Table Of ContentFrom Autism and Mutism to an
Enlivened Self
From Autism and Mutism to an Enlivened Self explores the importance of
intimacy, interaction with the environment and the mind–body connection
in early childhood development, with specific reference to autism. Built
around a detailed case study of a severely autistic child, the book offers
an illuminating account of the development and successful treatment of
autism both from the perspective of the clinician and from the family.
In Part I, Diana Thielst (writing under a pseudonym) gives a description
of her experience with her daughter who was autistic at birth, minimally ver-
bal at age five, and did not respond to her name. She details the severe family
stress and her ineffectual attempts to get professional help. Finally, she hears
of consultants who may be able to help in St. Petersburg, Russia. Guided by
the consultants, Thielst and her daughter then embark on a uniquely innova-
tive method for Anna to both build a vocabulary and for the first time learn
the value of coordinated and cooperative effort. Armed with a vocabulary
and a long history of solo pursuits of organizing inanimate objects, Anna
suddenly begins to explore “human” interaction as revealed in comics – a
turning on to an emotional life of relatedness and intimacy.
In Part II, Joseph D. Lichtenberg uses his knowledge of neonate and early
infancy to offer the reader an understanding of autism – its history – and a
unique comparison of the normal well adapted neonate and infant at one
year with the disrupted development of the child with autism. Lichtenberg’s
theoretical construct of three major pathways to a healthy adapted develop-
ment breaks new theoretical ground and gives enrichment to a contemporary
portrayal of the autistic experience.
With unusually rich clinical material grounded in accessible theory,
the authors jointly offer a new perspective on understanding, treating and
living with autism. From Autism and Mutism to an Enlivened Self will
appeal to psychoanalysts, psychoanalytic psychotherapists and clinicians
working with autistic children.
Joseph D. Lichtenberg, M.D., is Editor-in-Chief of Psychoanalytic
Inquiry, Director Emeritus of the Institute of Contemporary Psychotherapy
and Psychoanalysis, past President of the International Council for
Psychoanalytic Self Psychology, and a member of the Program Committee
of the American Psychoanalytic Association.
Diana Thielst, M.D., is a pseudonym under which the co-author of this
book is writing about the treatment of her autistic daughter. She is a scientist
and musician.
PSYCHOANALYTIC INQUIRY BOOK SERIES
JOSEPH D. LICHTENBERG
Series Editor
Like its counterpart, Psychoanalytic Inquiry: A Topical Journal for Mental
Health Professionals, the Psychoanalytic Inquiry Book Series presents a
diversity of subjects within a diversity of approaches to those subjects.
Under the editorship of Joseph Lichtenberg, in collaboration with Melvin
Bornstein and the editorial board of Psychoanalytic Inquiry, the volumes
in this series strike a balance between research, theory, and clinical appli-
cation. We are honored to have published the works of various innovators
in psychoanalysis, including Frank Lachmann, James Fosshage, Robert
Stolorow, Donna Orange, Louis Sander, Léon Wurmser, James Grotstein,
Joseph Jones, Doris Brothers, Fredric Busch, and Joseph Lichtenberg,
among others.
The series includes books and monographs on mainline psychoanalytic
topics, such as sexuality, narcissism, trauma, homosexuality, jealousy,
envy, and varied aspects of analytic process and technique. In our efforts
to broaden the field of analytic interest, the series has incorporated and
embraced innovative discoveries in infant research, self psychology, inter-
subjectivity, motivational systems, affects as process, responses to cancer,
borderline states, contextualism, postmodernism, attachment research and
theory, medication, and mentalization. As further investigations in psy-
choanalysis come to fruition, we seek to present them in readable, easily
comprehensible writing.
After more than 25 years, the core vision of this series remains the
investigation, analysis and discussion of developments on the cutting edge
of the psychoanalytic field, inspired by a boundless spirit of inquiry. A full
list of all the titles available in the Psychoanalytic Inquiry Book Series
is available at www.routledge.com/Psychoanalytic-Inquiry-Book-Series/
book-series/LEAPIBS.
From Autism and Mutism to
an Enlivened Self
A Case Narrative with Reflections
on Early Development
Joseph D. Lichtenberg and
Diana Thielst
First published 2019
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2019 Joseph D. Lichtenberg and Diana Thielst
The right of Joseph D. Lichtenberg and Diana Thielst to be identified as
the authors of this work has been asserted in accordance with sections
77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Names: Lichtenberg, Joseph D., author. | Thielst, Diana, author.
