Developmental Bisexuality in Autistic Spectrum Children

Increasing publicity given to the raised incidence and the nature of Autism Spectrum Disorder (ASD) offers a challenge to child psychotherapists to enter the debate about the phenomenology, aetiologies and appropriate treatments of ASD. Engaging with other theories of autism such as developmental psychology and physiological accounts has been very productive for child psychotherapy. The work of Anne Alvarez and Vivienne Green and their colleagues are good illustrations of what we have gained theoretically and clinically. Also, it is arguably through engaging with other theoretical and therapeutic frameworks that both the distinctive contribution of child psychotherapy and where it fits in relation to other approaches will become clearer both to us and to parents and other practitioners.

One of the current high-profile theories is the ‘Extreme Male Brain Theory’ (EMBT), put forward by Simon Baron-Cohen, previously associated with the ‘Theory of Mind Deficit’ Theory of Autism. The idea in EMBT is that autism exaggerates cognitive styles, ways of thinking and managing emotional situations in ways typically thought of as ‘male’ at the expensive of softer, more personal and affectively charged characteristics. The evidence provided includes the sharply raised incidence of ASD in males, the raised levels of testosterone found in the amniotic fluid of pregnant women later found to be carrying autistic babies and well known features of cognitive style in autistic children. In Baron-Cohen’s account the explanation of the difficulties revolves around differences or relative deficits in the brain structures of ASD children.

Apart from the perennial problem of moving from neurological to psychological levels of description, one problem with this account is a circularity resulting from a particularly narrow definition of masculinity. It also appears to be at odds with the observation of many child psychotherapists that ASD children can be very sensitive emotionally, suggesting, indeed, an excess of ‘feminine’ characteristics. The EMBT theory does, however, pull together a number of well-recognised characteristics and raises the interesting question of what happens in ASD girls.

This paper recasts the issue of exaggerated male characteristics as less one of relative dominance than one of the relative balance of masculinity and femininity, or what I am calling ‘developmental bisexuality’. Highlighting Frances Tustin’s distinction between autistic objects and autistic shapes, reflecting preferences for extremes of hardness and softness respectively, Didier Houzel has previously argued for fundamental problems with bisexuality in autistic children. In this paper I am concerned primarily with children who are a little more able than those described by Houzel and Tustin and am conceptualising developmental bisexuality as including the capacity to identify with characteristics of both parents. In the ordinary developmental situation, the beginnings of this development are epitomised in the pregenital Oedipal situation.

Hobson and his colleagues have argued for an absent or reduced capacity for identification in ASD. Anna Burhouse has pointed out that a diagnostic feature of autism, evident before the end of the first year, is the absence of prelinguistic indicative pointing, which presupposes the infant’s grasp of the need to manage a triangular situation. Burhouse links this with the autistic child’s failure to come to grips with the pregenital Oedipal situation, with tragic consequences for the development of communication, language and thought. From this it follows that evidence that indicates the development in ASD children of a greater capacity for identification with both feminine and masculine aspects of the parents, particularly the protective function of the paternal object and the care-giving aspects of the maternal role, should be associated with a reduction in autistic features and an increased propensity for communication and symbolic functioning.

This paper illustrates the usefulness of these ideas. Firstly, it describes psychotherapeutic work with parent couples in families with a young autistic child that facilitates the emergence of developing enhancing environments. Secondly, it explores the developmental balance between masculine and feminine aspects achieved over time in the intensive psychotherapy of a three-year-old girl undertaken by Tony Lee and supervised by Maria Rhode.

In addition to highlighting technical implications for psychotherapy with ASD children, the conclusions argue that this work can generate research questions relevant to the wider research community as well as contributing to a fuller understanding of ‘bisexuality’ in child psychotherapy and psychoanalytic thinking.