Frances Tustin (1913-1994) was renowned for her pioneering work on the psychoanalytic treatment of childhood autism. She was the first to emphasise the central importance of the body for these children, for whom the experience of separateness can feel like physical mutilation. She came to realise that many of their self-protective strategies were similarly bodily based, and that actions that might have seemed symbolic were in fact aimed at generating sensations that allowed the children to feel they continued to exist. This opened up a way of approaching unrepresented states, in line with Wilfred Bion’s theorisation of ß-elements but rooted in the phenomenological detail of the child’s experience.
Early life and career
Tustin was born Frances Vickers in Darlington in 1913. She trained as a primary school teacher before developing an interest in psychoanalysis. She married twice; her second marriage to engineering professor Arnold Tustin was a long and happy one, although the couple suffered the sadness of stillbirths.
In 1952, along with Martha Harris and Dina Rosenbluth, Tustin joined the second intake of the new child psychotherapy training, which Esther Bick had founded at the Tavistock Clinic. Her analyst was Wilfred Bion, and her supervisors were Bick, Herbert Rosenfeld, Donald Meltzer and, later, Sydney Klein. She greatly valued her supervision with Meltzer and shared his views on the importance of sensuality in children with autism, and on their reliance on adhesive identification. She preferred to call this ‘autistic equation’ or ‘autistic identity’, as she felt that this better expressed the complete identity and lack of space between the child and the other.
After qualifying, Tustin spent a year in Boston, where she was introduced to the work on autism being done by Margaret Mahler, Anni Bergman and their group, to which she often referred.
Autism and bodily sensations
Tustin’s first paper on autism, ‘A significant element in the development of autism: A psychoanalytic approach’, was published in 1966. John, the three-year-old whom she analysed for three years, developed language and subsequently went to university. He famously showed her that he had believed that the ‘red button’ (his word for the nipple) was part of his own mouth, and that he felt his mouth contained instead, a ‘black hole with a nasty prick’ when he realised that this was not so. Tustin returned many times to this material; one of her later formulations (1986b) was that John experienced the breast as having a hole in it, so that his mouth, which was equated with the breast, had a hole in it also. Another patient, whom she described in her first book, Autism and Childhood Psychosis, was 10-year-old David, who constructed a suit of armour to keep himself safe. This led her to the idea of autistic encapsulation, by means of which a child protects him- or herself from environmental impingements or the dangers of relationships, through self-generated sensations which generate a sense of self-sufficiency.
Understanding autism’s self-protective strategies
Tustin became aware that the phenomena she was encountering were difficult to theorise in terms of the Kleinian concepts of splitting and projective identification. She recognised that Winnicott and Mahler had described similar states, and this led her to adopt some of their theoretical framework, including the idea of a normal, primary stage at which mother and baby are undifferentiated. In her first book she proposed a classificatory scheme, according to which various sub-types of ‘pathological’ autism arose through regression to ‘normal primary autism’. She later revised this view (1990, 1991), partly because of the findings of developmental researchers on the very early capacities of infants. In her last presented paper (1994), she put forward a two-stage theory of autism, according to which undue, sensuously-based closeness between mother and baby was interrupted by a traumatic realisation of bodily separateness, which the baby tried to manage by relying on self-generated sensation. However, she retained her earlier distinction between encapsulated and confusional children with autism: between the ‘shutters-out’ and the ‘drawers-in’. She also described the use of autistic self-protective strategies as a ‘straitjacket’ to keep psychotic anxieties in check.
‘Autistic objects’ and ‘autistic shapes’
In Tustin’s own view, her main contribution lay in understanding these sensation-based mechanisms, which protect the child but interfere with his openness to help from other human beings. ‘Autistic objects’ (1980a) are hard sources of sensation that make the child feel strong, whereas ‘autistic shapes’ (1984), such as patterns made with the child’s own breath or spit, are soothing and tranquillising. She emphasised the importance of integrations on these fundamental sensory levels, where hard and soft are the forerunners of male and female. Many of her readers would also single out her paper, ‘Psychological birth and psychological catastrophe’ (1980b), in which she outlines some of the terrors that the separateness of being born can hold for children who are not contained in what she calls a ‘mental uterus’; as well as her memorable, meticulous account of counter-transference processes (1981b). She emphasised that parents should not be blamed for their child’s condition.
Conveying the experience of autism
Tustin wrote vividly, in a way that allowed her readers to understand experiences far removed from those of the normal neurotic adult. She avoided technical terms in favour of quotations from the poets, and her work reached many outside the profession. Her third book, Autistic Barriers in Neurotic Patients (1986), illustrated the importance of autistic anxieties (such as falling forever, spilling out, and losing parts of the body) in the experience of children and adults who did not have autism. She saw autistic self-protective strategies as part of the human condition – tragically restrictive though felt to be necessary.
Her particular genius perhaps lay less in theoretical formulation than in the capacity (one she shared with Bick) to feel her way into a child’s bodily experience; she could then convey the human essence of patients who seemed to have no essence.
As a supervisor she was enthusiastic and generous, (and a supervision was typically followed by a letter containing ideas that had occurred to her afterwards). She taught extensively, both abroad and in Britain, and her books have been widely translated. She was an Honorary Member of the Association of Child Psychotherapists and an Honorary Affiliate of the British Psychoanalytical Society.
Several months after she died on 11th November 1994, Tustin’s husband, along with psychoanalysts Judith and Theodore Mitrani, founded the Frances Tustin Memorial Trust in Los Angeles (now based in Paris). The Trust awards an annual Frances Tustin Memorial Prize and lectureship for a clinical paper on, ‘the treatment of primitive mental states in general and autistic states, in particular, in children, adolescents or adults’. The Mitranis’ edited book, Frances Tustin Today, was published in the New Library of Psychoanalysis series in 2015. Tustin’s archive is held at the Wellcome Library.
Maria Rhode, 2017
Photograph: © Lucinda Douglas-Menzies (www.douglas-menzies.com)
1996 Tustin, F. ‘A significant element in the development of autism: A psychoanalytic approach’. Journal of Child Psychology & Psychiatry.
1972 Tustin, F. Autism and Childhood Psychosis. Hogarth.
1980a Tustin, F. ‘Autistic objects.’ International Review of Psycho-Analysis.
1980b Tustin, F. ‘Psychological birth and psychological catastrophe’. In Autistic States in Children. Routledge.
1981a Tustin, F. Autistic States in Children. Routledge
1981b Tustin, F. ‘Thinkings’. In Autistic States in Children. Routledge.
1984 Tustin, F. ‘Autistic shapes’. International Review of Psycho-Analysis.
1986 Tustin, F. Autistic Barriers in Neurotic Patients. Karnac.
1990 Tustin, F. The Protective Shell in Children and Adults. Karnac.
1991 Tustin, F. ‘Revised understandings of psychogenic autism’. International Journal of Psychoanalysis.
1994 Tustin, F. ‘The perpetuation of an error’. Journal of Child Psychotherapy.
2015 Mitrani, JL and Mitrani, T. (eds) Frances Tustin Today. New Library of Psychoanalysis, Routledge.
The Frances Tustin Memorial Trust: www.frances-tustin-autism.org