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Tustin, F. (1984). Autistic Shapes. Int. R. Psycho-Anal., 11:279-290.
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International Review of Psycho-Analysis
(1984). International Review of Psycho-Analysis, 11:279-290
Autistic Shapes
Frances Tustin Author Information
INTRODUCTION
This paper seeks to study what autistic children call their 'shapes'. The nature and
function of these 'shapes' will be investigated, and also the part they play in autistic
pathology. Finally, psychoanalytic therapy in which such 'shapes' play a part will be
described.
'SHAPES'
In the days when I was working as a psychoanalytic child therapist with young
autistic children, as they began to talk, they would tell me about their 'shapes'. I
knew that shape was important to such children because if they were testable at all
(and most of them were not) the psychological tests on which they did best were
those to do with the matching of shapes. But I began to realize that the 'shapes' the
autistic children were talking about to me were not these objective geometrical
shapes which we all share. They were entirely personal shapes which were
idiosyncratic to them, and to them alone. They were not the shapes of any
particular object. They were just 'shapes', the circle being an especially comforting
one for all of them. I do not know what other forms were covered by what they
referred to as 'shapes', but I do know that it was the bodily 'feel' of such 'shapes'
which mattered to the child. These 'shapes' brought in the rudiments of the notion
of boundaries enclosing a space, although they themselves were not located in
external space as are the shared geometrical forms to which we ordinarily give the
name 'shapes'.
As we shall see later, the feel of an object held loosely in the hand could be a
'shape'. When it was used in this way, the particular features which made it into a
specific named object were not differentiated or attended to. It was not the shape of
a specific object which existed in actuality; it was just a 'shape'. I inferred that it had
arisen from inbuilt dispositions in the first place. Later, we shall see that an autistic
adolescent girl was concerned to produce a bi-partite 'shape' whose two sides were

symmetrical, whereas two shapes which exactly matched each other were
important to an autistic young man. It is characteristic of autistic children that
asymmetry, contraries, differences and lack of fit to shapes are unpleasant and are
avoided.
With the younger children the 'shapes' of sound, smell, taste and sight seemed to
be 'felt' rather than heard, smelled, tasted or seen. Such children's consciousness is
very restricted because what they take in is so restricted: 'touch' being an avenue
of awareness which, in these younger autistic children, overrides other sense
perceptions. Also, conscious and unconscious levels of functioning are scarcely
differentiated although, at times, these children can become agonizingly conscious
as the outside world impinges unexpectedly. The children struggled to use words to
tell me about these unverbalized experiences. It is a struggle for us to understand
them. They seem so different from our own more differentiated experiences.
However, let me make an attempt to describe their nature still further. To do this,
autistic shapes must first be differentiated from those that can be inferred to be
normal ones.
Normal shapes
It seems likely that the normal human infant has an inbuilt disposition to form
'shapes'. These primary 'shapes' are likely to be vague formations of sensation.
They would tend to offset the randomness of the flux of sensation which constitutes
the infant's early sense of being. In the first place, these 'shapes' will occur without
the child's

(MS. received October 1983)


Copyright Frances Tustin
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intervention. However, the child will soon learn that he can make some 'shapes'
recur by his own movements. Thus, as well as arising spontaneously, they will
become self-induced. These early shapes arise from the 'feel' of soft bodily
substances such as faeces, urine, snot, spit, the food in their mouths, and even
vomit, some of these being elements for repeated experiences. However, it is the
'shapes' rather than the bodily substances which are important to the child. The
bodily substances are merely shape-producers. In normal development, this shapemaking propensity will soon become associated with the actual shapes of actual
objects. This will result in the formation of percepts and concepts which facilitate a
working relationship with objects in the outside world which can be shared with
other people. Normal sensation shapes are the basic rudiments for emotional,
aesthetic and cognitive functioning. If things go wrong here, then dire trouble is in
store. This is what happened with autistic children.

