Table Of ContentFrances Tustin
This is the first book to describe the life and work of Frances Tustin, a
brilliant clinician whose understanding of autistic and psychotic children
has illuminated the relationship between autism and psychosis for others in
the field.
Sheila Spensley defines Tustin’s position in traditional and
contemporary psychoanalytic theory and explains how it is related to work
in infant psychiatry and developmental psychology. She clarifies key terms
and concepts of her work, showing how they are linked with the work of
Bion, and with that of Grotstein and Ogden. Evaluating autism from an
evolutionary point of view, she also considers the possibility of autism as a
‘missing link’ in the developmental chain of psychic growth.
Frances Tustin makes Tustin’s seminal work accessible to the non-
specialist reader and shows how relevant her thinking is to work in other
areas such as learning disability and work with adult patients.
Sheila Spensley is Consultant Clinical Psychologist and Psychoanalytic
Psychotherapist at the Willesden Centre for Psychological Treatment,
Willesden Community Hospital.
Sheila Spensley’s Frances Tustin is a remarkable work: the author deftly
interweaves a sensitively constructed personal account of the life of
Frances Tustin with a detailed discussion of Tustin’s major clinical and
theoretical contributions to the psychoanalytic understanding and
treatment of autistic patients.
Mrs Tustin’s ideas and clinical approach are subtle and complex (often
deceptively so). I have been richly rewarded by careful study of her work
over the past fifteen years, but nonetheless came away from each chapter
of Spensley’s book feeling that I had learned something new and
important about Tustin’s thinking. Spensley, with clarity and unpretentious
erudition, discusses such topics as Tustin’s concepts of the sensation-
dominated nature of autistic experience, the biological and interpersonal
origins of autistic psychopathology, the unique quality of autistic anxiety,
the differences between encapsulated and entangled forms of autism, the
nature of ‘relatedness’ to autistic shapes and autistic objects. In each
instance Spensley provides a rich commentary on the theoretical context
for the idea under discussion as well as vivid clinical examples of the
concept as Spensley has applied it in her own work.
Frances Tustin will be highly valued reading by all mental health
practitioners and teachers (of every level of experience) who are attempting
the difficult task of deepening their understanding of autistic patients as
well as the autistic component of healthier patients.
Thomas H.Ogden, MD, Co-Director, Center for the Advanced Study
of the Psychoses, San Francisco; Supervising and Training Analyst,
Psychoanalytic Institute of Northern California; author of The Primitive
Edge of Experience.
The Makers of Modern Psychotherapy
Series editor: Laurence Spurling
This series of introductory, critical texts looks at the work and thought
of key contributors to the development of psychodynamic
psychotherapy. Each book shows how the theories examined affect
clinical practice, and includes biographical material as well as a
comprehensive bibliography ofthe contributor’s work.
The field of psychodynamic psychotherapy is today more fertile but also
more diverse than ever before. Competing schools have been set up, rival
theories and clinical ideas circulate. These different and sometimes
competing strains are held together by a canon of fundamental concepts,
guiding assumptions and principles of practice.
This canon has a history, and the way we now understand and use the
ideas that frame our thinking and practice is palpably marked by how they
came down to us, by the temperament and experiences of their authors,
the particular puzzles they wanted to solve and the contexts in which they
worked. These are the makers of modern psychotherapy. Yet despite their
influence, the work and life of some of these eminent figures is not well
known. Others are more familiar, but their particular contribution is open
to reassessment. In studying these figures and their work, this series will
articulate those ideas and ways of thinking that practitioners and thinkers
within the psychodynamic tradition continue to find persuasive.
Laurence Spurling
Frances Tustin
Sheila Spensley
London and New York
First published 1995
by Routledge
11 New Fetter Lane, London EC4P 4EE
This edition published in the Taylor & Francis e-Library, 2005.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s
collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
Simultaneously published in the USA and Canada
by Routledge
29 West 35th Street, New York, NY 10001
© 1995 Sheila Spensley
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic,
mechanical, or other means, now known or hereafter
invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in
writing from the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalogue record for this book has been requested
ISBN 0-203-97635-5 Master e-book ISBN
ISBN 0-415-09262-0 (hbk)
ISBN 0-415-09263-9 (pbk)
To Philip
Much analytic theory is not only compatible with, but derives some antecedent
probability from, our beliefs about biology.
Money-Kyrle (1978)
I am convinced of the strength of the scientific position of psychoanalytic
practice.
Bion (1962b)
Contents
Acknowledgements ix
Introduction 1
1 Growing up in the bosom of the church 6
2 Professional development 11
3 The discovery of autism and the search to 19
understand it
4 Unnatural children 27
5 Encapsulation and entanglement 33
6 Mental cataclysm and black holes 43
7 The frontiers of consciousness 52
8 Of objects: concrete, sensory and transitional 60
9 The keeper of the keys 69
10 Mental handicap and mental illness 83
11 Psychoanalytic perspectives on learning impairment 96
12 The restoration of god 110
Glossary 121
Chronology 126
Publications by Frances Tustin 128
Bibliography 131
Index 139
Acknowledgements
The suggestion that I might write this book originated in conversations
between Frances Tustin and Laurence Spurling, the editor of this series. It
was a pleasure for me to accept the task of writing about an area of
psychoanalytic investigation which has long been a particular interest and
about a writer whose work has contributed substantially to my own
understanding. Personal friendship with the subject of biographical work
can present problems but in this case I think the strength of shared
interests and priorities has fortified rather than interfered with objectivity
and critical freedom. I am grateful to Frances Tustin for her generosity in
making available to me as much as she could recover of her history and of
her memories and for providing me with the manuscripts of some of her
clinical work.
The research for the writing of the book has also brought unexpected
pleasures in becoming an opportunity to renew old acquaintances and
friendships and to make new ones. Pleasurable memories remain with me
of a beautiful day at the New Forest home of Mrs Shirley Hoxter, retired
Head of the Child and Family Department of the Tavistock Clinic, who
gave her time to a careful reading of the first typescript and made a
number of corrections and helpful suggestions.
I am grateful to Fiona Spensley Barton and to Melinda Schneider who
read the chapters as they emerged, hot from the PC, and made
constructive criticisms.
Thanks are due to Michael Sinason, former consultant psychotherapist
at the Willesden Centre for Psychological Treatment, for first introducing
me to computer technology. He was responsible forteaching me to become,
much to my surprise, computer literate. Colin Spensley introduced the
wonders of Windows and I am grateful also for his technological help and
supervision which retrieved the book from many a threatened ‘black hole’.
It would not have been possible to write this book at all without a
substantial experience of working with deeply disturbed patients and it was
my work with psychotic and borderline adult patients which interested me
in the disturbances of childhood. I am ever grateful for the rare
opportunity of having worked in one of the few NHS in-patient
