For Frances Tustin, autism is both a primary stage of development and a serious medical condition (which brings it closer by Margaret Mahler [1] ). It is through the study of autism as a separate clinical pathological she could deduct her views on autism primary normal, and reconstitute elements of psychopathology may lead to the formation of an abnormal autism . 1 - The early object relationship and psychotic depression
According to Frances Tustin, a perspective that approximates the designs of Margaret Mahler, the first period of normal development of the child is autistic-like. The normal primary autism, according to its name, is characterized by a lack of awareness of the outside world and especially the separation between the newborn and external objects, which, in the foreground, the mother. The objects are not different from the self.
Frances Tustin believes that the newborn can maintain this illusion through innate forms: an innate form is a form of an erogenous zone that coincides with the shape of an object (eg a nipple innate form that will be sought by the language to complete). The newborn, whose language research naturally innate form of the nipple, may, when the two meet to maintain the illusion that both are continuous.
is the mother who plays a decisive role in the passage of this stage in the later stages of development. Indeed it is, again, the quality of the situation and holding the items that Winnicott has described as accompanying (handling, the presenting object) by Frances Tustin depends on maintaining the illusion of continuity. This is particularly the presentation of " real breast just where the child is ready to create, at the right time " [2] that can preserve the illusion of continuity mother and child.
At the moment there is indistinctness of self and the object, the object loss at this stage results in characteristic effects. On this point, Frances Tustin takes up this finding Winnicott: when the separation from the breast takes place too quickly, before the subject is the emotional equipment to cope with this loss, the loss of the breast is also loss of certain aspects of the mouth which disappear at the same time as the mother and breast. "A few months later, the loss of the mother would be a loss of object, without loss of part of the subject" [3] . Frances Tustin known as early and traumatic oral frustration.
Therefore it is tearing the oral object as part of the body of the child who is at the origin of psychotic depression.
This does not mean that the object is missing, however. This case corresponds to a stage below a drawing of the loss of the object as it is occurs in less archaic stages of development libidinal or the Kleinian depressive position [4] . Frances Tustin
[5] considers after Bion [6] that for forming the mental image breast absent, the subject must tolerate the frustration caused by lack of breast activity Mental begins when "within the desired" is seen as an "idea breast absent 'and not as a" bad breast present'.
Thus in the case of autism, breast desired presence is seen as a bad breast, which prevents the development of thought. For Frances Tustin, uprooting of the object, which amounts to a situation of "no-breast" was experienced by the subject too early autistic [7] at a time when it has not yet experienced enough "good breast" in order to tolerate "no breast". The subject accesses
not the idea of the absence of the object but remains on the perception of the presence of a persecutory object, in the form of bodily substance, part of the body itself. Hence the anger is considered by Frances Tustin as the attempt to expel the bad internal object. After the anger expressed fear that part of the body itself is "fallen apart".
In a clinical examples cited by Frances Tustin (case of John [8] ), she believes, citing specific about John, that "absence is the more''then''(goneness) the''more''then something is broken, a''black hole''full of''bad''quills. "The absence
seems therefore experienced by the subject as the introduction into the body of an object broken and irreparable (" wicked spines "). According to Frances Tustin, this does not show up for John in thoughts, he feels ingest the broken object in his body: "the pain caused by the loss seems more physical than mental [9] . Similarly during his explosive temper trying to expel the object, the child seems to fear that part of his body has fallen, and John checks his penis is still there (which is no castration anxiety, since is the real body is at stake)
In the treatment of John, it appears a dichotomy between two registers, what is "nice" (sweet, soft, comforting) and what is "bad" (rough, hard, worrisome). Frances Tustin therefore notes that the "kindness" is what can be "shaped by innate forms and thus seems continuous with the bodily substance (...) the" evil "is the hard material that does not give shape to appear part of the body " [10] . The outside world ("not me") is apprehended on the mode of failure of continuous physical, physical damage, hole: this is what Frances Tustin appointed as psychotic depression.
Finally, always falling in the current post-Kleinian, Frances Tustin also incorporates the importance of empathic identification of the mother, as his ability to dream and its capacity to function as a container for the child. Indeed, the growing awareness of the separation is accompanied by bodily sensations of displeasure for the subject, which lead dumps her. It is the ability of mothers to receive and welcome these discharges depends the formation of the child to an internal object container that replaces bodily continuity. However
Tustin noted that such attacks can be poorly supported by the mother, which may thus hinder the ability of holding both physical and psychic (entertainment speaker). Side of the child, the reactions can go in the direction of an attempt to maintain the more the illusion of continuity. This all-powerful illusion, when it is threatened at moments of separation, leads to a feeling of terror which the child defends itself by focusing on the sensations of his own body. This is the case of John, who, having been confronted with these mechanisms, remains in a first environment as undifferentiated from his own body, indefinitely and attempts to model objects as forms innate.
2 - Construction of the "shell"
Frances Tustin perceives the phenomena that lead to autism as a cyclical process. The separation body a shock and is a moment of terror when the child is perceived as full of poisonous substances. This causes an explosion, (tantrums, etc..) In an attempt to eject the bad object present, a phenomenon which can also be perceived by the subject as an actual eviction part of the body itself, with all the anguish that can accompany such a sensation. In an attempt to reinstate the expelled party, and the object he has come to symbolize the separation, the child recovers from inanimate elements that form an envelope.
