Wednesday, December 14, 2011

Frances Tustin

I mentioned in the previous post I'd reference some of Tustin's work. I can't find the piece that mentions explicitly the pre-symbol and maybe pre-image epistemological status of her work with autistic kids but some of the passages below show how her work is positioned in regards to Klein:

In their papers on Symbolism, Hanna Segal (1957) and Marion Milner (1955) do not subscribe to Jones' (1916) view that symbolism is a bar to progress, rather they incline to Melanie Klein's (1930) proposition that 'symbolism is the basis of all talents'. As Milner says, to use the term 'symbolism' in this latter sense brings it into line with the way it is used in epistemology, aesthetics and the philosophy of science.

The development of the symbolizing capacity is dependent on the subject's ability to tolerate separateness from the outside world. When we first see them, psychogenic autistic children do not differentiate between subject or object to any extent, nor between what is internal and what is external. They are in such a state of undifferentiation from the world around them that they are often thought to be deaf, or even blind, since some of them try to walk through objects as if they cannot see. Such children live in a shadowy world of diminished consciousness in which conscious and unconscious are barely differentiated. It is a very different world from ours. To empathize with it is very difficult. This muted consciousness is to avoid the agony of consciousness they suffered when, in an insufficiently differentiated and integrated state, they discovered that the sensation-giving 'button' was not a part of their mouth.

As we have seen, their reaction to this traumatizing awareness had been to use parts of their body, and later, outside objects experienced as bodily parts, to generate hard object-like sensations and soft shape-like sensations. These kept them trapped in a state of undifferentiation from outside objects. Thus, such children are not sufficiently integrated and differentiated to be able to use one thing to represent another thing. This means that the toys we provide for these a-symbolic autistic children, will not at first be meaningful to them in terms of communication and fantasies. They will only be meaningful in terms of the sensations they can produce by holding them either tightly or loosely. At first, basic sensation-giving materials such as sand, water, clay and plasticine or playdough are likely to be used much more by autistic children than are toys.

In more normal infants, missing and longing for the suckling mother stimulates the use of substitutes, such as sucking the thumb, the fingers, the fist or a rubber comforter. These temporary substitutes for the breast (or bottle experienced in terms of the inbuilt gestalt of a breast), enable the baby to wait until the suckling mother comes. I call these normal objects, 'autosensuous objects', in contradistinction to 'autistic objects' which are pathological. Normal autosensuous objects are sucked, whereas pathological autistic objects are clutched, or may be sucked compulsively in a clutching sort of way. The child may also stick himself to hard objects so that they seem to be a part of his body. These hard autistic objects, which do not have to come through space, as do normal autosensuous objects such as the finger or the thumb, replace the breast and block out awareness of the nurturing mother. The trouble with these patients is that they have supplanted the mother, and in the transference, they try to supplant the therapist. We must not allow this.

Tustin, F. (1988). Psychotherapy with Children who Cannot Play. p. 98

Melanie Klein's findings had come from schizophrenic-type children. I have come to realize that - at least in the early days of work with autistic children - these insights are not relevant to them. The only autistic child Mrs Klein treated was a child she called Dick, whom she wrote about in 1930 (Klein, 1930). This was thirteen years before Leo Kanner's seminal paper (Kanner, 1943). Although Mrs Klein realized that Dick was different from the other children she had worked with, and although with great perspicacity she anticipated many of Kanner's findings, after much agonizing she settled for a diagnosis of dementia praecox, as schizophrenia was then called.

Mrs Klein's concepts of projective identification and splitting are particularly relevant to schizophrenic-type children. Such children have developed relationships, although they are distorted ones. However, a significant feature of autistic children's psychopathology is that they do not relate to people. In treatment, one finds that they have not even developed the first basic primary relationship to the mother, or, if they have done so, it has broken down in a disastrous way. So, while Mrs Klein's theories are relevant to children who have developed relationships, they are not, at first, applicable to autistic children, who do not relate to people. Concepts such as encapsulation, imitative fusion, autistic objects and autistic shapes, as defences against the ‘black hole’ of nonrelationship, are more descriptive of the autistic child's reactions.

Let me now tell you about the shock I had when I first realized that Melanie Klein's insights did not seem to apply to the early stages of work with autistic children. This will illustrate how I came to develop my present views on the possible origins of psychogenic autism.

Tustin, F. (1988). The ‘black hole’: a significant element in autism. p. 38-9

I'm currently writing on the connection of Klein's stages of development to early myth and, as you've seen in previous posts, clarifying the connection of the Oedipus complex to later myth. In my estimation Tustin in right and Klein basically gives us theoretical formations from Cronos and the separation of the world parents and hints at an earlier oral stage in her early work. And, in her later work she merely just takes these stages and moves them earlier on the time line of infant development instead of discovering earlier stages. It very much seems to me that Tustin did for Klein what Klein did for Freud.

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