Chapter 3 Prenatal Trauma and Autism1

Human beings seem to have a primary need and capacity for meeting the ‘other’ and creating links. Trevarthen (1979) refers to this phenomenon as ‘primary intersubjectivity’ and describes it as ‘our innate sympathy for the feelings and interests of other persons’ (Trevarthen . 1996). Autistic children lack this primordial search for communication. What has gone wrong, and at what point? And what are the reasons for autistic retreat?

Shortly before her death, Tustin (1994b) acknowledged the complexity of the processes that lead to the development of autistic states and suggested in the preface to the second edition of Autistic Barriers in Neurotic Patients (1986b) that the term ‘psychogenic autism’, which she had previously used to describe children who had been assessed as not brain-damaged, be changed to ‘psychobiological autism’. By doing so, she not only recognized the contributions of other disciplines, such as genetics, biochemistry, and neuroscience, for a deeper understanding of the genesis of autistic pathology, but also reaffirmed implicitly that nature and nurture are interwoven from the very beginning, and that the further we go backwards in time towards the origins of life, the less it is possible to separate the physical and the psychic aspects of events. Tustin in fact refers to autistic encapsulation as a ‘psycho-physical protective reaction rather than a psychodynamic defense mechanism’ (1990a: 154). With this definition she underlines the precocity of the onset of pathology. The earlier in development a traumatic event occurs, the more any protective reaction will be rooted in the body and the senses. On the other hand, it is equally true that from the moment of the first appearance of protomental activity, every physical event has its psychic counterpart. This is why we cannot exclude that even prenatal experiences can re-emerge in some form in later life.

Although Tustin (1990a) never went into the question more systematically, she a