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Spensley, M.S. (1996). Review of Frances Tustin. Int. J. Psycho-Anal., 77:1234-1235.
  

(1996). International Journal of Psycho-Analysis, 77:1234-1235

Review of Frances Tustin

Mrs Sheila Spensley

Dear Sir:

Few fields of study are more prone to cross-disciplinary misconstruing than autism and its treatment. There is a vast research literature on the treatment, training and education of autistic children, which psychotherapists working in the same field cannot afford to ignore. The majority of autistic children are (perforce) treated by methods other than psychoanalytic ones and often with very respectable results. Communication across these professional boundaries is essential and for this, the common language of science has to be employed. At the very least, basic and specific diagnostic criteria must be accepted.

In her review of my book Frances Tustin, Kate Barrows reintroduces Tustin's muchquoted criterion of autism. However, ‘the worst case X ever saw’, no matter how distinguished X is, will not do at all as a diagnosis and I had thought it tactful not to draw attention to it. The worst cases of autism reside in institutions and never see a psychotherapist. The child in question was in mainstream schooling when he commenced psychotherapy with Tustin. At the same time, she referred to him as a ‘psychotic’ child (Chapter 17, Autistic States in Children, 1981, London: Routledge).

Distinguishing between autism and childhood psychosis continues to present classificatory difficulties, but one important characteristic of autism has now been experimentally demonstrated (Baron-Cohen, 1989, ‘The autistic child's theory of mind’, J. Child Psychol. & Psychiat., 30: 385-97) and provides a new research benchmark. Autistic children, uniquely, have been shown to lack empathic awareness of mental states. It remains for child psychotherapists to demonstrate whether this specifically autistic condition is reversible.

I think Kate Barrows is confusing two separate issues in relation to Tustin's late retraction of her concept of ‘normal autism’.

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