Trying to enter the long black branches: Some technical extensions of the work of Frances Tustin for the analysis of autistic states in adults

Abstract

The author suggests a number of technical extensions/clinical applications of Frances Tustin’s work with autistic children, which are applicable to the psychoanalysis of neurotic, borderline and psychotic adults. These are especially relevant to those individuals in whom early uncontained happenings (Bion) have been silently encapsulated through the use of secretive autosensual maneuvers related to autistic objects and shapes. Although such encapsulations may constitute obstacles to emotional and intellectual development, are consequential in both the relational and vocational spheres for many analysands and present unending challenges for their analysts, the author demonstrates ways in which it may be possible to detect and to modify these in a transference‐centered analysis. A detailed process of differential diagnosis between autistic states and neurotic/narcissistic (object‐related) states in adults is outlined, along with several clinical demonstrations of the handling of a variety of elemental terrors, including the ‘dread of dissolution.’ The idiosyncratic and perverse use of the analytic setting and of the analyst and issues of the analysand’s motivations are considered and illustrated. A new model related to ‘objects in the periphery’ is introduced as an alternative to the more classical Kleinian models regarding certain responses and/or non‐responses to transference interpretation. Issues a propos the countertransference are also taken up throughout.

Key words:

• autistic states in adults
• Bion
• countertransference
• enactment
• Frances Tustin
• interpretation
• Klein
• motivation
• technique

Acknowledgements

I would like to acknowledge Drs. Judith Goodman, Yvonne Hansen and Theodore Mitrani as well as Maria Rhode and Jane Schulman for their inspiration and their contributions to the development of this paper.

Notes

1. When the object is unable or unwilling to receive, to make sense of and to reflect the baby’s own internal state, or when the object projects her own internal state onto the infant, intentional states will not be symbolically bound and the developmental basis of the self‐structure will be absent (Fonagy and Target, 1996). The weakness of such a self‐image leaves the child with affective and perceptual happenings that remain nameless, confusing and frightening, what Bion considered to be unmetabolized or uncontained (Bion, 1962) and what this author has termed ‘unmentalized’ (Mitrani, 1994).

2. Sidney Klein (1980) first described patients who, despite the appearance of progress in the analysis, remain untouched in some essential way due to encapsulating forces that cut them off from the analyst as well as from the rest of the personality. Klein posited that walled off in these cystic areas are intense and unbearable fears of “pain, and of death, disintegration or breakdown” (p. 400) related to unmentalized experiences of separateness of early infancy. He suggested that such phenomena “are strikingly similar to those observed in so‐called autistic children” (p. 400). Compellingly, novelist Patrick Süskind (1986) writes of this encapsulation phenomenon in the extreme. He describes his protagonist Grenouille, born of an overly preoccupied, deprived and unsupported mother. His means of survival is compared to that of a tick: “For which life has nothing better to offer than perpetual hibernation & which by rolling its blue‐grey body up into a ball offers the least possible surface to the world; which by making its skin smooth [and] dense, emits nothing & makes itself extra small and inconspicuous [so] that no one will see it and step on it. The lonely tick, which, wrapped up in itself, huddles in its tree, blind deaf and dumb and simply sniffs ... for the blood of some passing animal that it could never reach on its own power & the tick, stubborn, sullen and loathsome, huddles there and lives and waits & for that most improbable of chances & and only then does it abandon caution and drop and scratch and bore and bite into that alien flesh & The young Grenouille was such a tick & encapsulated in himself [he] waited for better times” (p. 25).

3. All clinical material concerns patients who, after the initial evaluation sitting up in a chair, were engaged in four or five times per week analysis reclining on a couch utilized for that purpose only.

4. Tustin distinguishes autistic objects from ordinary objects (inanimate or animate) in that the former are not related to as objects, but rather used for the tactile sensations which they engender upon the surface of the skin of the subject. Autistic objects differ from ‘transitional objects’ (Winnicott, 1953), which are a combination of ‘me’ and ‘not me’ that constitute a bridge that links the two together during physical absence, while autistic objects are barriers to the awareness of ‘not me’ and as such are impediments to growth and development. Autistic shapes are differentiated from objective shapes (such as a square or a circle), in that they are idiosyncratic, endogenous swirls of sensation produced upon the surface of the skin or internally with the aid of bodily substances or objects. These distinctions, first based upon observations with autistic children, are now widely extended to include numerous other behaviors observable in adults and children with an enclave of autism, which may be conceived of as sensation‐dominated delusions. The key word here is ‘sensation’. Such sensations either serve to distract one’s attention away from insufferable happenings, providing an illusion of safety, strength and impermeability, or they may have a numbing or tranquilizing effect upon the individual, which blocks out some terrifying awareness.

5. Tustin (1986) defines these as “flexible, sensuous moulds into which, at an elemental level of psychic development, experience is cast, and which are modified by the experience so cast. When an innate form seems to coincide with a correspondence in the outside world, the child has the illusion that everything is synonymous and continuous with his own body stuff” (p. 85).

6. Due to the limitations of scope of this paper, I have not addressed in depth the differential diagnosis between dissociative and autistic states, a topic that deserves a paper of its own. Suffice to say that, although both states are related to trauma, the dissociative state can be included in the object‐related category. It may be expressed in amnesia (forgetting) or fugue and dissociative/multiple personality disorders (in which the split‐off or repressed aspect(s) of self can be given life/expression, at least temporarily). In contrast, the encapsulation common to autistic states constitutes a virtual isolation chamber in which the unmentalized traumatic perception (as well as what Meltzer and Bion described as the associated aspect of the dismantled perceptual apparatus) is hermetically sealed off from future development, expression or memory. Such relatively advanced defenses as splitting and projection, repression, denial and displacement are not relevant in the autistic state. As such, traumatic events can neither be remembered nor forgotten. Additionally, the traumatized aspect of the personality cannot be lived (in the ordinary sense of the word) either tentatively/alternatively.

7. Dr. Theodore Mitrani pointed out that the word ‘ecstasy’ comes from the Greek term ex stasis. So it appears that, in ancient times, the Greeks knew something about the destabilizing effect of experiences of joy, beauty and love, which may become overwhelming to the baby when left unmet and uncontained by the mother (Mitrani J, 1998b).

8. In a scholarly paper drawing the work of clinicians from several orientations, American analyst Ruth Stein (2005) discussed patients who were seen as engaged in non‐sexual perverse relationships with their analysts whom they approach as inanimate things, manipulated in service of creating physical sensations that camouflage hatred and paranoia. She coins the term ‘false love’ to characterize the nature of relatedness that may appear affectionate, but which circumvents affect.

9. In the interest of clarification, although Tustin often stated that Bettelheim’s (1967) notion of ‘the empty fortress’ was an apt way of describing the autistic protection, she explicitly disagreed with his characterization of the mothers of autistic children when she wrote: “I have a great deal of sympathy for these mothers. In my view, Kanner started a regrettable fashion in seeing them as being ‘cold and intellectual’. Ever since he said this, phrases such as ‘refrigerator mothers’ have been bandied about to describe them. I do not subscribe to this view” (1986, p. 61). Consistent with Tustin’s attitude, it is perhaps essential to take into consideration the possibility of either a failure in the environment, a failure of constitution, and/or a combination of both: what I have referred to as a ‘coincidence of vulnerability’ in the infant–mother couple (Mitrani, 2003).