Response

Dear Sir:

Thank you for offering me the opportunity to reply to Sheila Spensley's letter. She mentions several different issues, some of which I think were dealt with in my review. I would like to confine my reply to the questions which she raises about the diagnosis of Frances Tustin's case, ‘Peter’.

Spensley refers to ‘the worst case X ever saw’ as Tustin's ‘criterion of autism’. Tustin was well aware of the complexities and difficulties of diagnosing these children and wrote about them at length. In addition to this, in the case of Peter the child was seen originally by Anni Bergman, a senior psychotherapist working with Margaret Mahler and highly experienced in the diagnosis and treatment of autistic children. It was Bergman (Spensley's ‘X’) who described Peter as ‘one of the most severe cases of autism she had ever seen’. This was never cited by Tustin as a criterion of autism but was accepted along with the details of the case and her own opinion on assessing him. Spensley fails to provide convincing reasons for doubting the judgement of two highly distinguished clinicians.

Forging the links between experimental research and clinical psychoanalytic accounts is a delicate business, involving as it does different models of understanding and different traditions of terminology. It seems particularly difficult to carry out these debates in relation to cases seen some thirty years ago, where there was no attempt to correlate a psychoanalytic point of view with experimental research.

While recent research developments including Baron-Cohen's work on empathy are of great interest, Spensley seems to use the ‘facts’ of research to decry the clinical facts of carefully documented case studies. To imply that Tustin might not have recognised that lack of empathy is an important characteristic of autistic children seems extraordinary. Tustin's case description captures precisely the beginnings of the move towards empathy which Spensley suggests that child psychotherapists need