ARW – Project France 
PDF This article is the translation of the paper published in the magazine of the leading French newspaper “Le Monde” on January 13th 2012 and titled “Autisme : la Psychanalyse au pied du mur”
Translation: Karen Wilshin
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Autism: Psychoanalysis against the Wall
Autism may well be France’s National Cause for 2012, but families living with autism remain helpless. Why? Because in France, psychoanalysts oppose behavioural methods which have already proven their effectiveness abroad. A retrograde position highlighted by Sophie Robert in her documentary “The Wall” (“Le Mur”), whose public release hangs on a court decision to be given on January 26. By Laure Mentzel / Illustrations Shannon Freshwater
On the screen, a grandmother in a dainty blouse jams her arm between the jaws of a plastic crocodile. This veteran child psychiatrist is miming the Lacanian concept of the “crocodile mother”- all-invading and castrating – used to explain the causes of autism. In the 1950s, with Bruno Bettelheim and Jacques Lacan, it was thought that this condition was the result of problems in the mother-child relationship. At a time when the whole world now accepts the neurological origins of autism, and the need to re-educate children with ASD, this professional doesn’t flinch in describing her approach: we must above all treat the “maternal madness”. If we believe the documentary “The Wall” by Sophie Robert from which this scene is taken, French psychiatrists are totally dependent on psychoanalytical theories which are considered as obsolete as a therapy for autism everywhere else. One after another, psychiatrists appear, condemning parents as obviously responsible for their child’s disability, a delay in language development is due to a desire to “stay in the egg” with no solution and rejection even of the idea that children with ASD could progress… The film is both chilling and infuriating Is there no psychiatrist worth their diploma in France? Do all the neuroscience discoveries and cognitive and behavioural therapies which have proved their effectiveness in Anglo-Saxon and Scandinavian countries stop at our borders like the Chernobyl mushroom cloud? This was debated at the court in Lille on December 8 last year. Sophie Robert was taken to court by certain of those professionals interviewed who want to ban The Wall.
According to their lawyer, this is because the way the film was edited damaged their reputation and their moral rights. “Presented as a documentary”, The Wall is “in fact a campaigning film” which made them look “ridiculous” Other interviewees who did not go to court are flooding the Web with irate corrections, and criticising “dishonest” procedures An “betrayal of trust” according to Caroline Eliacheff who defended the psychoanalysts on France Culture radio. Sophie Robert calmly replied that she had not “intended to make an anti-psychoanalysis film”. On the contrary it was because this discipline interested her that she started to look into the subject in more detail. During the discussions she admitted that if the problem was little-known and her film not broadcast, it was no doubt because “the decision-makers and influencers are all on the psychiatrist’s couch.” In other words, those who have been through analysis are closing ranks to defend the followers of Freud and Lacan. Is The Wall a scathing caricature or a long-overdue cry of alarm? On January 26, the court will give a legal answer to what is really a question of public health. Whether or not it is banned, the film will at least have brought into question the “French approach”. This in a year when autism has been named France’s National Cause 2012 aiming to “improve early diagnosis, develop the support of children with autism and promote and encourage their integration and continuing education in a school environment”. Psychoanalysts against behaviourists – is it war? With 1 child in 156 affected by this condition, it is worth asking the question.
IN FRANCE certain members of the medical profession still see a bad mother-child relationship as the cause of autism spectrum disorders. Virgine Gouny found out to her cost. Mother of Matteo, almost 3, she was astonished when she consulted a child psychiatrist only to find herself being questioned by the doctor. Was this child a wanted child? Now that he was here, was she able to leave him? The psychiatrist wrote a stinging report, describing a “morning-after pill child”. Matteo was diagnosed with “Pervasive Development Disorder”, or “PDD”. This is the new name for for autism, the original term being unsuited to the multitude of symptoms it covers. From Kanner-type autism, which affects children and may impair their intellectual abilities, to a genius with Asperger’s, like the hero in Rain Man, autism manifests itself in many ways, the only common characteristics being an inability to communicate, to perceive what is real and to adapt to it. Psychiatrists often recommend community mental health centres. One of the problems with these centres, where the staff are not always trained in autism, is that the parents are often excluded from therapies, but also from psycho motility and speech therapy sessions, essential to children’s progress. Disgusted by this diagnosis which was more of an accusation, Virginie searched for other solutions for her son. But outside the big cities, if you refuse the mental health centre option, you’re on your own.
Even so, in local centres, training on developmental disorders is not always the most up-to-date. The personnel, who are still heavily steeped in psychoanalytical theories, apply them to the letter, thus hindering the progress of children with ASD. Valerie Sochon always suspected her son had a problem. She confided in her general practitioner who prescribed anti-depressants and tranquillizers – for her. Her son wasn’t growing properly, had food phobias and nutritional deficiencies. When he was 4, it was suggested that he attend a mental health centre. But, at best, all that Alexis was offered there was “therapeutic meals” where he was obliged to prepare and eat foods that he was terrified of and the “paddling pool” where he was observed playing. At worst, his head was plunged under water so that he could relive his birth, to free him from this original trauma. When he was 5, the educational team recommended placing him in an institution. Finally, Valerie heard about a well-known child psychiatrist who lives in Brittany. She left everything and moved to the region to consult this doctor. Today Alexis is a full-time student at the local junior high school, where he is getting very good results. . Mr. Khanfir has also had to compensate for the lack in institutions. His son Ryan “as in Saving Private Ryan” has ASD. After several years attending a day hospital, he was sent to a less specialized day centre “basically somewhere to park kids with serious disabilities.” Ryan became sullen, violent and completely lost the power of speech. Since he was removed from there and has been working with a private educator, trained in behavioural methods, he has learned to communicate, is toilet trained and sociable. And much happier.
