Perhaps this would not be true if the professionals had access to a sure body of knowledge about psychotic or defective children, which they could have imparted to us. But they did not, nor did they pretend to. What they had was a body of observations, some of it crystallized into theory, on the behaviour of a large number of children and what appeared to affect it. These children were different from Elly and from each other; conclusions drawn from their problems or solutions were of doubtful applicability to this particular child. In the absence of sure knowledge in this case, these professionals did not substitute theory. They gave us instead the gift that amateurs and professionals alike can give — their sympathy, understanding, and support.
Not that they withdrew from the attempt to apply what they did know, to place Elly within the categories they found meaningful. In this, as in other things, they were candid. The severity of her condition, which we had uncertainly divined from the gnomic generalities of the Institute, these people made quite plain. Up to this time we had had, as a guide to prognosis, only a small number of case histories that Kanner had got together some years before. [13] Its utility was doubtful, since very few of his cases had had time to grow to maturity, but such as it was it could be used to predict any kind of future for Elly. The cases showed a complete range of functioning, from quasi- vegetative existence in a state hospital to (one case only) apparent normality. But Hampstead, like the Institute, did not seem to find infantile autism a valuable category, and they did not encourage us in any vague hopes based on observation of it. The social worker emphasized that Elly had missed out on the most formative years of childhood, and that those lost years could never be made good. The psychiatrist discussed the difficulty children can experience in realizing the boundaries between themselves and others; his final report speculated that ‘the defect may lie in the integrative processes of the ego’. He brought forward the terms ‘childhood psychosis’ and ‘schizophrenia’, only to stress their extreme generality. The term childhood schizophrenia, he suggested, would in time be seen to cover a variety of conditions we could not as yet distinguish.
Elly, as he spoke, was absorbed in play. Compulsively she turned on the taps in the playroom washbasin, filled it, and emptied it again. She was tense with excitement. This was a new fixation; in any building now she sought out sinks and tubs, screaming if she was prevented. The unexpected presence of a washbasin here made any contact impossible. Back in her citadel, she was incommunicado. The Institute psychiatrist, eight months before, had fared better than this.
The whirr of running water made a background for the doc-tor’s words: ‘The prognosis is not good.’ When he said that she could not be expected to become an integrated personality, I knew that he was not thinking merely of a withdrawn woman who collects stamps and never marries.
Yet it was the painless evasions of the Institute that hurt us, not this hard candour. We were grateful for much, but most of all for the fact that these people respected us enough to trust us with what they thought. It was, after all, that for which we had come.
And if we could no longer strengthen our efforts with inchoate hopes of full recovery, we had been given another source of support. ‘A massive regression now appears unlikely.’ The wise and gentle professionals of the most famous children’s clinic in the world had given me the reassurance I could not give myself. They did not think that in my lonely and presumptuous work I had injured my child. They thought I had helped her. Their present recommendation was not that Elly begin analytic therapy, but that I continue to work with her as before, with one difference. I would now have professional guidance. One of their analysts was transferring her practice to the city where we were living. I could see her there.
I saw her three times a week at first — a lot, it seemed to me, not enough, to her. The sessions, to my initial surprise, centred not on Elly but on me. It was not until much later that my husband told me the one thing that the Clinic had withheld; that they had thought that it was less with Elly’s emotions I would need help than with my own. We talked about me for several weeks, stirring up a good deal of mud and taking a good deal of time I didn’t have — the analyst the while cheering me on to find more time to myself, to read, to write, to meet the English, and generally encouraging me to feel talented, heroic. and unappreciated. It was a rather enjoyable process. The things she said were flattering and sympathetic; as no one else, she seemed to realize how hard my job was. But I grew uneasy. I was grateful for the support, but as time went on I feared the pleasure was self-defeating. The process seemed to breed self-absorption and self-pity, and at this juncture there was no use I could make of either.
What happened then was a tribute to a good analyst’s perceptiveness and flexibility. We seemed to reach our conclusions almost simultaneously. Abruptly she shifted her approach. She came to see Elly at home. We talked, not about me, but about her problems. I came less often. The analyst became, and remained, a trained adviser, wise in the ways of children, giving me the benefit of her knowledge. But she was an adviser who now knew me well.
I knew her too. She too became a friend. She tried not to, for it is contra-indicated in the training. She told me that; I had not known it. But we had too much in common. We could not inhibit our friendship, and it was as a friend that she helped me.
That help took various forms. There were, for example, words I used which revealed certain presuppositions. Several times I had spoken of a ‘breakthrough’. Gently the analyst asked me what I meant by that word. ‘What arc you expecting?’ I saw then how much had been involved in it — how many romantic notions, fostered by how many accounts of cures that seemed like miracles but presumably were not to those who understood the dark mysteries of the unconscious. I had been told — though not by Hampstead — that Elly had no mental deficiency. Yet in all but a few areas of actual behaviour she was grossly defective. What could be the explanation, then, but some emotional blockage, some log jam of fears and repressions, which could be opened up and removed? We had already begun to remove them; with Jill, with the children, with her father, with me, was she not now often laughing and affectionate, more open than ever before? If she was healthy in body and had no mental deficiency, then her trouble must be all emotional. And was that not tantamount to saying that there was a normal child hiding inside her, and that if we could find the right things to do we could call it out?
All that, I now saw, was inherent in my use of the word ‘breakthrough’. Though I had not been told so, I had unconsciously assumed that underlying the practice of psychiatry was this kind of optimism. I saw now that the wiser practitioners had too much experience to make such naive claims for their method. There were miracle recoveries, to be sure, and well-publicized ones — a recent book [14] tells the story of a child who could have been a stand-in for Elly, restored by play therapy to brilliance and affection. No doubt it happened. Miracles do. But I was in the presence of someone too wise to claim she could chart the processes to bring them about, or to allow herself or me the illusion that one was in preparation here.