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Further Thoughts on Miriam Voran’s Response: Containment, Origin of the Self, and Pathways to Autism

Miriam Voran’s original article, “Containment, Origin of the Self, and Pathways to Autism,” and her responses to the commentaries by Allen Schore and myself highlight the issue of how we align clinical evidence with psychoanalytic perceptions in very young infants at risk for autism. I consider that it is perhaps premature to pathologize defensive behaviors and use psychoanalytic theory to interpret a 6-month-old infant’s experiences of their own vitality, doubting if they are capable of distinguishing between “self” and “other,” as they do not yet possess language or “theory of mind.” However, as long as we do not have clear biomarkers to diagnose autism, we shall have to rely on our clinical observations. Similarly, psychoanalytic and psychodynamic concepts may play a valuable role in opening insights into aspects of the inadequate development of the self in infants at risk for autism, which presumably is the core of autism. Children with autism are extremely sensitive to the environment as a result of their lack of sensory regulation and are also easily fraught with anxieties. One of the major questions presented in this article is whether existential anxiety appears as part of the development of the self or does the self fail to develop, because it is inhibited by anxiety. However, I would like to suggest that this crucial phase is a significant window of opportunity for therapy.