HOWARD BUTEN, THE FAMOUS AMERICAN CLOWN-PSYCHOLOGIST-WRITER, who has been working with young French people with ASD for years, doesn’t hesitate to severely criticise the French system, still too heavily steeped in psychoanalysis and firmly against behavioural methods. What do the “old school” psychiatrists say? That cognitive and behavioural therapies are like “training an animal” Twenty years ago, the psychiatrist Stanislaw Tomkiewicz declared energetically, if not quite politically correctly “The most violent thing we can do to a child with autism is to leave them to stagnate”,
ABA, Teacch, and PECS: at Bussy-Saint-Georges (Seine-et-Marne), near Paris, these acronyms for behavioural therapies are part of the daily routine for around thirty people. Twelve children and fourteen adults work non-stop at the “L’Eclair” day centre. A haven of efficiency and gentleness founded by Liora Crespin, mother of a child with ASD, and which does receive state funding. At the entrance to the building, coats are hung under lockers, just like in any school. Next to each child’s name is their photo. Everywhere, there are visual signposts to structure the space and time: a vertical timetable made up of small images which are stuck on and moved as the day goes on, enables students to see which tasks have been completed and which are still to do. There are also expression cards: television, Meccano, drink. “Non-verbal” children learn to communicate, to express what they want without screaming, and in this way to modify behaviour which may be seen as inappropriate. The centre is clean, calm and colourful. Children learn by playing, whilst a delicious smell of cake wafts through the building. A little girl jumps from one hoop to another on the ground, encouraged by an adult. Hopscotch or psycho motility? In the “blue room”, a little boy asks for a sweet from a young woman sitting at a miniature table. She is using ABA (Applied Behaviour Analysis), which consists of rewarding children who respond correctly to a request with a sweet or something else they like. As for the baking whose smell fills the corridors, the children had a cooking workshop, which was also the occasion to learn something: in this case to count to three – the number of eggs to break. One of the major differences between behavioural therapies and traditional psychoanalysis is the involvement of parents in the educational program. Children are stimulated non-stop by the around them in order to build their cognitive skills and independence.
These methods work: in the UK, three quarters of children with ASD go to school, compared to around a quarter in France. But far from ignoring the success of these therapies, French medicine is relying less on the psychoanalytical texts than the film suggests and is now planning to add them to the range of therapies offered. Liora Crespin proudly displays the report from the team at Saint Anne’s hospital, who regularly test the programme, noting “great progress”, and concluding: “It is a real pleasure for us to work with the team in this structure.”
THE PSYCHIATRIST MOÏSE ASSOULINE INSISTS: the difference lies not between psychoanalysts and behaviourists, but between those who promote intensive therapy and the others. He is in charge of the centre for young people with ASD at the hospital in Antony, which in reality resembles anything but a hospital. It’s a welcoming neighbourhood house with a small garden. In one room, the teenagers and carers get together for their weekly meeting. The teenagers are happy to be back in the centre which is set up like a school. The previous week was the Christmas holidays and in their families they missed the hospital. A hospital which, importantly, uses behavioural methods: here too there are photos on each door, and picture timetables. It’s common sense to help non-verbal children to communicate. Most importantly, here, the carers respect those they call “our young people”. This means not abandoning them to their autism, but on the contrary, offering exciting, worthwhile and stimulating activities. “Le Papotin” started at Antony thirty years ago. The interviews in this “unusual newspaper”, as it says on the front page, are all made by patients in the day centre. You only have to read them to admire their pertinence. To Mazarine Pingeot: “You are the secret child of President Mitterrand, why?” To Bertrand Delanoë, Mayor of Paris: “The question may seem a little crude, but never mind, when you choose this [homosexual] way of life?” No surprise then that Howard Buten, interviewed in the first ever edition of the paper says: “Without wanting to be wilfully spiteful (…), I think I’ve found the only journalists in Paris worth calling my friends.”
They are all on the same side: that of the “young people”. Psychoanalysts, behaviourists, the labels don’t matter, as long as things improve. Bernard Golse, child psychiatrist at the Necker Hospital in Paris and psychoanalyst, is one of Sophie Robert’s unhappy interviewees. Haughtily he declares that obviously “no relational problem between the mother and child can explain autism.” On the contrary, he says he is “with parents” who want their child to go to school. Furious, he goes on: “We are getting aggression which should be directed at the State for not respecting the law. To integrate children with ASD in schools, we must stop cutting 44,000 teaching posts every two years.” To find out the reasons why France lags so far behind we should be asking the government. Bernard Golse is on the management committee of the CRAIF, the Centre for Autism Resources in Ile-de-France. It is made up of an equal number of parents and professionals and aims to improve the situation of people with ASD. For Jacques Baert, President of the CRAIF and father of a 30 year-old with ASD, this squabbling pitting psychoanalysts against behaviourists, carers against parents is dangerous, particularly for those with ASD. “Finally we are managing to work together” he stresses, choosing his words carefully. He re-centres the debate: “It may be stupid, but what a person with ASD needs is respect. Self-respect, which is acquired through worthwhile activity”, such as sheltered employment centres, which is where his son now works. “The paradox with parents is that they want their children to go to school like everyone else, to work like everyone else, but their children are not like everyone else, we have to take account of that too.” Physiotherapy, psychotherapy, integration in ordinary schools, boarding school… Nothing’s perfect, but we should try everything. Jacques Baert is driving. Talking about such sensitive subjects made him lose his concentration, he’s lost his way. Suddenly his on-board SatNav tells him which road to take. Hands on the wheel, he stops being serious for a minute for a bit of black humour: “You see, therapies for autism are not as simple as a SatNav, there are no miracles!”
