Response to Francis Tustin's Letter

September 15, 1993

We are pleased that Dr. Gillett's letter has received some notice as he brings up points about the freedom of exchange in psychoanalysis that are crucial to our future. We also welcome the new information provided in Mrs. Tustin's letter concerning Mahler's late life renunciation of her idea of primary autism in response to Stern's data. Those of us who heard her "conversations with Stern" in New York and at the American Academy of Child and Adolescent Psychiatry in her later years, also heard similar remarks in statu nascendi. Nonetheless, Mrs. Tustin's notion of nonorganic autism as a response to a vulnerable child's traumatic response to a depressed mother needs reconsideration as well.

Turning back to Mahler, her (1961) paper, "Sadness and Grief in Infancy and Childhood," clearly contrasts anaclitic and depressive psychopathology and autism. More important, we have a serious confusion across the Atlantic in regard to the term Autism used as a diagnosis versus autism used as a defense.

In the U.S. psychiatrists and psychoanalysts, by and large, adhere to the DSM-III-R diagnosis of Pervasive Developmental Disorder, Autism, as a developmental disorder that carries a prognostic implication of seriousness. Outcome studies are available and there is general agreement about the biological origins of this disorder. There is strong adherence to this vantage, even among our few psychoanalytic colleagues who see such cases. We shall continue to be at cross-purposes, I am afraid, if we use the term nonorganic autism.

I do wish that our psychoanalytic community could come up with another term and a better description of the children they include in non-organic populations, because to me as an analyst, as well as an investigator, these children sound descriptively, if not dynamically, different from the children we describe as autistic on this side of the Atlantic.