A PSYCHOANALYTIC VIEW OF AUTISM
1. Karnac Books recently had Frances Tustin's book "Autistic barriers in
neurotic patients" reprinted. It was first published in 1986. The new
edition has added some comments to the contents, which mostly consist of
formerly published articles, describing clinical experience of the author.
As a whole the book is well written and easy to read. Even though the
psychoanalytic approach on understanding autism is no more in fashion, many
people still try to push it and it is still the accepted approach in much
of Western Europe. I am going to be nasty about it so those who do not like
it, please jump to the next message.
2. As a general comment of the psychoanalytic approach I may note as a
person with a positivist approach to science that psychoanalysis is not
scientific at all. The approach to work is based around observations of the
client in the famous couch and in the "method" of interpretation of the
spoken thoughts and other expressions of the client. The sessions last from
about an hour and occur at most a few times a week, often just every two
weeks or once a month. It seems that no other information of the client is
used. The method of symbolic interpretation is crucial. It is based on the
model of psychoanalysis and intends to find the deep motives behind the
obvious. If a certain thing is not observed the psychoanalyst may interpret
that it still exists but is repressed, pushed to the unconscious.
3. Frances Tustin developed a hypothesis that "early-childhood autism is a
two-stage illness: the first stage being an unduly close association with
the mother, the father often being virtally absent or excluded. Such a
child has been described as a `cork child' to plug the hole of the mother's
depression and loneliness. The second stage is when this over-vulnerable,
'hot-housed' child inevitably becomes aware of bodily separateness. This is
in such a sudden and painful way for it to be a life-threatening disaster.
It is traumatic." She seems to have been active in UK and has good contacts
with psyhiatrists in USA, Italy, France and Spain.
4. From the point of view of experimental psychology psychoanalysis works
improperly. No hypothesis is ever tested in any convincing way. Never are
groups of people tested for some hypothesis, but all observation is
subjective, no data is ever taken. the approach Tustin gathers no data but
tries to support her hypothesis on the her psychoanalyst's interpretations.
These seem arbitrary, but are of course related to her hypothesis and the
psychoanalytic tradition. How can one measure whether a child has "unduly
close association to mother"? And then how can we reliably establish that a
child becomes aware of bodily separateness. In fact the opposite question
is even harder. How do we know whether a child has the illusion of being
bodily the same as his mother?
5. Frances Tustin makes much about 'autistic objects', usually hard
surfaced objects which autistic children use in self stimulation. She
believes that the selection of an object is very significant and she draws
deep conclusions out of them. It does not seem to occur to her that in her
highly artificial and unstructured play therapy environment the autistic
child does not know what to do and thus retracts to self stimulation. A
familiar object brings him some security.
6. In describing her patients Frances Tustin does not give much
information as to their level of development, although good forms existed
at that time for that purpose. It is well known that autistic children
behave very differently in different environments. The patients are
observed only during the therapy sessions, of which there may be hundreds.
This gives obviously very little information. I would not give much value
to such accidental information. It seems to me that she does not understand
autism at all.
I find it amazing that she coldly describes how a patient is playing with
his feces, which must have arrived during the therapy session. She
described how he felt pain about the dried very hard cake on his anus,
which he tried to break. Is it really impossible for a therapist to help
the child in such a distress? Then she goes on and develops completely
arbitrary theories on this matter of basic care, which requires no complex
theories. Obviously she finds all this exercise of the child, created
through her neglect, very interesting. I find it very cruel, much worse
than the aversives discussed in the list.
I wonder how *she* would feel, when not allowed to go to toilet and then
carry the feces in *her* petty pants until it all dries and starts to hurt
*her* bottom. What deep symbolic conclusions could another psychotherapist
find of *her* behaviour, maybe related to an alleged Oedipal complex? But
sorry, I forgot that she is a normal adult person, and we were discussing
treatment of a handicapped child, perhaps with a low IQ. Perhaps people
wonder, why I pick just this small detail out of the book. My son also
participated in a similar series of sessions. I could not understand why
the therapist never helped my child, because I was not allowed to be
present during the session. The time chosen happened to be such that my son
had dined before it. But now I know better, it is part of the practice to
let the child suffer.
7. It is known in psychological literature that testing of psychoanalytic
hypothesis, e.g. the idea of people with "anal" character that supposedly
leads to grudginess, is a total failure. The fact that a person has had
some anal problems as a small child and his character as adult are
Seppo J. Halme