Autistic children's 'shapes'


In autistic children, their shape-making propensities have taken an atypical course
which seriously hampers on-going psychological development. Because their
'shapes' are unshared with other people, they become entirely personal and
peculiar. They are much more contrived than those of normal children, as for
example, their use of regurgitation of food similar to infants suffering from
'rumination' (Gaddini, R. & Gaddini, E., 1959). Their use of contrivances gives their
functioning a stilted, mechanical quality.
When they first come into treatment, young autistic children are usually not toilettrained. At home, some of them smear with their faeces, presumably making
'shapes' on their skin. When they become toilet-trained, they manipulate the faeces
in their anus to make 'shapes' on the skin surfaces there. (Outside and inside of the
body not being clearly differentiated.) This is not to imply that, at this stage, the
child does anything as developed as drawing a shape. It is the impression of a
shape which these young children obtain on body surfaces. Nor are the skin
surfaces differentiated clearly as such, they are merely the medium upon which the
impression of 'shapes' arises, some surface-media being more sensitive than others.
The young autistic children told me that they wriggled or rocked their bodies to
make 'shapes' from bodily substances. Spinning and swinging also produced them.
The children also bubbled with the spit in their mouth or the snot in their nose.
These bubbles were experienced as the 'felt' sensation of a circle, and not as a
three-dimensional object located in external space. I presume that all the 'shapes'
had this two-dimensional quality, although most of them would not have such a
precise shape as that of a circle. (In discussing such elemental pre-image
manifestations which arose in his pyschoanalytic work with the psychosomatic
disorders of adult patients, Eugenio Gaddini (1982) makes especial reference to the
circle.)
These autistic 'shapes' were also produced by non-bodily objects and processes
experienced as if they were bodily ones. The 'felt' shapes produced on the child's
bodily surfaces by these non-bodily objects and processes did not lead to their
being shared with other people as is the case with more normal children. The
objects and processes were at the service of the autistic child's entirely personal
idiosyncratic purposes. Like the bodily substances they were merely shapeproducing agents. They scarcely existed in their own right for the child. Some young
autistic children are so unaware of the actual existence of objects that they try to
walk through them as if they did not exist. In the same way, they listen to other
people's voices, not as a communication, but as a self-envelopment by lulling
shapes. Thus, they are often thought to be deaf before it is recognized that they are
autistic. The children are capable of forming elementary percepts and concepts
from their shape-making propensities, but these are idiosyncratic to them, and they
are not very interested in them; they are so captivated by 'shapes'.
The non-bodily equivalents to bodily substances are such things as mud, sand,
plasticine, clay, water, paint and so on. As we shall see later, toys can also by used
in this way. Also, we shall meet a 13-year-old girl who used arithmetical notation,

and also an 18-year-old young man who used the letters of the alphabet as
equivalents to bodily processes. The necessary quality of these equivalents is that
they lend themselves to being
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manipulated as 'shapes'. These 'shapes' are not the differentiated shapes of actual
objects as we see and 'feel' them. Nor were the arithmetical and alphabetical
processes used as we would use them. They were used as contrivances to produce
the 'shapes' that the child wanted. Autistic children are 'stuck' in this peculiar mode
of functioning. Very little on-going psychological activity takes place.
There was another important way in which the autistic child's 'shapes' were
different from those of more normal children. They were repetitive and unchanging.
Metaphorically speaking, they went round and round in an unbroken sequence.
Unexpected, spontaneous 'shapes' which popped up out of the child's control were
upsetting. They struggled laboriously to shut out the unexpected 'shapes' by trying
to make the known and familiar ones recur again and again. They felt that things
must not get out of their control. For the child, his bodily movements were felt to be
all-powerful to produce known and familiar 'shapes'. These 'shapes' were also felt to
be all-powerful in that they could make the child feel soothed and comforted, or, if
they got out of control, for example, a loud and unexpected noise hitting his ears,
they could upset him. 'Shapes' had powerful effects upon his moods. He tyrannized
over them and they tyrannized over him. He was enthralled by them. The child felt
that the existence of the magical 'shapes' depended upon his activities, and that he
depended upon their magical presence to give him a sense of 'being'.
Just as the philosopher, Bishop Berkeley felt that his 'looking' created the world, so
autistic children feel that their 'shapes' are all powerful to create it. With the
younger autistic children these were primarily 'felt' shapes, but with the older
children sight became important also. Of course, we all create our world in that, in
terms of our modes of perception, we construct a working simulation which helps us
to function in what we quaintly call 'the real world'. We all share the experience of
the Scandinavian god Odin who, at the beginning of time, before he could create
the World, leaned over a bottomless chasm until the swirling mists below formed
themselves into shapes.
'Shapes' are the primary means by which we create both our inner and our outer
worlds. The trouble with autistic children is that their 'creation' is unduly 'quirky'.
They have used the shape-making propensities of the human mind in their own
idiosyncratic way. The evolution of their construction had not been modified by cooperative interplay with other people. It is also unduly suffused with crude autosensuousness. This makes the children pick up the wrong cues for on-going
psychological development. They become trapped in a vicious circle from which
they cannot escape. Only what they can easily manipulate seems real. 'Shapes' are
easier to manipulate than actual objects used as actual objects, thus 'shapes' seem
more real.

