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David Rosenfeld, the Argentinean psychoanalyst, introduced the notion of the "tube-ego" in an article written in 1981. Frances Tustin makes several references to it, particularly in chapter 10 of Autistic Barriers in Neurotic Patients (1986).

Based on convincing clinical material coming from adult patients, David Rosenfeld shows that in very regressive states they experienced their body image as a system of tubes controlling their bodily fluids. He suggests that this image of the body as a system of tubes seeming to contain the bodily fluids is more elementary than the image described in Esther Bick's 1968 account of the skin as container.

Frances Tustin seems to agree when she says: "My own clinical work confirms that the body image as a system of pipes is more elementary than the image of the whole body being contained by the skin. However, the 'system of pipes' body image implies awareness of 'insides,' and also awareness of outside situations and identifications with them. It is a movement away from undifferentiated autism to a transitional awareness of 'me' and 'not-me' " (1986, p. 228). She uses this concept not only to describe infantile autism but also to describe ancient levels of representation of the image of the body in relation to certain anorexic pathologies during adolescence.

Like Frances Tustin, Geneviève Haag in France also relies heavily on this concept in her work with autistic children.

Bernard Golse

See also: Autism; Body image; Ego.


Bick, Esther. (1968). The experience of the skin in early object relations. International Journal of Psycho-Analysis, 49, 558-566.

Rosenfeld, David D. (1981). The notion of a psychotic body image in neurotic and psychotic patients. Finland: Congrès psychanalytique international.

Tustin, Frances. (1986). Autistic barriers in neurotic patients. London: Karnac Books.