Autistic phenomena in neurotic patients

I have described a group of patients who are seemingly successful in their professional and social lives, and who seek analysis ostensibly for professional reasons or for minor difficulties in their relationship. However, sooner or later they reveal phenomena which are strikingly similar to those observed in so-called autistic children. These autistic phenomena are characterized by an almost impenetrable encapsulation of part of the personality, mute and implacable resistance to change, and a lack of real emotional contact either with themselves or the analyst. Progress of the analysis reveals an underlying intense fear of pain, and of death, disintegration or breakdown. These anxieties occur as a reaction to real or feared separation, especially when commitment to analysis deepens. In the case I have described in detail the patient used various projective processes to deflect painful emotions either into other people, including the analyst, or into their own bodies. As a consequence the various objects or organs of the body swell up and became suffused with rage as a result of having to contain the unwanted feelings. This process leads in turn to intense persecutory fears and a heightened sensitivity to the analyst's tone of voice and facial expression. It would seem that the initial hypersensitivity of part of the personality is such as to lead it to anticipate danger to such an extent that it expels feelings even before they reach awareness. The sooner the analyst realizes the existence of this hidden part of the patient the less the danger of the analysis becoming an endless and meaningless intellectual dialogue and the greater the possibilities of the patient achieving a relatively stable equilibrium. Although the analyst has to live through a great deal of anxiety with the patient I feel that ultimately the results make it worth while.