This means that the activities of autistic children are mostly a-symbolic. They do not
play, dream, fantasize or imagine to any appreciable extent. It is a progress when,
in treatment, such a child has visual hallucinations. (The 'shapes' may be a kind of
tactile hallucination.) They do not suck their fingers or their thumbs. Nor does
genital masturbation appear. It is a progress when they do these things. It is a great
progress when they begin to play. Through lack of contact with other people's
'shapes' which could change and transform their 'shapes' into common coin, they
are cut off from the enriching psychological possibilities of every day life with
ordinary people. Their thinking, if it can be called such, is restricted and meagre.
Imagination is completely lacking. Speech is either absent or crippled by echolalia.
Their emotional life is similarly muted, except on the rare occasions when it bursts
forth in an explosive way which is terrifying to the child.
In Greek mythology, Morpheus, who was the son of the god of sleep, could change
his shape at will. From this we get the term 'morphology'. Winnicott has suggested
the term 'psycho-morphology' for the study of psychological forms and shapes. This
paper concerns an aspect of psychomorphology which is concerned with
nonobjective shapes. We live in a world dominated by words and by the shapes of
actual objects. In studying autistic children we have to try to enter a wordless world
dominated by self-induced, amorphous, unclassified, concocted 'shapes'. Writing
this paper has brought home to me how difficult it is to cross the threshold into this
world. The reader may be finding it as difficult as I did.
To help you to understand it, try a little experiment. Forget your chair. Instead, feel
your
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seat pressing against the seat of the chair. It will make a 'shape'. If you wriggle, the
shape will change. Those 'shapes' will be entirely personal to you. The autistic
child's attention becomes so focused upon these entirely personal 'shapes' that the
chair, as such, is not important to him, although he may be vaguely aware of its
existence and may even know its name.
Perhaps this has made it a little clearer. It may become clearer still when these
'shapes' are seen in action in actual children.
AUTISTIC 'SHAPES' IN ACTION
The stereotypes which are so characteristic of autistic children are an exhibition of
the child's shape-producing activities. Mrs Shirley Hoxter described a moving
example of such a stereotype when she wrote as follows:
On my way to the clinic, I drive past a couple who are slowly making their way along
the pavementapparently a father taking his 12-year-old (?) daughter to school (?).
Every now and again the girl stops, obviously immovable, she holds up her hand,
twists it and twiddles her fingers gazing at it in entranced joy. Nothing else in the
world exists and certainly there are not joys like this to be found elsewhere. Her
father stands by, patiently waiting for long minutes like someone resigned to

chronic, repeating spasms of pain. The eternity of suspended time is over. They
proceed on their way for a few yards and then it is repeated. (Personal
communication.)
As I read this account, I feel full of sadness that the girl could not turn to her caring
father for comfort and reassurance from her terrors, instead of resorting to her
concocted self-induced 'shapes'. But at 12 years of age this is likely to have become
an established way of life. It would be very difficult to help her change it. However,
it has been my experience that it is possible to bring about changes if autistic
children come into psychotherapy at under 7 years of age or thereabouts. If such
psychotherapy is to be tactful and sensitive, we need to understand some of the
functions that 'shapes' have for the children. However, before discussing these,
autistic shapes need to be differentiated from autistic objects. This latter
phenomenon was described in a paper which was published in this journal (Tustin,
1980), and also in my book Autistic States in Children(1981). They had been hinted
at in my earlier book AutismNext Hit and Childhood Psychosis(1972).
I understand them better now. As one lives with such elemental phenomena they
become better understood and their critical importance to psychotherapy with
autistic children becomes realized. (I now prefer to call them 'autosensuous objects',
particularly in their normal manifestations; 'autistic' can then be restricted to
pathological ones.)
Autistic 'objects'
Autistic 'objects' also arise from self-induced bodily sensations. Like autistic 'shapes'
they arise from auto-sensuous activities. Their difference from 'shapes' is that they
are stimulated by hard bodily substances such as hard faeces, hard snot, hard
muscles and hard bunched-up tongue or the insides of the cheek. They are
experienced as clusters of hard sensations. In these instances the child's body is
tight and taut. Later, hard objects such as toy cars, toy trains, keys etc., are used as
if they are part of the body to give the child the same sensations as those aroused
by the hard bodily substances. The actual detailed features of the objects are not
attended to other than those that the child wants. These are the 'feel' of their
surfaces and outlines. Autistic 'objects' are different from the soft, amorphous
'shapes' in that, as well as being hard, their outlines are rigid and static. They do not
change as those of the malleable, fluid 'shapes' can do.
Both Bick (1968) and Meltzer et al. (1975) have described the way in which
unintegrated children feel that their skin surfaces 'adhere' to other surfaces in order
to offset their terror of falling apart or spilling away. Autistic 'objects' meet this
need. The autistic child presses a skin surface against the hard surface of an object,
for example a small car held tightly in the palm of his hand. The hard well-defined
cluster of sensations caused by this, gives him a sense of bodily definition as well as
making him feel secure and safe. Since the child's body becomes equated with the
hard objects to which they adhere, 'adhesive equation' would seem to be a more
appropriate description of them than the term 'adhesive identification' as suggested
by Bick (unpublished paper). Bick was obviously dissatisfied with this
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term since in private communications she changed it to 'adhesive identity'. Based


