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In her two previous books Frances Tustin has developed and described her highly original approach to understanding and treating psychogenic autism - those autistic states in which anxiety and emotional difficulty play a major causal role. In her Autistic States in Children she hinted at the implications of there being autistic phenomena in neurotic patients who are not overtly autistic. These consist of intensely private and primitive ways of screening out aspects of reality which would otherwise be experienced as overwhelming - for example, in certain obsessional states, fanatical and rigid states of mind, and all the variety of common ways in which people try to impose a rigid order on what they fear to be a potentially chaotic world. When looked at in this way, who can be considered entirely without autistic areas of their mind? Tustin's work is a fine example of how the study of extreme states of mind casts light on related processes in more everyday and normal states. This is the theme of her most recent book.
Tustin describes how her views on autistic states in children developed from an initially purely Kleinian perspective in child psychotherapy. She began to realise that autistic disturbance concerned phenomena and anxieties more primitive than those of the social emotions of love, hatred, jealousy and envy described by Klein. She saw that autistic children related to people as if they were inanimate objects whose failure to behave in predictable ways evokes rage and terror. These children seem to exist in a sensation-dominated world, clinging to hard ‘autistic objects’ or secretly engaged with ‘autistic shapes’. Autistic shapes are really sensation patterns which are somehow divorced from the object producing them. The actual sensation produced by contact with an external object is in fact part of the subject's body, and thus when divorced from the object itself can function to preserve the illusion of self-sufficiency. For the autistic child the encounter