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This book is a memorial tribute to Frances Tustin - one of the pioneers in the psychoanalytic understanding of the pre-thinking protomental mind and in the analytic treatment of autistic states in children and adults with whom she worked for over 40 years. Her concepts also contributed to the comprehension of the autistic pockets present in other patients with psychosomatic illness, drug addiction, anorexia, and learning difficulties, which Rosenfeld, Meltzer and others have also identified.
Tustin's first book, Autism and Childhood Psychosis, came out in 1972. In this she enlarged upon her development of ideas about the psychogenic, sensation-dominated state of autism. The difficulty at that time was that of recording her formulations within the schemata of established theoretical notions. Tustin believed the child inhabited a godless world in which the autistic shell was the last refuge. She saw autism as an arrest rather than a regression that arose from the shock of the premature awareness of bodily separateness from the mothering person, and the autistic withdrawal an ultimate defence against psychotic depression. She invoked the concept of the ‘black hole’ and associated it with Winnicott's ‘falling forever’. She came to see this state as one covering a range of illnesses which she described as primary autism, and encapsulated or regressive secondary autism. She saw the disorder as one which developed in a sensitive child predisposed to autism but whose external circumstances also contributed to the development, where the containment (Bion) is lacking or deficient, both by the nature of the maternal personality and circumstances and the child's inborn inability to tolerate the pain of the realisation of the separateness so early. She saw this as a state of mind preceding the development of projective identification, the paranoid/schizoid and depressive states. Later she adapted her views, influenced by the works of Trevarthan, Stern and Anzieu who opened up her