on Eugenio Gaddini's useful clarifications in his (1969) paper, 'imitative fusion'
would seem to be another possible description.
It is important to realize, that, since the child's body seems fused with 'autistic
objects', they have scarcely reached the status of an 'object' in the usual sense of
that term. The child's attention becomes so riveted upon these hard object-like
clusters of sensations that they prevent the normal use of actual objects
distinguished as actual objects which are separate from the body. They also prevent
the development of relationships with people, who by contrast with autistic 'objects'
which are always available, seem unreliable. 'Autistic objects' need to be
differentiated from Winnicott's (1953)'Transitional object' which, having reached the
status of an object, and being a combination of 'me' and 'not-me', can facilitate ongoing psychological development.
Let me now return to the discussion of autistic 'shapes' and try to elucidate their
function for the child.
The function of autistic shapes
As well as distracting the child's attention away from the 'not-me' outside world, the
perseverative recurrence of self-induced, familiar 'shapes' is important in calming
autistic children after an explosion of tantrum or ecstasy. These extreme states are
terrifying to such children. They feel that they will be blown apart and spill away.
The hardness and definition of autistic objects helps the child to feel safe and
securethey feel 'all-buttoned-up'. The amorphous softness of auto-sensuous
shapes is soothing and comforting. They are like a self-induced warm bath which is
always on tap. The 'shapes' induced by bed-wetting are an example of this function.
Mr Park, the father of an autistic adolescent girl called Elly, has written an
interesting paper in which he describes the obsessional 'shapes' used by Elly to
calm herself down after such explosions (Park & Youderian, 1974). He calls them
'ordering principles'. 12-year-old Elly's shapeproducing equivalents of bodily
substances were numbers. For Elly some numbers produced 'nice' sensations and
others produced 'nasty' ones. Some numbers aroused such 'rapture', (as the father
terms it), that they were unutterable; Elly could only write them.
The moon was number 7 for Elly. The father describes her unutterable rapture about
the full moon.
On the nights following a full moon, it rises outside Elly's window and stays for
several hours partly visible behind a large tree She will not say its name but will
refer to 'something behind the tree' If the moon is obscured, Elly lies in bed and
cries her tearless autistic cry.
As well as the moon being number 7, so was the sun and also a cloudless sky. Seven
was a rapturous number.

Elly had a system of doors based on numbers with which she dealt with her states
of rapture. Here is her drawing of that system:
Figure 1

The sun with many rays and no clouds obscuring it, represented Elly's greatest joy.
For this, she had to have 4 doors to cope with her ecstasies about it. A sun with less
rays and 1 cloud needed 3 doors. A sun with even less rays and 3 clouds needed 1
door, whereas the sun with scanty rays and 4 clouds obscuring it, needed 0 doors.
In this, we see the number basis for Elly's world. Just as a younger child would have
used the 'shapes' arising from his bodily substances to create his world, so Elly used
the 'shapes' arising from numbers. This meant that she expected arithmetical
precision both from herself and from other people. Enraged frustration resulted
when her calculations were disappointed.
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Mr Park gave an example of this. It occurred when a guest took the first helping
from a salad which Elly had made and from which she had arranged in her mind
that she would be the first to take a helping. Another person's unexpected action
disturbed her world. To calm herself down after the tantrum which this provoked,
she embarked on a skilful manipulation of multiplication and division sums with
large numbers, to which she knew all the answers beforehand. From these
manipulations she got 'shapes', in this case the answers to her sums, which were
known and familiar. These numbers were completely at her service and under her
control. She manipulated them so that she got 13691369 as the answer to her
sums. For Elly, the symmetrical 'shape' of such a number was always comforting.
The two sides were the same; they matched each other.
This desire for matching 'shapes' and fear of lack of fit for 'shape' was illustrated by
an autistic 18-year-old young man whom I will call Tony. As with Elly, his autistic
conditions had been ameliorated by a caring family. After being sheltered by this
family and by a Rudolf Steiner school, Tony expressed the wish to go to the local
College of Further Education, which he did at 17 years of age. This was too stressful
for him. He had a breakdown in which he deplored his loneliness. To solace this, and
to calm himself down after the upsetting experience of the College, he resorted to
what he called his 'play'. This concerned 'shapes'. The caring parents could only sit
on the sidelines. They were completely cut off from him. The headmaster of the
College suggested to them that it might be helpful to Tony if he made a taperecording of his 'play'. He was very willing to do this and the parents have allowed
me to make a copy of this tape-recording.
The essence of what Tony said was that the right people had to be 'matched' with
the right house. The letters of the alphabet were used as the basis on which this
'matching' took place. For 18-year-old Tony, the letters of the alphabet were
equivalent to the malleable bodily substances of the younger child from which

