by Jo Rostron on April 2, 2011
Clara, aged seven, had recently been given a psychiatric diagnosis of high functioning autism associated with dyspraxia. She could read at a level well beyond her years, but was unable to write. She was referred to me at a local authority Family Centre because her mother was at her ‘wit’s end’ with Clara’s defiant behaviour and poor communication, her running away and bed wetting. The mother had experienced a succession of bereavements of significant male figures in her life: a brother, her father, and her husband shortly before the birth of their first baby, a stillborn boy. Eventually she ‘became tired of crying’ and remarried. She gave birth to two daughters, the youngest of whom had Down’s Syndrome. In a final attempt to bear a son, she ‘took a risk’ late in life to become pregnant again and subsequently Clara was born.
During two preliminary meetings with me Clara made two drawings. The first represented a child in the back of a car, with mother in the front, driving along a lane that was ‘going nowhere’ and that ended in ‘mud’. Her second drawing, of a girl with bows in her hair and a ‘dirty belly button’, seemed to lay bare a kernel of perceptions and sensations that were nonsensical to her. Mother joined the sessions for six months, to observe rather than to participate, and was situated at the far end of the room. Some time later, Clara commented, fascinated, ‘There’s a boy in our class called Jo but his name has an E on the end.’  With the idea that a letter can make the difference between femininity and masculinity, she began flattening clay. Quickly, she transformed the clay into a life-like representation of male genitalia. Clara told me ‘It’s a model of Robin Hood, an outlaw with excellent archery skills.’
One morning Clara brought in a cast of a tiny foot, taken when she was an infant. ‘Do you want me to know you as a baby?’ I asked. She released a torrent of questions, of signifiers without signifieds, that only her mother could answer. A playful protocol for our communication evolved as verbal interactions between mother and daughter were triangulated via the therapist, grammatically into the third person. With the change in addressee, Clara tried to fathom the mystery of her mother’s desire. She observed that Mum was ‘old’, wanting to know when she had started ‘getting babies’, perhaps by way of inviting her to talk about the baby boy who had died. Clara asked fearfully if she had been a good or bad baby, indicating she had identified herself with the ‘bad baby’, the stillborn brother.
Her question ‘When can I be Sam?’ repeated on two or three separate occasions, revealed Clara was not only wanting to be, but expecting to be this boy Sam (also in her class) just like the boy her mother desired. I understood from the mother that until now Clara had believed she was a boy. She once arrived with short tufts in her long red hair after cutting it at school, close to her scalp. She had been chastised by the teacher, just as she had been by her mother when she was unable to form the letters necessary for writing. I learned that at home she used to flee from a children’s arithmetic programme on TV during which the numbers zero to nine became animated and ran around. In the sessions she would play peekaboo joylessly, exploring being seen and seeing, and via the mirror, watching herself and us. After the mother had ceased attending the sessions, this activity developed into a game. Clara was sensitive to different voices, startled by certain sounds and frightened by certain words or actions of mine. She used some neologisms, such as ‘licamon green’ (for a blue) and spontaneously created rhymes and tunes: her imagination was abundant, not a feature generally associated with autism.
Clara let loose trails of paint, ink, foot and handprints across surfaces, including the floor and walls, explored rims of palettes and jugs, the holes in clay modelling tools and the spaces inside containers. She scribbled wildly with a pen and then used fluorescent marker to highlight certain shapes, instructing me about the ‘double scissor loop’ or the ‘kicking back flip’ of the ‘Clara Neeeopitan Language’ (a name based on a phoneme she had used, playfully, earlier). These activities were interspersed by intervals when leaking jugfuls of water, lumps of clay and paper towels were dumped repeatedly into a large black bin and abruptly abandoned as she ran to use the lavatory. Before the summer break, she devised a pretend email exchange, during which I took dictation and also corresponded with her, taking on the roles, as requested, of various schoolmates on vacation. Sometimes I would become present to her as the analyst, when she ‘emailed’ at length how much she really hated me…, ending with : love, Clara. During the intensity of her hainamouration I could occasionally slip her my notebook, and she formed some letters and words to me herself.
Over the following year, aged eight to nine, she constructed ways of bearing her jouissance, or what she came to call ‘The Ordeals’. One involved a bucketful of red paint and a humdrum account of what was written in the diary of Ann Boleyn the night before she was beheaded. This narrative became a series of dramas on the theme of ‘Mealtimes At Home with the Tudors’. Around the table were Henry VIII’s children Mary, Elizabeth and Edward, three of his wives named Catherine and his father Henry VII. These characters always had the same place at the table, reserved by a sheet of A4 paper. Onto each of these, Clara wrote a name and an age (three were inscribed Clatherine and marked with a corresponding fate: divorced/died). Each paper placemat appeared to function as a letter, giving some form to the characters’ differing perspectives that were created by Clara and that emerged according to her whim. She was trying to accept the idea that mothers were obliged to have sons because boys were better than girls. ‘Why?’ I asked. ‘They just are’ she explained.
A construction in which she renounced some jouissance developed in parallel to the ‘Tudors’ as a series of drawing games with me. It started as ‘The Battle of the Pens’ in which the opponent’s pen was aggressively scribbled off the paper. She introduced a river, bridges and then, to allow opposing soldiers and armies across, a few rules. Dungeons and palaces appeared. Negotiations began between the King of one territory and the Queen of another. The Queen’s ‘serving girl’ offered herself in exchange for some of the King’s soldiers and for a house on his land. A market place with a variety of labelled stalls gradually sprang up, followed by a temple, a school and, towards the end of our work, an orphanage. The small society she had created appeared to signify her memories of the sessions, inscribed onto paper as a visual narrative or a mapping.
By now Clara had found the courage to engage with writing at school, albeit laboriously, and had also made a few friends. The final session arrived, after two and a half years, owing to the long waiting list of the institution that had referred her. She played a starving orphan, found in the street by a young boy, who finally persuaded her to enter the orphanage. Once there, the orphan was surprised that girls and boys had dormitories on separate floors of the building. ‘Why?’ she asked. ‘Girls and boys are different’ I explained.
How did psychoanalysis work here? For Clara, it enabled an articulation of the sexual drive that helped her to create her own signifiers and to orientate herself through meaning. Gradually the holes she experienced at the level of the body were filling with language containing its own sensory memories. She sacrificed some jouissance through fictions that entwined gender and sexuality and that were linked to the Other. Having a relation to the analyst at the level of the ideal ego enabled her to begin to feel ‘both satisfactory and loved’ .
Note: This is the text which was presented in London on Saturday 2nd April,2010 at the 9th conference of the New Lacanian School: ‘How Psychoanalysis Works’. Published 1) Translated by Bruno de Florence as: Quelque chose manque: in Mental: Revue internationale de psychanalyse, vol 26: “Comment la psychanalyse opère”, June 2011, pp. 121-124. 2) p63-66 of The Psychoanalytical Notebooks, Vol 23:Our Orientation, Oct 2011, Section: Clinical practice with children
 In English, the name ‘Jo’ is feminine, while ‘Joe’ is masculine.
 Jacques Lacan: Seminar XI: The Four Fundamental Concepts of Psychoanalysis: 1964: Session of 17th June 1964 – From interpretation to the Transference: p257 of reprint of Alan Sheridan’s translation: 2004: Karnac Books:London,. Quote: ‘The subject has a relation with his analyst the centre of which is at the level of the privileged signifier known as the ego ideal, in so far as from there he will feel himself both satisfactory and loved.’