"Tustin deals very sensitively and sensibly with the knotty problem of parents' contribution to autistic development, providing a balanced interactive view which does not allocate blame. Her discussion of autistic objects and autistic shapes is illuminating and has widespread clinical applicability. This book is highly recommended reading" - Mary Boston, British Journal of Medical Psychology.

This book is by a professional for other professionals, but thoughtful people who are interested in the fundamental aspects of human nature will also find much to interest them. The papers which have been published in various journals or delivered to professional audiences since the appearance of Frances Tustin's previous book Autistic Barriers in Neurotic Patients are integrated with unpublished material written especially for this book, so that they can enrich and illuminate each other. A paper from the early days of her work with autistic children is the focus of this present work, since her awareness of encapsulation as being the major protective reaction associated with the autistic states of both psychotic and neurotic patients, has stemmed from that early paper.

With contributions from Anne Alvarez, Joshua Durban, Jeffrey L. Eaton, Bernard Golse, Didier Houzel, Howard B. Levine, Suzanne Maiello, Sylvain Missonnier, Bernd Nissen, Marganit Ofer, and Jani Santamaria. The capacity to create psychic representations is now understood to be a developmental achievement. Without it, meaning cannot be ascertained and this can lead to "psychic voids" and "unrepresented states", which can contribute to the development of autism and autistic spectrum disorders (ASD). Unrepresented states are also implicated and encountered in other, non-autistic, non-neurotic conditions, such as psychosomatic disorders, addictions, perversions, and primitive character disorders. The affects that unrepresented states produce or are associated with are often those of terror, emptiness, annihilation and despair. The organisation of the psyche consists of psychotic - i.e. unstructured - as well as neurotic parts of the mind; unintegrated as well as integrated areas; and unrepresented areas with little meaning as well as represented states consisting of specific ideas imbued with affect. Given this organisation, we should expect to find both an unstructured and a dynamic unconscious in all patients. This implies that, to some degree, unrepresented and unintegrated states are universal and will exist and be encountered in all of us. Consequently, the opportunities and challenges presented by the understanding and treatment of autism and ASD, where the unrepresented and its consequences (e.g. defensive organisations employed to protect against annihilation anxiety and catastrophic dread) can be encountered may offer us metaphors and clues relevant to aspects of the treatment of all patients, no matter what their dominant diagnoses may be. Packed with theory and helpful case studies, this carefully edited collection from an international array of experts in the field is essential reading for all practising clinicians.

This text presents the work of 21 eminent psychoanalysts and child therapists from three continents - including Professors Didier Houzel of France and Renata Gaddini of Italy; Drs. David Rosenfeld of Argentina, James Grotstein, Victoria Hamilton, Judith Mitrani and Thomas Ogden of the USA; and Susanna Isaacs-Elmhirst and Isca Wittenberg of England - who explore and expand upon the work of the late Frances Tustin, which was devoted to the psychoanalytic understanding of the bewildering elemental world of the autistic child. Her realization that neurotic and borderline patients are haunted by the same primeval forces which constitute an enclave of autism has been profound, and the notion that autistic manoeuvres serve as a protective shell against the terrifying premature awareness of bodily separateness and dissolution into nothingness has had a substantial impact upon the re-thinking of many notable workers in the mental health field.

Frances Tustin Today explores some of the ways and means by which Tustin’s work has enabled psychoanalytic clinicians to enter into the elemental domain of sensation: what Bion called the ‘proto-mental’ area of the psyche-soma. Through detailed clinical contributions of several of her exponents worldwide, this book demonstrates how her ideas -- rooted in decades of work with children on the autistic spectrum -- have influenced and are being expanded, extended and applied to the treatment of ordinary patients from early childhood through adulthood. The contributors to this volume represent a selection of the contemporary thinking that organically grew out of Tustin’s discoveries, and show that Tustin's model has added new dimensions to the fields of infant observation, family therapy and neuro-psychology. Each chapter is augmented by demonstrable clinical experience. Frances Tustin Today is a valuable resource for psychoanalysts, psychotherapists, educators and parents who are interested in learning more about this uniquely independent clinical observer's findings and their impact upon the treatment of autistic states in children, adolescents and adults by contemporary workers in the field of mental health. Judith L. Mitrani, and Theodore Mitrani, are Fellows of The International Psycho-Analytical Association, Training and Supervising Psychoanalysts at The Psychoanalytic Center of California in Los Angeles. They are founding members of the Board of Trustees of The Frances Tustin Memorial Trust, and authors, editors, translators and teachers in the private practice of psychoanalysis and psychoanalytic therapy with Adults and Children in Los Angeles, California.

