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Autism as a diagnostic category has the connotation of incurability, like cancer. The conviction exists even among psychoanalysts that
psychoanalytically oriented treatment of autistic children is not useful or possible. What this does not take into account is that the descriptive autistic picture can reflect different degrees of severity and that autism does not as yet have an identifiable organic cause.
Frances Tustin, originally trained as a Kleinian, has developed her own theory and treatment methods for autistic children. She agrees that some autistic children are clearly brain damaged and that it would be wrong to raise false hopes in the parents of such children. In all cases she feels that it is important not to blame the mothers for their children's disability. I would like to add something from my own experience, namely, that I have found it difficult at times to predict how a given autistic child will respond to treatment. In one case I treated a child who did not develop language until she was eight years old, a fact known to be a negative indicator for psychoanalytic treatment. Nevertheless, circumstances made treatment seem possible. Even though this child did not speak, it was clear that she was highly intelligent and artistically gifted, and she had extremely devoted parents. Treatment eventually proved to be quite successful. Another child, who also had very devoted parents and two older healthy siblings, had developed some communicative language by the time she came to treatment at around four years of age, making her case seem hopeful. However, with her, psychoanalytic treatment was not successful, and she had to be placed in a residential treatment program. In every case of an autistic child, parents and therapists together have to be ready to embark on an adventure, the result of which cannot be guaranteed or predicted. Tustin captures this spirit of adventure in her case discussions.
The book is divided into two parts, the first (C