance (-)          NF0                Jouissance (+)

-----------------------------[      ]--------------------------->

 

It is then the subject himself who we find in this place, a subject already at work to realize this substitution thanks to his construction, which functions to subtract him, insofar as he is an object, from the em-pire of the Other.¹⁰ But at what price!

"There is something one can say to them" 

I would respond to the second question (if they succeed in treating the Other, what should we do?) in the following manner: "There is something one can say to them," Lacan told us, which is like a summons for those of us concerned. To Dr. Cramer, who said to him of autistic children that "their language remains something closed," Jacques Lacan responded: "It is exactly what makes it so that we don't hear them. It's because they don't hear you. But, finally, there is surely something that one can say to them."¹¹ This is indeed a problematic point. We are cornered in what Lacan said between a "they don't hear you" (they play deaf to put the Other at a distance) and a "there is surely something one can say to them." We are cornered between the danger of presentifying, by our voice, the Other of complete knowledge and a jouissance which it remains, however, to localize. In other words, we're cornered between a "they are already at work" and a "there is all the same something to say to them."

So how do we get the subject to associate us in the treatment of his Other? What offer can we make? We propose the following deal: firstly, it concerns conforming ourselves to the very same level the subject is realizing; secondly, it concerns making a displacement of the imaginary dialectic of (+) and (-). It is like at the circus, for example; the juggler performs alone throwing his batons in the air and at a certain moment a second juggler includes himself in the performance, without the show stopping. In our case, and it is almost on the order of the impossible, it is about inserting ourselves in the performance of the autist who juggles, however, to remain alone, to keep his Other at a distance, like his second juggler.

For example, when Deborah¹² rocks back and forth, batting the straps of an intervenant's purse while saying "yes-no, yes-no"; the intervenant echos her. When Deborah says "yes" the intervenant adds "no." Little by little, this will bring Deborah to say "yes" and await the "no" of the adult, and to look at her when she makes Deborah wait for her "no". Deborah, from then on takes more interest in this intervenant, in her presence. She leaves aside her initial construction and finds a place in a regulated Other. This Other is regulated because it is held at the level of the subject. It is only associated to her work, to her pantomime, but this all the while knowing to "say something to her," for example the "no" of the intervenant which responds to the "yes" of Deborah. What is said here is a "word empty of knowledge", a word that shelters Deborah from the unregulated field of a crazy Other.

A New Dialectic 

Thanks to this calculated inclusion by the intervenant, Deborah associates her in the realization of her construction. She takes her as a dialectical pole of verification for her construction, and this precisely because she consideres her as a regulated place, an Other in which she can verify her construction. The intervenant thus represents for Deborah both a regulated Other and a pole of "verification" for her construction.

Autism and Psychosis

Thus, thanks to the calculated inclusions of intervenants, autists come to have more articulate imaginary constructions and consequently operate a certain "rectification of the Other."¹³ And they can go pretty far in this work. For example, Tano,¹⁴ who at first was profoundly autistic (he spent hours rolling the same, little, red truck before his eyes, his sole occupation) at the end of a certain time began speaking and elaborating, in a work he does with Nicole, delusional circuits that take him from the station at Genval to the church and the monument to the dead. Rather than pass his hours with the little, red truck, he went to Genval with Nicole and, in so doing, he elaborated a delusional construction. When he left the institution, he was ready to start school.

What is important here is that Tano's little, red truck or the more complex circuits have the same structure. It concerns a delusional construction, which is to say a construction realized without recourse to phallic signification, but, in Tano's case, setting out from the little, red truck at the beginning. This type of construction is already underway among the autistic children described by Leo Kanner. Even when the subject seems, to all appearances, isolated, turned in on himself, withdrawn from any libidinal bond, one can locate where he is already at work to realize either a rhythm, or a more elaborate construction. Marie, for example, seems absent while she tirelessly gesticulates with her hands in front of her mouth. Didi spreads his spit on the window sill, Filippo babbles ceaselessly.

Consequently, it seems to us more rigorous to affirm that this subjects called "autists" are indeed psychotic subjects, contrary to what certain authors have put forward. Through their language-like constructions, through their "stereotypes" as Leo Kanner calls them, they are already at work to decomplete the Other. In other words, their metonymic constructions have the same function as delusional metaphors have for paranoid subjects.

As Eric Laurent suggested at a conference on autism at Toulouse in 1987, there is no reason to detach autism from scizophrenia.¹⁵ He makes this suggestion precisely from a case of infantile autism with whom we have worked in our institution.¹⁶ Autists thus do not pass from an autistic position to a schizophrenic position or paranoid position. In this case, they would only pass into a second period in a psychotic position. But, from the fact that they are already at work to rectify their ill Other, it seems to us more rigorous to affirm that these children are already in a psychotic position.

One last question: is there a structural difference between the period before our manoeuvre of inclusion in the realization of the subject and the period after? In the period before, the psychotic subject succeeded in a certain effect of "metaphoric knotting," which was not inscribed for once and for all. The subject must maintain it; he must constantly be at work, without ever letting up. He is in a certain social bond, but essentially this takes the shape of excluding himself. In the period afterwards, a certain effect of "metaphoric knotting" also occurs. It is inscribed in the imaginary. It is thus fragile. The subject realizes his delusional construction on one condition: to be taken inside a field regulated by a barred Other. But then, and only then, can the subject on the one hand let up and on the other, risk more in a certain form of social bond.

Cito, tute, iucunde

In conclusion, I found the following formula in a note, in Freud's conference on "On Psychotherapy."¹⁷ An ideal cure, Freud says, must be rapid (cito), sure (tute), and not unpleasant (iucunde). Here is one way of saying well what orients our work in institution. Cito: we have discovered that the subject, beneath the "stereotypes," is already at work. He is at work "promptly," if I may say so. This means that he is already at work, he is not late, not behind, not retarded. The question is to know how we also can be prompt to include ourselves in the treatment of his Other. Tute: on the one hand, surety comes from our just orientation on the hypotheses of Freud and Lacan; on the other hand, our work will have a certain "sureness" if and only if the subject comes to lodge his delusional construction in an Other who is regulated. Iucunde: it is rather an after-effect of $cito and tute. At the end, the subject can experience not only a pacification and a new social bond, but also how to smile. As for us, we discover a taste for a new knowledge, one to which these subjects give us access.

 

 

 

---