TUSTIN, FRANCES (1913-1994)

Child analyst Frances Tustin was born on October 15, 1913, in Darlington, northern England, and died on November 11, 1994, outside of London. She was the only child of parents who separated in 1926. Traumatic memories of this separation remained with her, especially because she had been very close to her father and would not see him again for some fifteen years. Married for the first time in 1938, she divorced in 1946, and two years later she married Professor Arnold Tustin, an eminent physician who took a close interest in her work and greatly encouraged her in her research. She at first focused on the teaching profession and worked in that field for several years.

In 1943 she had the opportunity to attend courses in child development taught by the Kleinian psychoanalyst Susan Isaacs at the University of London. She was fascinated by this approach to children, which was entirely new to her. Six years later, in 1949, after the death of her first baby, she felt a calling to become a child psychotherapist. She learned of a nascent training program at the Tavistock Clinic and enrolled. As a part of her training, she had to enter into analysis with Wilfred Bion. She decided to end her analysis after fourteen years (with two interruptions, once for an internship in the United States and once for her second pregnancy, which ended, yet again, in the death of the baby at birth). After stopping treatment, she was beset with terrors, which she later understood as an expression of autistic anxieties. Because Bion had returned to the United States, she had to call upon another analyst, Stanley Leigh.

At the Tavistock Clinic, Tustin first heard about autistic children by way of a lecture given by Marion Putnam at the invitation of the clinic's then director John Bowlby. She was fascinated by what she heard. In 1953, her husband having accepted a one-year appointment as visiting associate professor in the United States, she had the opportunity of doing an internship at the James Putnam Center in Boston, one of the first treatment centers for autistic children. Back in London she wanted to apply the Kleinian method of analysis to autistic children. She soon realized that Melanie Klein's theories had to be expanded to account for this new pathology.

Her treatment of her first autistic patient revealed to her the anxiety that is at the heart of this disorder and that is due to the trauma associated with the emerging awareness of bodily separation from the object at a stage when the ego cannot yet form symbols. The child feels as if it were experiencing not just loss of the object but also the sensation of being bodily uprooted. She showed that this uprooted feeling is usually localized in the mouth. It is as if the autistic child felt brutally exposed to a series of discontinuities along the mouth-tongue-nipple-breast axis. These discontinuities not only lead to loss of the illusion of controlling the object of instinctual satisfaction, but also give the child the intolerable anxiety of feeling amputated, emptied, and annihilated, and of feeling that the object too is amputated and emptied. The child then erects defense mechanisms against the anxiety of this traumatic experience. These defense mechanisms consist of autistic forms (impressions that the autistic subject procures for itself with its own bodily secretions, stereotyped movements, or interoceptive sensations), autistic objects (concrete objects that the child manipulates not for their conventional uses or their symbolic values, but rather for the sensations that they cause against the skin or the mucous membranes, and that procure autistic forms), and the autistic shell (a world of pure sensations made of up autistic forms and objects, without otherness; a two-dimensional world in which the only possible relationship is an adhesive one of "sticking").

Tustin's work broadened and updated the understanding of childhood autism and made possible an effective therapeutic approach to it, but her influence went beyond the realm of autism itself. In effect, she described autistic pockets or barriers present in personalities affected by various disorders: phobias, melancholia, mental anorexia, psychopathy, psychosomatic pathologies, and severe childhood functional disorders (enuresis, encopresia). These autistic pockets are parts of a personality caught in a system of autistic defenses, and they must be analyzed to avoid interminable analyses and negative therapeutic reactions.

An honorary member of the British Psychoanalytical Society, Tustin taught at the Tavistock Clinic, where she trained many students. In addition, many child psychotherapists and psychoanalysts from around the world went to London, and later to Amersham, in the greater London suburbs, where she lived at the end of her life, to benefit from her supervision. She was invited to deliver lectures in numerous European countries and in the United States. She published some thirty articles and four books. In addition, there are videos recordings of three interviews with Tustin. Nearly all of her publications and research focused on childhood autism. From her first contact with children afflicted with this disorder at the beginning of the 1950s until her death, she continuously strove to promote deeper understanding and better treatment of this condition.

Didier Houzel

Notions developed: Autistic capsule/nucleus; Black hole.

See also: Autism; Autistic defenses; Breakdown; Dismantling; Infantile psychosis; Lack of differentiation; Psychic envelopes; Self-mutilation in children; Sucking/thumb-sucking; Trauma of Birth, The ; Tube-ego.

Bibliography

Spensley, Sheila. (1995). Frances Tustin. London: Routledge.

Tustin, Frances. (1972). Autism and childhood psychosis. London: Hogarth.

——. (1981). Autistic states in children. London: Routledge.

——. (1986). Autistic barriers in neurotic patients. London: Karnac Books.

——. (1990). The protective shell in children and adults. London: Karnac Books.