comforting 'shapes' would be manufactured. The alphabetical system from which


Tony's 'shapes' were made is as follows.
If people had certain letters in their name, for example D.O.M., then they would
match with a house which had a name that contained those letters. This idea was
repeated over and over again throughout the 'play'. Thus, Tony reinstated his
comfortable and reassuring view of the world by enveloping himself in repeated
familiar shapes which matched each other. (I should say here that neither Tony nor
Elly had had psychotherapy, so their material was quite unaffected by
psychoanalytic ideas and by my views on 'shapes'.)
These children are powerful enough to impose their private pattern of concocted
'shapes' upon the public shapes of the outside world, and to get people to collude
with these. They want to keep everything on a dead level of sameness. Extreme
states of ecstasy or tantrum threaten to send them 'mad' with excitement. In
popular parlance which is very revealing, they threaten to send them 'off their
rocker'. Both Elly and Tony illustrated their frantic attempts to get back on their
'rocker'. Mr Park describes how Elly would sit in her little rocking chair, listening to
Hard Rock. When it threatened to become to much for her, that is, when it
threatened to send her 'off her rocker', she would cover her ears to shut it out.
Persevering, solitary rocking is very characteristic of these children. It is their selfmade brand of tranquilizer. The self-induced autistic objects and autistic shapes
stimulated by this rocking are not so much an attempt to express feelings as an
attempt to clamp down on them and to tranquilize them. Of course, we all do this to
some extent, but with autistic children it is a perpetually dominant state. Thus, their
inner and outer worlds do not grow and change as those of more normal individuals.
They are not sufficiently modified by interactions with the actual characteristics of
actual objects and with those of other people.
Their simulation remains a freakish construction which does not help them to relate
effectively to the actualities of the outside world nor of themselves. Thus, the 'notme' becomes increasingly strange and frightening to them. Autistic objects and
autistic shapes divert their attention away from this strange, frightening 'not-me'.
The more their attention becomes focused upon these autistic procedures, the more
remote and strange the everyday world of ordinary people becomes. Thus, the
effect of these practices is that of
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alienation. In studying autistic 'shapes' and autistic 'objects', we are studying the
anatomy of madness. An important part of psychotherapy with these children is to
lead them away from their idiosyncratic autistic world into the shared world of
sanity and common sense, whilst at the same time preserving their originality and
individuality. To do this tactfully and skilfully we need to understand the nature and
function of their diversionary distractions. For this we need to have some
understanding of why they may have resorted to them.

