What To Do If the Mind Does Not Develop is a psychoanalytic study of pervasive developmental disorders, based on what I have been able to learn in my work with children and adolescents, as a child and adolescence therapist in the course of about thirty years.
My interest in this type of psychopathology was born towards the end of the 1960s, when I was still a young doctor, undergoing a training in child neurology at the Institute of Mental and Nervous Diseases of the Catholic University of the Sacred Heart (UCSC) in Rome.
However, the contents of the book illustrate only what happened later, during and after my training in psychoanalytic psychotherapy for children at the Tavistock Clinic in London. This was a period of my professional life during which I was fortunate enough to personally see – without any traumatic interruption and within time periods ranging from one to ten years – a number of young patients, children and adolescents of different ages with a diagnosis of pervasive developmental disorder and, at the same time, to keep a written record of the analytic work done with them.
The study that is presented in the book concerns seven key therapeutic experiences and is based on the understanding of the psychoanalytic process of this limited number of patients, even though in addition to them, for the past fifteen years, I have been able to witness, either as a therapist or as a supervisor, many other similar clinical situations. These experiences cover many chapters of the book, mainly the central ones (see chapter six, seven and eight), where the psychoanalytic observations of three cases have been sequenced in such a way as to provide 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, as the necessary premise (even if not the only one) of its 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.
I am sure that readers will become immediately aware of the fact that the various definitions of the pervasive developmental disorders, even the most refined ones, do not properly catch the experience these patients have of themselves and of others, but only shed light on what is absent, what is missing in their development and their way of being and relating, compared to a model of normality. They shall instead grasp the complexity of what is really taking place at an ‘experiential’ level and being in a position to observe one person that is with them, close to them for so many hours in a personal relationship that is informed only by the wish to get to know them and help them know themselves. The reader will immediately see that these patients are quite different from one another, in terms of the seriousness of their disorders, the quality of their infantile Self, their object relations, and the atmosphere that they are able to create around themselves. Indeed, so different that they 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, I expect readers to be able to discover other “facts” of which they were previously unaware, that belong to those complex and “primitive” experiences that, in the course of development, are the foundation or ground of the “exercise of knowing the Self and the Other”, that constitutes the birth to a psychic life. They shall appreciate what even psychology and neuroscience have discovered in their research in the last fifty years on phoetal and neonatal behavior from the point of view of sociality and of the interest and motivations for the human connection, beginning from the maternal body, indisputably showing that in normal development the child is a precociously sociable subject. This is a point of view that has already been expressed by Melanie Klein in her theory of objet relations (1959) and that has been confirmed by the observations of the mother-child relations of naturalistic studies, carried out with the method of Esther Bick.
At the same time, through the therapist’s countertransference experiences they will be introduced to the discovery of something uncommon and apparently incomprehensible, that is to say that everything which normally creates proximity, contiguity, and sympathy between two human beings, even in the absence of a motivational conflict, remains foreign to whatsoever interpersonal exchange, seemingly contrary to every experience of aesthetic reciprocity. Therefore, they will not record in the clinical material the “natural” birth and growth of an infantile transference as it normally happens with less disturbed patients (see chapter three): rather, they will be confronted with unusual events that appear like moments of suspension of mental life.
Lastly, they will be in a position to see, even after years of work, the permanence in the personal link of the therapist with his patients, of a disconnection between their personalities and his own, and an irreconcilable difference between his and their mode of participating in real life. Therefore, they shall reconsider their concepts of “treatment” and “cure”, observing that, in these patients, even after years of therapy, there is something irreducibly peculiar about their mode of being, which is difficult to interpret on a developmental basis: does it represent an overcoming of the initial condition or simply a sophisticated transformation (see chapter ten)?
Beyond these clinical insights on the structural aspects of the personality of the children and adolescents who suffer from a pervasive developmental disorder, What To Do If the Mind Does Not Develop offers the readers some new ideas about child psychoanalysis, and draws their attention to one particular aspect of the children’s developing mind – the aesthetic dimension – that has been the subject of investigation primarily by Bion, Meltzer and Money Kyrle in the psychoanalytic field and Meg Harris Williams in literature and poetry.
I have positioned my understanding of them in chapters three and nine, which together surround as a natural frame the presentation of the majority of cases, and in the appendices, that have eventually become areas of conceptual and methodological research for the future. But the readers will easily find them dispersed in the entire book and will soon realize how they have been the main navigational instruments in orienting my analytic work with the patients and in the publication of my findings.
Roberto Bertolini has a degree in medicine; he specialised in Neurology at the Catholic University in Rome and in Child Psychotherapy at the Tavistock Clinic in London, where he was for many years a visiting teacher 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 and 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 is the author of 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 recently been published by Karnac.
Reviews and Endorsements
‘Reading this book has provided a much-needed injection of faith in the future of our discipline, and it is well known how scarce this opportunity has become at a time when psychoanalytical thinking has been transformed into something that frequently departs from what our teachers in the 1960s and 1970s conveyed through their admirable inspiration and sensitivity, so that at times the core values of psychoanalysis become unrecognisable. This volume encompasses an impressive body of knowledge that has been accumulated throughout the author’s life and is didactic, consistent, articulate, sensitive, and intelligent.’
– Dr Alberto Hahn, from the Preface