Repeating this process leads the child to live permanently fitted to the envelope, Frances Tustin calls "shell", "protective shell" (hence the term "child shellfish" means that these subjects). From this shell are such that permanent muscle tension in certain subjects autism, the bubbles of saliva continual retention of stool, etc..
The "shell" is here a function similar to the "second psychic skin" described by Esther Bick. Well here is because of insufficient internalization of experience soothing and reassuring the mother that results in an inability to countenance the intrapsychic object. In terms more strictly Kleinian, so here it is an impossible transition to the depressive position with a lack of access to the whole object.
3 - Listed autistic What
Frances Tustin called autistic objects [11] is either part of the body of the child to the world outside that are seen as not separate from me. Initially, the objects are pills: breast, bib etc.
Normally, these objects must give way to transitional objects. There are two main cases in which the transitional object does not appear: either the situation has been a nurturing experience internal reassuring and satisfying, in which case the child does not need the passage through the transitional object, he can invest directly external objects or maintenance of autistic objects prevents the transition processes.
Now is when the "frustration" (within the meaning of the tearing of the object that was not developed as separate from the body itself) becomes intolerable, that objects are used autism, thus coming to place this object not separated from the subject. The objects used are autistic so regarded by the subject as integral parts of the body and as things, thereby excluding the frustration: "autistic objects" me "should remove the" not me "dangerous". In individuals with autism pathological, these objects can be clinically when the child sucks his tongue, keeps his stool, blowing bubbles of saliva. They are part of the "shell" autistic.
addition to the case of a premature denial of the nipple, Tustin believes that the appearance of abnormal autistic objects may also be due to prolonged use of nipple autistic too.
4 - A classification system autism pathological
psychopathological These elements are found in different clinical emerges as Frances Tustin and are three in number. We specify for each category name a child Frances Tustin describes the case: we shall return later to the treatment of these children [12] .
a-Autism Primary Abnormal (APA Tom)
Frances Tustin believes that ABS is an extension of normal primary autism, either through lack of care or due to innate deficiencies. "This state is characterized by very low differentiation at an emotional level, a vague awareness of the separation body, the body image, identity and personal life " [13] . These children are still using
late parts of their own body as autistic objects (hand, finger). They do virtually no distinction between animate and inanimate. Differentiation from the mother is virtually absent.
The body has no place, it is "soft, flaccid, leading to Frances Tustin call them" children amoebae. The thought is present with "islands", the language is chaotic or incomprehensible [14] .
Autism Secondary b-shell (AUC: John David)
Frances Tustin close this clinical entity of early infantile autism.
She believes that the CSA is the product of an early cessation of development.
one viewpoint body, the shell can maintain the illusion of a body wrap by the mother. These children give the impression of being "wrapped in themselves." Separations occur without a backward glance.
The shell acts as a cohesion for those children whose personality had to be integrated at a time too early in development.
The illusion of continuity with the outside leads the child to use external objects as if they were part of himself, in an attempt to reject psychotic depression ("key hole"). The objects are prevalent outside of autistic objects (objects hard mechanical). It does not appear there be no discrimination between animate and inanimate objects.
There is a divide between the good and not me me persecutor, and thus rejected. The shell can hide this "not-me" scary. Consequently, these children fleeing physical contact, the gaze even voice.
They have little or no activity fantasy, imagination is limited to body parts, functions and bodily orifices. There is also an inhibition of thought. These children give the impression of being empty, they are often mute or echolalia.
Finally there is a tendency to any ritualized, dependence on a set routine. This search for the absence of change is another aspect of the "shell".
In psychotherapy, they come to an undifferentiated global object or a broken object.
c-regressive secondary autism (ASR1: Toby, Paul; ASR2 Ralph)
Frances Tustin close this clinical entity of schizophrenia infant.
It considers that the ASR is the product of a regression in development.
Compared to the CSA, the protection against "non-self" terrifying being dispersed, tiny split into parts which we think is closer to the developments of Bion on schizophrenia. Therefore personality is unstructured, "incoherent and confused."
The prevalence of pathological projective identification as a defense against the shock of the separation of body and cons of depression that follows leads to a fragmentation of self and the object.
The object relationship is marked by a persistence of transitional objects in an age where they should be abandoned. The separation may be impossible with the mother or be helped by the existence of a transitional object.
The distinction between animate and inanimate, people and things, is poorly made, as well as that between good object and bad object.
activity is bizarre fantasy, often related to bodily functions. The thought is confused, the language also, he is poor, sometimes meaningless.
In psychotherapy, they come to an object into pieces, a strange object, an object consisting of poorly assembled pieces.
Frances Tustin distinguishes ASR (1) where the personality is split into two parts, and ASR (2), evolution of the ASR (1), where personality is cleaved into multiple fragments, disintegrated.
[1] Frances Tustin thus achieves a rapprochement between the current post-Kleinian English (she was a student of Bion) and a first psychosis derived from ego psychology-American.
[2] Winnicott, DWW (1951-1953). "Transitional objects and transitional phenomena." Playing and Reality. Paris: Gallimard, 2000 21
[3] DWWinnicott, cited by Tustin, F. (1972). Autism and psychosis of the child. Paris: Editions du Seuil, 1977, p. 14
[4] As well as the extraction of the object in Lacan and experience of the mirror stage.
[5] Ibid . p. 176
[6] See Part II -
[7] In particular in autism secondary shell
[8] Ibid . p. 31
[9] Ibid . p. 32
[10] Ibid . p. 33
[11] Ibid . p. 67-75
[12] See Part IV-
[13] Ibid . p. 101
[14] Ibid . p. 102-105
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