After many years of work with autistic children, I have come to think that childhood
Previous HitautismNext Hit is the result of an interaction between a temporary state
of depression or underconfidence in the mother during the child's early infancy, and
the particular nature of the child. (For an insightful understanding of the mothers of
these children see the paper by Dr Salo Tischler, 1979.) Also, in my experience, the
father had played a negative part in that he is either absent, or too malleable for
this powerful child. Although, as infants, these children were physically well-cared
for, the psychological ambience surrounding them was not adequate for their needs.
Ordinarily, the mother in co-operative interaction with the father, provides the child
with a means of interpreting and managing the world of sensations and emotions.
Lacking this, the autistic child has invented his own nave scheme concocted from
repetitive self-induced shapes. Excessive auto-sensuousness stimulated by certain
material objects, has attempted to compensate for their psychological lacks. Thus,
'me'-centred manipulations and auto-sensuousness have remained unduly
important.
By nature, autistic children react to difficulties by retracting their psychological
feelers. They opt out. This lack of empathy affects their capacity to relate to other
people (Hobson, 1982). Also, work in the Institute of Childhood Neuropsychiatry of
Rome University suggests that some of these children may have minor brain
irritations and hormonal imbalances (De Astis & Giannotti, 1983). All this makes
them tricky infants to rear, even when a mother is functioning normally. It has
seemed to me that what began as their particular reaction to the mother's
underconfidence and inattention, becomes hardened over the years into terrorstricken strategies. Almost the whole of their attention becomes focused upon rigid
contrivances, and thus they seem to be inaccessible to human care. Without
therapeutic intervention, they continue on the treadmill of their repetitive, allpowerful 'shapes' which are facile rather than facilitating.
Let us now consider the type of psychoanalytic therapy which can modify the child's
recourse to such restrictive practices.
PSYCHOANALYTIC PSYCHOTHERAPY
Such psychotherapy gives the child the chance to meet some of the inevitable facts
and frustrations of life in a protected and caring setting. This is because no
psychotherapist, however good, can understand him all the time. The
interpretations are not always accurate nor do they always meet his needs.
Sometimes they are not even understandable by the child! Nor are the shapes
which occur as precise as these exacting children demand. Inevitably, there are
holidays and days when the therapist is not working as well as usual. From this point
of view alone, psychotherapy is a very salutary experience for these children, for
they meet these facts in a situation in which the therapist's only work is to listen to
them and imaginatively to try to understand their difficulties whilst strengthening
them to meet them. But understanding does not mean sentimental collusion with
their pathology. Such children are Pied Pipers who have led their 'shapes', and will
lead us if we are not careful, away from the concourse of human beings into the
darkness of the autistic mountain. We must 'not walk the child's autistic way', as the
late George Stroh expressed it (1974). However, 'calling their bluff' without a

therapeutic ambience to relieve and contain the murderous rage provoked by this,
is unnecessarily assaulting, and is likely to result in further autistic manoeuvres. If
we are to help these children to change, we need to have therapeutic insight into
the use their autistic behaviour has for them. We do not strip them of their means of
comfort and protection without providing something better.
Autistic objects and autistic shapes are not merely psychological curiosities. They
are blocks to more normal functioning. Insights into these phenomena promise to be
the keys by which we can tactfully enter the world of the autistic child
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to enable changes to take place there. These changes result in the child becoming
interested in using the percepts and concepts which he can share with other people.
These process incoming information and facilitate co-operation with other human
beings and with the object world. Some workers have become pessimistic about the
possibility of basically re-orienting an autistic child. They think that the only
changes that can take place are the development of ever-widening circles of more
and more complex autistic functioning, and that their autistic pivot will remain
unchanged. In my experience, these insights into 'autistic objects' and 'autistic
shapes' promise to provide a means whereby the child's autistic approach to life can
be radically changed.
The precise details of how this occurs in psychoanalytic therapy are still somewhat
mysterious but that it does occur, particularly with younger children, is borne out by
my own experience. (Some older children have been habilitated.) However, if it is
not to be damagingly intrusive, such a transforming entry into their world has to be
insightfully tactful. At these levels we are working with psychosomatic and neuromental elements. The therapist has to use those human resources which are
suitable for these levels of functioningthe human being's capacity for empathy
with another person's states being the psychotherapist's most valuable asset when
working with such children. Psychotherapy is an art as well as a science. As in all
detective work, progress in understanding comes from empathic identification with
the person being studied, by imaginative reconstruction of his situation, by informed
and inspired guesses, as well as by careful following of the clues. If we are listening
to them, the children will often put us right if we are wrong.
When children introduce us to their 'shapes' it is a sign of developing trust. It is
important not to abuse this privileged entry into their world. We need to be careful
not to use our knowledge to impose a conformity on these children by flattening out
those private personal shapes which will become part of originality and individuality.
These children are often poetic, artistic and musical. We do not want them to lose
these gifts. And, after all, a little eccentricity is refreshing! Good psychotherapy is a
kind of sanctuary in which private 'shapes' can be safely shared with someone who
respects and reveres them. In Bion's (1962a) terms, they are held in a caring
person's 'reveries'.

