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This is the kind of book we have long been in need of: nothing less than a “natural history” of the autistic child, and his development in therapy.
The book does many different things for us: it gives features to a notoriously blank landscape, focal points around which our observations can cluster and our intuitions gravitate. It throws light on the pre-conditions of developing the ability to think and to use symbols, in healthy children also. Furthermore, it throws light on the vestiges of autistic ways of functioning in ourselves, which can be such a help to our patients if we are in touch with them, or such a hindrance if we are not.
And most important it opens up a way of seeing things, and so gives existence to relations and feelings which previously, even when sensed, had to be put to one side, for there seemed to be no concepts, no vehicles on which they could ride into the light.
Mrs. Tustin describes pathological autism in terms of an attempt to establish an experience of continuity, of fusion with a containing mother, that either had been too harshly or too soon disrupted, or had only partially existed in the first place.
The state of being contained, of not yet being separated out, is part of the earliest condition of everyone; Mrs. Tustin calls it “normal primary autism”. To emerge from this stage and to become sufficiently contained in oneself to be a separate person with a “skin” round him (for example page 60), requires for the child to have had the experience of being “held” by a mother sensitive to him, in whose response he can find resonance of his own communications, who could in some way be experienced as giving him back to himself. The alternative to coming together in this way, is to have unbridgeable gaps in himself, “holes”, with their accompaniment of panic, irritation, helplessness, despair.
Mrs. Tustin's description of her autistic patients, as well as her quotations of other people's observations, brings the experience of the autistic child's