To sum up: what seems impaired is not only the capacity for affect, but another capacity perhaps even more fundamental, the capacity for undertaking exploratory behaviour and sustaining it. We know little about what we still call by its old-fashioned name of curiosity, still less about the qualities we describe, with more sophistication, as ‘motivation’ or ‘drive’. All of us know, however, that normal individuals vary enormously in the degree to which they possess these qualities. We know that curiosity, motivation, and drive are affected by the stresses of the environment, but we know also that even babies differ markedly in their desire to explore the world around them, for no apparent environmental reason. There are those from whom no medicine bottle is safe, who pull every light cord, who poke into every drawer to see if something interesting might be hiding there, and others (like my three normal children) who are much less interested in physical exploration. And there is Elly, who is not interested in exploration at all.
Families can reinforce curiosity and drive in their children, or discourage them. Societies can do the same; we all know that three thousand years of Egyptian intelligence is a very different thing from three hundred years of Greek. But however it is reinforced or discouraged, all normal human beings exhibit the drive to learn and to explore — indeed all animals do, our cousins the apes most of all. Years ago W. I. Thomas listed ‘a desire for new experience and stimulation as one of the instincts’,[36] and indeed it must be so. What if it were not? If animals were born without that positive enjoyment of new experience which leads them to explore and master their environment, neither they nor their species would survive. Curiosity and drive are essential to evolutionary survival, and if we can expect any characteristics to be built into animal biology it would be these. One day we may know how such things are built in — into brain impulses, into nerve structure, into blood chemistry, into mechanisms we cannot yet suspect. Even now we — not neurophysiologists only, but all of us — know how will and motivation can be reduced, even temporarily annihilated, by physical causes such as ageing, sleeplessness, or drugs. Most of us feel such a reduction as unpleasant, but it need not be. Suppose a child felt always the detachment that in certain people is produced by LSD? Such a child would not initiate action, would welcome the limits that made it unnecessary, would, as its irreversible growth engaged it inevitably with the world’s complexity, seek out and enjoy the unchanging patterns that affirm stability in a world of Becoming.
The inertia of such a child might affect even cognitive functions, so that ideas that normal babies associate without apparent effort would be connected only with difficulty, and past experience would be only minimally available for use in new situations. All the autistic child’s deficiencies could be seen as converging in this one: the deficiency which renders it unable or unwilling to put together the primary building blocks of experience. It affects the senses, it affects speech, it affects action, it affects emotion. The autistic child does not move naturally from one sound to another, from one word to another, from one idea to another, from one experience to another. Yet reality, as human beings experience it, is a web of connections to be made. The reality of persons and emotions is the most complex web of all. The baby who can make little sense of the simpler interconnections will make even less sense of these complexities; it will be ‘deficient in affective functions’. Because this deficiency is more conspicuous than the others, it will tempt us to consider it as primary. But if over years we watch this deficiency steadily diminish, while others simply change their faces, we will begin to wonder.
Not all individuals possess all the characteristics of the species — even the essential ones. By imagining an individual born with the capacity to explore the environment, but with whatever it is that determines the drive to do so absent or grossly impaired, we can arrive at all the characteristics of the autistic child. Because of the negative survival-value of the trait, such individuals would be uncommon — as autistic children are. But such a hypothesis would explain much that other explanations leave untouched.
I have deferred discussing one last deficiency of Elly’s until now, almost at the end of the story, because it is so pervasive and difficult to catch hold of that the appreciation of it has need of all that has gone before. It is directly related to the lack of exploratory drive, for it concerns Elly’s signal lack of interest in future experience. My husband thought of the word for it — one day, watching as Elly moved with agonizing slowness through the hundreds of motions that were necessary before she could reach the enjoyable experience of school, he exclaimed, ‘It’s the sense of purpose that’s missing!’ We began then to think about purpose and what it entails, and to relate it to a lack in Elly we had long felt without being able to give it a place in the total picture.
Purpose entails drive and the capacity to sustain. But it entails another capacity as well, one which itself plays an obvious part in motivation — the capacity to
She is curiously matter-of-fact. The Institute, long ago, told us she had many fears, and at the time we were quite ready to assent. Fuller experience has made us less so. Fear is not mere anxiety, such as Elly exhibits daily when some trivial thing goes wrong. Fear envisages; it imagines; it is anxiety in anticipation. It is fear, not of what is visibly present, but of what
Her attitude towards dogs in general provides another illustration of the difference between fear, which envisages what is not present, and anxiety, which does not. Elly is anxious in the presence of rambunctious dogs, but she would never refuse to visit a house where from previous experience she might expect to meet one. Relevant here also is the absence of hallucinations that has been noted in autistic children. What is hallucination but imagination so vivid that it takes over the very mechanisms of the senses themselves? In contrast, Elly’s sense of what is and is not the case is unusually sharp; it is the main source of her humour. At four, her father taught her to pretend, mimicking bedtime, laying her on the floor with a sheet of paper for a blanket, a stick for a doll, while she laughed at the ridiculousness of it all. At seven and eight she could pretend a little for herself (significantly, ‘real’ and ‘pretend’ were adjectives she learned very easily). Seeing her suck her thumb, I told her it was chocolate; she herself added ‘strawberry’ and ‘vanilla’. Recently she stroked me, giggling ‘Furry, furry Mama!’ There could be no possible doubt that this was a joke, part of a constant and enjoyable interplay between truth and falsehood. ‘Is Mama downtown?’ ‘No!’ ‘Did Jill go downtown?’ ‘Yes!’
No hallucinations, no fantasies. We could use some; they would make her play much richer. Nor have we ever seen any evidence of nightmares. Her focuses of severe anxiety all have the same characteristic — they are immediate and visible. I do not say that she is like the boy in the Grimms’ fairy tale who could not shudder. But it is certainly true that one of the reasons it is so hard to read her the simplest children’s story is that she is as yet incapable of understanding why Peter Rabbit was afraid of Mr MacGregor, because for her out of sight is out of mind.
As with fear, so with other emotions. To attain its full human complexity, emotion must include an element of imagination. Jealousy would be a minor affliction indeed if we felt it only in the actual presence of the loved one. Without the power to envisage, to interconnect, to bring to bear past and future, we should experience only a very simplified version of hatred or affection or love. And if the deficiency in imagination is relevant to deficiency of affect, its relevance to the deficiency of exploratory activity is even clearer. Recently I played hunt-the-button with Elly and discovered that she could envisage no new hiding places. Though I restricted the hiding places to my own person, Elly could find the button only if left in plain sight, or in places I had hidden it previously.
A final illustration of this matter-of-factness is her attitude towards blood. Blood can be a touchy subject for children and psychiatrists — for children, the focus of much emotion and fantasy, for psychiatrists, of much theory. Elly knows about menstrual blood. In the general lack of privacy attendant on life with Elly I made an effort to keep this inconspicuous, but over a period of years there are bound to be slip-ups. There was reason to worry about Elly’s reaction to blood, especially since there were no words for explaining the phenomenon to her. I was not reassured when to ‘Red blood, hurt!’ she added ‘Leave your tail alone’, showing that she had made a connection between masturbation and menstruation, which I was as far from being able to discourage as I was from having
