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What is the relevance of Tustin’s classic work Autistic States in Children (newly reissued in the Routledge Classics series) to child and adult psychoanalysts today?
I would offer that her concept of “encapsulation” (in extreme and lesser forms, along with her clinical approach to such protective yet harmful defences) as well as her observations of early bodily terrors (and accompanying somatic defences) would be valuable for any clinician. In her Foreword to the new edition Maria Rhode notes that Tustin saw her primary contribution as
understanding the sensation-based mechanisms that protect the child with autism from what has felt like a catastrophic realization of bodily separateness … However, turning for protection to self-generated sensations prevents the child from being open to help from other human beings. (xvii)
Rhode notes that, more broadly speaking, Tustin saw “autistic self-protective strategies as part of the human condition - tragically restrictive, though felt [by us!] to be necessary” (xvii).
I undertook this review with the understanding that I would approach this classic as a child and adult analyst with a general practice, not as an expert on the treatment of autistic children. I knew I could benefit from thinking more deeply about what Tustin calls “pockets of autism” in patients who would not receive an autism spectrum disorder (ASD) diagnosis, but for and with whom I have grappled with autistic states and defences.
Tustin combines full-blown forms of autistic encapsulation and confusional entanglement together under the term “childhood psychosis”. Diagnostically, I did not find this helpful as ASDs are today generally considered neurodevelopmental. Tustin, however, is speaking from a Kleinian rather than a psychiatric perspective. From a Kleinian view, both autistic encapsulation and confusional entanglement yield an inability to face reality - fundamental to the Kleinian conception of psychotic process. From a heuristic point of view, I found t