Let me now summarize a psychotherapy session with an 8-year-old boy, whom I will
call Peter, who is talking about his 'shapes'. For those who are interested, this
session is given in full in my (1981) book Autistic States in Children. This session
was a turning point for Peter who made a definite move out of his autistic way of
functioning to becoming more accessible and co-operative. The week before this
session occurred Peter had asked his mother what 'autistic' meant. I do not know
what she told him, but she ended by saying that Mrs Tustin was helping him with
this. This information seemed to be operating in the session. Also, at the end of the
session his mother told me that peter had been very constipated. As you will see,
this seems to be operating in the session also. His revelations about 'shapes' had
been heralded by his telling me in the last session of the previous week that he
made shapes on his skin by tickling it, and also by making bubbles with his spit.
Up to the time of the reported session, he had never done anything approaching
what could be called play, so when, at the beginning of the session which is being
reported, he went to the drawer which contained his toys, I was both surprised and
pleased. He was now talking, though somewhat laconically, so when he took out the
toy giraffe and started to tie a long piece of string which went around the giraffe's
body, I asked him if he were thinking about the giraffe which had fallen down. The
Radio News bulletins had been full of a giraffe in a Zoo which had fallen down and
for whom ropes had been used to help it to stand up because if it did not stand up it
would die. It seemed as if the whole of Britain was in suspense as to whether the
giraffe would be hauled to its feet so that it could live. It was clear that Peter was
very worried about this giraffe and, indeed, identified with it. I talked to Peter about
his feeling that he had 'collapsed'. 'Flop' or 'collapse' being the child's way of
experiencing the psychotic depression which is at the centre of Previous Hitautism.
Peter said the giraffe had to be 'raised up', so I talked with him about his wish to
grow up properly and not to be 'flopped'.
After he had hauled up the giraffe on the string from the bottom drawer where his
toys were kept
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to the top drawer where his pencils and paper etc., were kept, he proceeded to
fasten other toy animals on to the string and to haul these up too. But there was a
difference in the way in which he dealt with these animals. For one thing, as he put
each animal on the string he said, 'And now I will put this shape on to the string'.
Also, when I asked him 'What are you doing, Peter?', he said, 'I'm taking the shapes
from the bottom to the top'. These remarks, and the loose way in which he handled
the animals, made me realize that for Peter, at this point in the session, the animals
were unclassified 'shapes' rather than specific animals. I was not as aware, at that
time, of the importance of autistic children's 'shapes' as I am now. This was one of
the sessions that drew together for me the other autistic children's remarks about
their 'shapes'. Looking back, I realize that the toy animals were being equated by
Peter with the retained faeces his mother had told me about at the end of the
session, and that they were being used as 'shape-producers'.

I realize now that at this stage in the session Peter was resorting to his self-induced
'shapes', just as Tony and Elly did, to calm himself down after a shock. The shock
had been his identification with the fallen giraffe as the 'flopped' part of himself. He
was trying to 'raise up' both his shapes and also himself into a better frame of mind.
By the magical act of raising the 'shapes' he was trying to reassure himself that all
was well. I did not understand that so well at the time, but I asked him questions to
try to clarify what he was doing and then drew his attention to the obvious. Knowing
that autistic children tend to equate their body with inanimate objects rather than
identifying with people, I asked Peter if the chest of drawers were like his body. He
said that it was and, since he had the top and bottom drawers, I suggested that the
top one was his head and the bottom one his bottom. I also suggested that the
locked drawers in the middle part might be his tummy, to which he replied firmly
and dismissively, 'That part if missed out'. Significantly, the middle drawers
contained the other children's toys and were locked, so he could not touch or handle
the contents.
In the light of this, I pointed out the obvious fact that if he had no stomach, then his
head was not connected to his bottom. This drew his attention to the lack in his
sense of his body 'shape'his 'felt-self' as Jonathan Miller has termed it. Whilst he
was in this state of bodily unintegration, he needed the magical envelopment by his
self-induced 'shapes' to seem to hold him together and to reassure him against the
ever-imminent catastrophe of being 'flopped'. His use of the 'shapes' was a kind of
rumination in which he chewed the cud of known and familiar shapes. What went in
at his mouth came up again unchanged because there was no stomach in which it
could be digested. But he was puzzled about how what went in at his mouth as
food, came out of his bottom as 'poohs'; how and where did the changes take place?
Later in the session, he stopped taking his magical 'shapes' round and round on a
string. He accepted the fact that he had a stomach and that processes of digestion
took place there. He obviously felt that the tummy-button buttoned up the stomach
and that if that came undone, all sorts of 'monsters', as he called them, would pop
out. So his stomach, and indeed any stomach, were frightening places where 'notme' things, including other children, might pop-out to hurt him. As these 'nameless
dreads' were 'stomached' in the therapeutic ambience of the session, he no longer
needed his magical envelopment by 'shapes' and so we could settle down to a
discussion of 'growing-up' properly. This was concluded when I said that I had turned
over his 'shapes' in the stomach of my mind and he had turned over my 'shapes' in
his, and something new had come out, to which he had replied 'I suppose that's
thinking', to which I replied somewhat sententiously, 'And you can't touch or handle
thoughts'.
Is it too far-fetched to think that during this session Peter's perseverative
ruminations associated with his idiosyncratic 'shapes' had been transformed into
'thoughts', through interplay with another person's 'shapes' which facilitated a
process of psychological digestion? The details of how this transformation occurred
are somewhat mysterious to me, as also to Peter.
A helpful way to get in touch with these non-verbal processes is by way of metaphor
and allegory. Peter's session, in which he obviously experienced the psychological

