Fonctionnements autistiques et perspectives psychopathologiques sur le devenir des personnes autistes

Abstract

ObjectivesPsychoanalytical and other theories of autism are mainly based on infantile clinical observation. Considering this, the perspective of the personal evolution of autistic persons during their teenage years and adulthood opens questions leading to a necessary reassessment of theoretical knowledge. Over the last decade, our understanding of autistic pathologies has increasingly underlined the importance of sensory elements in their symptomatic expression. The main objective of this theoretical reflection is to formulate new theoretical suggestions to help better understand the evolutions of autistic persons. Notably, this includes hypotheses allowing us to articulate the psychic functioning of autistic persons to other psychopathological functioning. MethodThis research is based on autobiographical writing by autistic persons, leading to a phenomenological point of view, which will be completed with elements of clinical experience. This corpus of knowledge offers insight into dismantling, stimming, and sensory pursuit, allowing us to better understand the peculiar forms of the use of the sensorial in the psychic functioning of autistic subjects. It will refer to existing psychoanalytical writing on autism, thereby suggesting a new psychopathological understanding of the archaic dimension made visible by autistic pathologies. ResultsDifferences between different forms of autism and psychosis are interrogated, in order to further understanding of clinical situations where this distinction is less evident. Autobiographical writing by autistic persons promotes understanding of the ways in which the sensory dimension plays a specific part in psychic functioning. What psychic processes are present in the sensory part of mental functioning of those subjects is theorized. Focusing on self-stimulatory behavior and sensory pursuit as they are seen in autism, it is suggested that psychic functioning builds itself with these sensory elements, thus stabilizing the psychic apparatus. The notion of autistic functioning is introduced to explain subjects’ reliance on the sensorial register as a stabilizer of the psychic apparatus. Psychic drives invest sensory sensations which are preorganized by the Id in order to become a perception. Then, these particular uses of sensory elements and perception find a way to persist in the subject's psychic functioning in diverse forms. This leads to a persistence of archaic functioning in the psyche that also can invest in other functioning. Three outlooks are explored. First, that autistic pathologies can develop in many ways, including evolutions where psychic functioning is closer to what exists in psychotic functioning. Then, how some psychotic subjects can make use of autistic functioning to help them deal with splitting anxiety. Lastly, autistic functioning can also punctually exist in certain types of trauma, opening the question of its existence outside of psychosis and autism. DiscussionThe notion of autistic functioning makes it clears how some archaic functioning, as seen un autistic persons, can maintain itself throughout subjects’ development. In the meantime, other psychic functioning appears and develops during teenage years and adulthood. Furthermore, this notion opens the question of differential diagnosis with psychosis and the possibility for autistic functioning to exist outside of autism. ConclusionsThe notion of autistic functioning leads to another way of thinking about the personal evolution of autistic persons as they get older. It, nonetheless, will require further reflection, particularly as regards evaluating its clinical relevance, as well as its usefulness for differential diagnosis.