Many people come to analysis appearing quite 'ordinary' on the surface. However, once below that surface, we often come into contact with something quite unexpected: 'extra-ordinary protections' created to keep at bay any awareness of deeply traumatic happenings occurring at some point in life. Judith Mitrani investigates the development and the function of these protections, allowing the reader to witness the evolution of the process of transformation, wherein defensiveness steadily mutates into communication. She lucidly and artfully weaves detailed clinical with a variety of analytic concepts, and her original notions - including 'unmentalized experience' and its expression in enactments; 'adhesive pseudo-object relations' and the way in which this contracts and compares with normal and narcissistic object relations - provide valuable tools for understanding the infantile transference/countertransference and for the refinement of our technique with primitive mental states. Ordinary People and Extra-Ordinary Protections will prove stimulating and accessible in its style and substance to a broad analytic readership, from the serious student of psychoanalysis to the most seasoned professional.

Psychoanalytic Work with Autistic Features in Adults deals with the diagnostic and therapeutic difficulties of working with patients with autistic residuals, formed in early life experiences that have remained dormant in the unconscious mind. Laura Tremelloni traces the process of identifying them in adult patients, and stresses the need to develop a treatment plan suitable for this kind of pathology. This book uses clinical cases to examine the difficulties of work with hard to reach adults with 'gaps' in their sense of Self and symptoms related to primitive experiences of "non-being". Tremelloni presents new, adaptive therapeutic intervention methods for overcoming such obstacles and identifies the personification and permanence of undeveloped parts of the Self, in hard to reach adults who have otherwise developed satisfactorily and would not be diagnosed as autistic. In such cases, the author suggests the need for clinicians to adapt classic psychoanalytic approaches to the alternating levels of development of the separate parts which the Self has broken into. Psychoanalytic Work with Autistic Features in Adults will help clinicians in psychoanalysis and psychoanalytic psychotherapy to more effectively reach such patients, whilst attempting to address the problematic limitations of therapeutic techniques in very difficult clinical cases.

Frances Tustin (1913-1994) was one of the first professionally trained child psychotherapists in Britain. Although internationally recognised for her pioneering therapeutic work with autistic children, her approach is considered by some to be controversial, as her psychogenic view of childhood autism challenged the belief that it is biological and genetic. Autistic States in Children is widely regarded as a vitally important work for understanding the causes of autism in young children. Vividly describing her clinical encounters with autistic children, Tustin argued that autistic states were above all self-protective ones. In her observational studies, she noted how autistic children's interaction with physical objects, such as keys, toy cars, or other play items, had a rigid and ritualistic quality, far removed from the typical kind of fantasy play seen in other children. Such objects are not used by autistic children for their intended purpose, Tustin argued, but rather in sensation-dominated ways that interfere with mental development. She also drew a fundamental distinction between two autistic groups: an ‘encapsulated’ group, which is withdrawn and non-verbal, and an ‘entangled’ group, who are hyperactive and chaotic but have some language. Autistic States in Children influenced not only those in psychotherapy and psychoanalysis but countless others who have contact with autistic children, especially families, and remains essential reading for anyone seeking a creative and compelling understanding of autism. This Routledge Classics edition includes a new Foreword by Maria Rhode.

As a group, babies later diagnosed as autistic are found to have more complications during gestation and delivery than their normal siblings and others. In addition to all these complications, infants later diagnosed on the autistic spectrum have a two-fold rate of residence in neonatal intensive care units. Over the past 50 years, ever younger previously non-viable very low weight babies are being kept alive, some born as much as four months before term. However, it is becoming apparent that miraculous procedures to counteract organ immaturity and prolonged incubation contribute to a new gamut of hitherto unknown forms of neurological damage. With pregnancy curtailed, prematurely separated mothers and their babies both experience a prolonged state of limbo, with the fragile infant being exposed to excruciating medical interventions and overwhelming stimulation. International researchers and clinicians renowned for their work in the field of early autism come together to resolve queries around the long debate on the development and resolution of autism.