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‘Autistic processes’, Frances Tustin tells us, is the revised version of a paper that she presented in March 1969 at what was then still called the ACP Study Weekend. Three years previously the Journal of Child Psychology and Psychiatry had published her description of her little autistic patient John (Tustin, 1966): something one cannot imagine happening today. Tustin describes the two publications as companion papers that should be ‘read in conjunction with each other’. Both concern what she calls the ‘hole’ type of depression, but ‘Autistic processes’ delineates ‘primitive processes which become excessive in order to protect against its catastrophic effects’. This statement foreshadows her later formulation that children with autism made use of self-protective strategies in order to deal with catastrophic, and sometimes psychotic, anxieties; a view that found expression in the title of her last book: The Protective Shell in Children and Adults (Tustin, 1990a). She preferred the term ‘self-protective strategy’ to ‘defence mechanism’, partly because the concept of defence arose out of Freud’s work with neurotic patients who were concerned with psychic conflict and whose ego was so much more developed than that of the children Tustin treated. Nevertheless, David, the patient whom she describes in ‘Autistic processes’, deployed his strategies as a way of coping with catastrophic experience: that is, for defensive reasons. Tustin stressed throughout her writings (e.g. 1994b) that the child’s reliance on such strategies had the effect of cutting him off from potentially nurturing relationships, so that a self-protective aim led to developmental deficits. In this she agreed with Meltzer (1975a: 16), who wrote that time spent in autistic states was time-of-the-child’s-life lost to developmental possibilities.
Fourteen-year-old David tried to protect himself from a monster by constructing a suit of armour. Freud (1911) had previously referred to the ‘