Title: From autism and mutism to an enlivened self : a case narrative with
reflections on early development / Joseph D. Lichtenberg and Diana
Thielst.
Description: Milton Park, Abingdon, Oxon ; New York, NY : Routledge,
2019. | Series: Psychoanalytic inquiry book series | Includes
bibliographical references and index.
Identifiers: LCCN 2018031156 (print) | LCCN 2018041748 (ebook) |
ISBN 9780429432354 (Master) | ISBN 9780429778742 (Web PDF) |
ISBN 9780429778735 (ePub) | ISBN 9780429778728 (Mobipocket/
Kindle) | ISBN 9781138362000 (hardback : alk. paper) | ISBN
9781138362017 (pbk. : alk. paper) | ISBN 9780429432354 (ebk)
Subjects: LCSH: Autism in children—Case studies. | Autistic children—
Rehabilitation—Case studies. | Parents of autistic children—Biography.
Classification: LCC RJ506.A9 (ebook) | LCC RJ506.A9 L533 2019 (print) |
DDC 618.92/85882—dc23
LC record available at https://lccn.loc.gov/2018031156
ISBN: 978-1-138-36200-0 (hbk)
ISBN: 978-1-138-36201-7 (pbk)
ISBN: 978-0-429-43235-4 (ebk)
Typeset in Times New Roman
by Swales & Willis Ltd, Exeter, Devon, UK
Contents
Introduction 1
PART I
Anna 3
1 From missing relationship at birth to missing name
and language at age five 5
Birth 5
First year 6
12 months 7
24 months 9
30 months 10
The first visit to a speech therapist 10
36 months 13
Finding the term “autism” when looking for answers
from the literature 14
Pulling her out of preschool 15
Her fourth birthday 17
Seeing a child neurologist 18
Starting to look for a way out: what can she do and what
could it mean? 19
Her hearing doesn’t make sense 20
Exposing her to different environments as the first
learning tool 22
Her fifth birthday 26
Losing her when the accusations take the worst turn 28
viii Contents
2 The four critical months before the sixth birthday:
from learning her name to reading and from reading
to learning to speak in 1000 hours 30
Meeting with Dr. Traugott 30
Meeting with a special educator and speech pathologist
specializing in minimally verbal children: more than
just a teaching program 40
Back home 43
Why existing learning materials don’t allow me to
communicate the contrasts that lead to comparison
and categorization – the basic components of
symbolic language 44
Building meaningful interaction at a glance: the
importance of speed 46
Bringing life into vocabulary cards 49
Month No. 1, January 1992 52
Discovering the first critical hour each and every day 52
Month No. 2, February 1992 53
Taking learning into the Piano Room 56
Having fun in the Piano Room 59
Taking interaction to public places 62
Month No. 3, March 1992 63
Expanding vocabulary to word combinations 63
Surprising difficulties: Echolalia 64
Month No. 4, April 1992 66
Creating a book for her that matches her
linguistic level 66
Her sixth birthday 67
3 New life begins: discovering the world beyond Legos
and puzzles, 1992 spring to 1993 fall 70
What changed during the first four months of highly
intensive multi-intervention? 70
From reading to speaking 76
Discovering that sounds in the environment have meaning 77
Visiting the art gallery 78
Math 79
Contents ix
Math and language in public 82
Puzzling interpretation of her nonverbal IQ score of
146 by a child psychiatrist 83
Age six, March 1993 83
Her seventh birthday 88
Introducing social development and independence: going
to school together with typically developing peers 90
Existing speech enables her to start
speech therapy 93
How a library becomes her favorite place to spend
time after school 95
4 Coming to America becomes a window to the world 98
Middle school 98
High school 108
University and beyond 109
Anna about her early memories 115
What can professionals and parents learn from the
developmental trajectory of my daughter? 116
PART II
Commentary on two remarkable journeys:
one therapeutic for Dr. Diana Thielst and Anna;
and one of discovery for psychiatry and
psychoanalysis 121
5 The recognition of autism as a developmental disorder 123
Kanner’s approach 124
A comment on terms 125
The etiology of early infantile autism 127
Two other experiences of children with autism 130
Gus: To Siri with Love: A Mother, Her Autistic Son, and
the Kindness of Machines 130
Owen: Life Animated: A Story of Sidekicks, Heroes,
and Autism 131
Interest and purpose: expanding the scope of being
a doer doing 131
