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This eloquent book concerns itself with the diagnosis, theory and psychotherapy of autistic states in childhood. Although the author's acquaintance with the psychiatric and psychoanalytic literature on autism and childhood schizophrenia is vast, her understanding of the various diagnostic and theoretical problems is always communicated in simple but powerful language which even the lay reader may grasp. In a chapter entitled, “Psychological Birth and Psychological Catastrophe”, she concludes with the following statement:
“The therapeutic setting acts as a kind of incubator in which the psychological “prem” can achieve those basic integrations he did not make in infancy. These extreme states are usually worked over within the privacy of parental sheltering. It seems somewhat indecent to lay them bare. Perhaps this is one of the reasons why psychosis seems so shocking and disturbing to normal individuals. Something is made public which should be kept private. Analysing such states seems rather like trying to put a dream or nightmare under a microscope. It just cannot be done. It is a paradox that these crude states need extreme delicacy and subtlety in their delineation. To write about them often seems brash and clumsy, but not to do so seems a professional derelication”.
The quotation may serve as a reminder of the enormous difficulty any writer in this field must face in trying to communicate his understanding of these children. What is extraordinary about Tustin's writing is that although it is metaphorical and evocative, (as she has suggested in her earlier book on the subject it needs to be), it is also extremely clear. The conclusions drawn from her long experience with psychotic children are shared with the diagnostician and practising therapist in helpful and non-esoteric language. In describing a particular feature of childhood psychosis, she is as careful to say what it is not as to say what it is, or seems to be, or is like. She also takes trouble to ground h