ambience of the session as a great big stomach in which significant changes took
place, reminded me of one of the sequences in a television series called
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Monkey in which Chinese allegories were brought to the western screen. In this
sequence, a pale young man of indeterminate sex symbolized 'pure thought'. (This
young man's rarified innocent look reminded me of an autistic child. He was like a
marble statue.) In the allegory, 'pure thought' loses his impulsive monkey and also a
strange faceless creature called 'shape-changer'. 'Shape-changer' and the impulsive
monkey go into the cavernous belly of the monster who makes earthquakes and
volcanoes. The irrepressible monkey and shape-changer are transformed there,
presumably because they felt that the volcanic eruptions of their earth-shaking
passions had been held in experienced containment. Having been through these
basic experiences, they were re-united with the young man whose sex seemed
more established and whose thought, we can take it, would become more earthily
dynamic and less cerebrally 'pure'.
Perhaps this allegory expresses better than any words of mine the mysterious
transformations that can take place within a context of psychotherapy which
understands the violent tempests of human nature and is realistic about the need to
contain them within the transforming crucible of a caring person's mind. It will be
obvious that in this work with Peter I was influenced by Bion's (1962b) formulations
concerning 'maternal reverie' and its importance in the transformation of what Bion
calls 'raw beta elements' by what he calls the mother's 'Alpha Function'. I was also
influenced by Segal's (1975) paper on 'Symbolic equations'. 'Autistic shapes' and
'autistic objects' are part of the early pre-symbolic mental phenomena dealt with by
these writers. Both Milner and Winnicott were aware of the importance of providing
a containing medium for the expression of these entirely personalized 'shapes' so
that violent passions could be held and expressed through the shared experience of
fun and play which had a very serious purpose. Milner (1969), by her 'doodles' and
Winnicott (1975), by his use of the 'Squiggle Game', enabled the child to share his
personal shapes so that mental and emotional assimilations could take place. But
when he first comes into treatment, a young autistic child does not put pencil to
paper, nor does he co-operate and play. An understanding of the function and
nature of his inhibiting use of autistic 'shapes' is necessary if he is to be freed from
their thrall. This paper has attempted to add to our understanding of such 'shapes'.
SUMMARY
Autistic children alerted me to the significance of what they called their 'shapes'.
These 'shapes' were not the actual shapes of actual objects, although these objects
could be manipulated to produce the entirely personal, reassuring and controllable
shapes the child wanted; the circle being an especially comforting one. Soft
malleable bodily substances, and their equivalents, induced the vague formations of
sensation which the children referred to as 'shapes'. The outlines of such 'shapes'
were fluid and could be changed at will, in contradistinction to those of autistic
'objects' which, being object-like clusters of sensation, arising from the manipulation

of hard bodily substances and their equivalents, had outlines which were fixed and
definite. Autistic 'objects' were actively grasped to help the child to feel secure; the
more passive experiences of soft, amorphous autistic 'shapes' were soothing and
comforting.
In normal development the inbuilt shape-making propensities bring some degree of
order to the randomness of the flux of sensation which constitutes the infant's early
sense of being. In autistic children, these shape-making propensities have become
idiosyncratic and perseverative due to undigested terrors of the 'not-me'. The
author's experience has been that psychoanalytic therapy with young autistic
children which is informed by insights into autistic 'shapes' and autistic 'objects' is
mutative. The 'flat-spin' of autism gives way to ongoing psychological development
as these handicaps to co-operation with other people are modified, and terrors are
thus relieved.
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Article Citation [Who Cited This?]


Tustin, F. (1984). Autistic Shapes. Int. Rev. Psycho-Anal., 11:279-290

Copyright 2015, Psychoanalytic Electronic Publishing.


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