Discussion of Paper on “Autistic Processes”

Because the scope of my own work with autistic and typical children has not been very extensive, I feel quite inadequate to opening our discussion of Mrs. Tustin's fascinating paper. In addition I believe that even to begin to do justice to this paper one ought to have a good mastery of Mrs. Klein's approach to some of the more primitive psychic mechanisms. I have found very useful here an earlier paper of Mrs. Tustin's. This is her 1966 paper called “A Significant Element in the Development of Autism: a Psychoanalytic Approach”. Since reading the two papers together was so helpful to me, I will feel free to refer to them both. I hope Mrs. Tustin will forgive me if I stumble when walking on the side of Kleinian theory.

Feeling today seems to be running high about how the autistic child and his parents can best be helped, and there is a comprehensible bias in some quarters in favour of simple, straightforward remedies. One recent account of work which uses the techniques of operant conditioning (Jensen and Womack, Amer. Jour. Ortho. XXXVII, 1, ) describes how the stereotyped behaviour typical of some autistic children was treated by the withdrawal of reinforcement. Practically speaking this meant that the therapist reacted to the child's use of this kind of behaviour by withdrawing attention from the child or even by leaving him on his own in the treatment room. The child was thus encouraged to surrender defensive behaviour by a threat of separation. Indeed the anxiety which this threat tends to arouse may have been that very thing against which the autistic defence was originally directed. I imagine that all of us would feel that changes in a child's behaviour thus obtained do not involve integration of experience on the part of the child.

In her 1966 paper Mrs. Tustin has described the trauma against which autism seeks to protect the child. This trauma consists of premature separations which tend to interfere with a primitive mechanism of projection by means of which