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This book has arisen out of a series of working papers given by Frances Tustin at conferences over the past five years at the University Institute of Child-Neuro-Psychiatry in Rome, but it is also an up-to-date complete collection of the author's lifelong research on childhood autism and infantile psychosis.
It is divided into three parts: diagnosis, theory and the psychotherapy of autism. The historical background is presented to describe the way autism has been approached in the past, both by child psychiatrists and by therapists with an organic approach, who were not concerned with a psychodynamic one. In her view ‘it is difficult to separate organic, metabolic and psychogenetic factors so it is regrettable that psycho-dynamicists and organicists should be in opposite corners’. She advocates a ‘deep and careful physical and psychological investigation which goes behind the surface’ for a useful classification in terms of treatment and prognosis to be obtained. She stresses the need for rigorously applied psychotherapeutic techniques based on observation, and differentiates them from abreactive therapy. She shows how a long training in detailed observation is required to pick up clues to the autistic child's idiosyncratic behaviour and the therapy set-up is compared by her to a research laboratory. Her own thirty years of observation and research with her students and colleagues and the comparing of notes is what has given her the necessary insight and authority in the therapy of these children.
Her diagnosis, schemes, and classifications differ both from Rimland's and from Mahler's. They are original and very helpful both to the expert and the student analyst. If applied too rigidly and schematically, however, they may appear somewhat static and over-simplifying.
Tustin proceeds by warning psychotherapists not to rely too heavily on findings concerning adult psychoses of Bion, Kohut, Laing and Rosenfeld, because their findings may only be applicable to the confusion