What To Do If the Mind Does Not Develop, by Roberto Bertolini

A Psychoanalytic Study of Pervasive Developmental Disorders

What To Do If the Mind Does Not Develop is a psychoanalytic study of pervasive developmental disorders. It is based on what I have learned in my work with children and adolescents. I have worked as a child and adolescence therapist for about thirty years.

My interest in this type of psychopathology began near the end of the 1960s. At the time, I was still a young doctor, and I was training in child neurology. I trained at the Institute of Mental and Nervous Diseases of the Catholic University of the Sacred Heart (UCSC) in Rome.

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However, the book shows only what happened later. It covers the time during and after my training in psychoanalytic psychotherapy for children. I trained at the Tavistock Clinic in London. During this part of my career, I was lucky enough to personally see a number of young patients. These were children and adolescents of different ages. Each had a diagnosis of pervasive developmental disorder. I saw them without any traumatic interruption. This happened within time periods ranging from one to ten years. At the same time, I kept a written record of the analytic work I did with them.

The book presents a study of seven key therapeutic experiences. It rests on understanding the psychoanalytic process in this limited number of patients. Beyond these patients, I have witnessed many similar clinical situations for the past fifteen years, either as a therapist or as a supervisor. These experiences cover many chapters, mainly the central ones (see chapter six, seven and eight). There, psychoanalytic observations of three cases have been sequenced to give the impression of longitudinally following one single case. The point of arrival in the development of symbolic processes in the first patient marks the starting point of the second case. This point serves as the necessary premise, even if not the only one, of the second case’s evolution, and so on.

I believe that the way in which the clinical material has been organized may offer the reader the unique experience of entering and standing inside the analytic encounter, to use it as a special place from which to gain a fresh and renewed look of the psychology of these patients. Therefore, the entire book has become and is an invitation to participate personally in my discoveries.

Readers will quickly see that the various definitions of the pervasive developmental disorders—even the most refined ones—miss how these patients experience themselves and others. These definitions only show what is absent. They reveal what is missing in their development and in their way of being and relating, compared to a model of normality. But readers will also grasp the complexity of what is really happening at an ‘experiential’ level. They will be able to observe one person who is with them and close to them for so many hours. This personal relationship is guided only by the wish to get to know them and help them know themselves. The reader will quickly see that these patients differ greatly from one another. They differ in the seriousness of their disorders and in the quality of their infantile Self. They differ in their object relations and in the atmosphere they are able to create around themselves. Indeed, they are so different that readers will think, as I have done many times, that these patients cannot belong to the same psychopathological syndrome.

Following the course of some of the psychoanalytic therapies described in the book, readers can discover other “facts” they did not know before. These facts belong to complex and “primitive” experiences. They form the foundation or ground of the “exercise of knowing the Self and the Other” during development. This exercise forms the birth to a psychic life. Readers will also appreciate what even psychology and neuroscience have discovered over the last fifty years. In their research, they have studied phoetal and neonatal behavior from the point of view of sociality. This work also looks at the interest and motivations for the human connection that begins from the maternal body. The findings indisputably show that in normal development the child is a precociously sociable subject. Melanie Klein already expressed this point of view in her theory of objet relations (1959). Observations from naturalistic studies of mother-child relations have confirmed it, using the method of Esther Bick.

At the same time, the therapist’s countertransference experiences will introduce them to something uncommon and apparently incomprehensible. Everything that normally creates closeness, contact, and sympathy between two people is missing from any interpersonal exchange. This happens even when no motivational conflict exists, and it seems to go against every experience of aesthetic reciprocity. Therefore, they will not record the “natural” birth and growth of an infantile transference in the clinical material. This normally happens with less disturbed patients (see chapter three). Instead, they will face unusual events that appear like moments of suspension of mental life.

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Lastly, even after years of work, they will see that the personal link between the therapist and his patients remains. Their personalities stay disconnected from his own. His way of taking part in real life differs from theirs in ways that cannot be reconciled. Therefore, they shall rethink their ideas of “treatment” and “cure”. They will observe that even after years of therapy, these patients still have a way of being that is peculiar. This quality cannot be reduced, and it is hard to understand on a developmental basis. Does it represent an overcoming of the initial condition, or is it simply a sophisticated transformation (see chapter ten)?

The book What To Do If the Mind Does Not Develop goes beyond these clinical insights. They cover the structural aspects of personality in children and adolescents who suffer from a pervasive developmental disorder. The book offers readers some new ideas about child psychoanalysis. It also draws their attention to one aspect of the developing mind that earlier work has mainly explored. This is the aesthetic dimension. In the psychoanalytic field, Bion, Meltzer, and Money Kyrle have done most of this work. Meg Harris Williams has explored it in literature and poetry.

I present my understanding of them in chapters three and nine. These two chapters form a natural frame around the presentation of the majority of cases. I also present this understanding in the appendices, which have eventually become areas of conceptual and methodological research for the future. But readers will easily find them dispersed in the entire book. They will soon see how they were the main guides for my analytic work with the patients. They also guided the publication of my findings.

Roberto Bertolini has a degree in medicine, and he specialised in Neurology at the Catholic University in Rome. He also specialised in Child Psychotherapy at the Tavistock Clinic in London. For many years, he was a visiting teacher there for the program, ‘Work with disruptive adolescents’. He is a teacher of the Scuola Quadriennale in Child Psychotherapy of the Centro Studi Martha Harris in Florence. He is a tutor of the Tavistock model courses in Observational Studies and Child Mental Health in Italy. He conducts training and clinical supervision for mental health and social services professionals in Italy and abroad. He has written books and articles on child development and primitive psychopathology.

His latest book, What To Do If the Mind Does Not Develop: A Psychoanalytic Study of Pervasive Developmental Disorders, has been published by Karnac.

Reviews and Endorsements

‘Reading this book has given a much-needed boost of faith in the future of our discipline. We all know that this opportunity has become scarce. Today, psychoanalytical thinking has transformed. It now frequently departs from what our teachers in the 1960s and 1970s conveyed. They did so through their admirable inspiration and sensitivity. At times, the core values of psychoanalysis become unrecognisable. This volume contains an impressive body of knowledge accumulated throughout the author’s life. It is didactic, consistent, articulate, sensitive, and intelligent.’

– Dr Alberto Hahn, from the Preface

Further reading

• Child psychotherapy — Wikipedia