Monday, 23 January 2012

Psychoanalytic treatment for autism: Interviews with French analysts

Last week a French documentary called “Le Mur” attracted attention in the New York Times. Plans to screen the film later this week in Philadelphia are being contested by three of the interviewees. They are all psychoanalysts who treat children with autism, and they complain that the film has been unfairly edited to make them look ridiculous. They are suing the film-maker, Sophie Robert in her native France. All the signs, though, suggest that their legal action is causing a Streisand effect, drawing attention to them and generating considerably more criticism of their activities than would otherwise have been the case. A website called “Support the Wall” has links to the documentary, with English subtitles, and to other sites highly critical of France’s idiosyncratic approach to autism intervention.
At nearly an hour long, the film is quite demanding to sit through, so I thought it might be helpful to post a transcript of the interviews with psychoanalysts, so people can judge for themselves whether the analysts have been ridiculed.
This text should, however, be read bearing the following points in mind:
  • The translation was not done by a native English speaker, and I simply copied the text from the subtitles, rather than attempting to improve on the translation. It is important to realise that some apparently incoherent utterances could be due to poor translation.
  • The subtitling is very amateurish and uses multiple colours in a way that can make it difficult to read at times. Unintelligible material is denoted as (xxx)
  • The speakers are indicated in brackets, with (I) denoting the interviewer (presumably Sophie Robert). All other speakers are psychoanalysts.
  • My ability to keep track of all the analysts is imperfect, and so I may sometimes have misattributed a statement - please refer to the original movie if you want to be certain of who said what.
(Update, 26th Jan 2012: World Service Health Check podcast on this topic)
The Wall
Introduction
For more than thirty years, the international scientific community has acknowledged that autism is a neurologic disorder that is the cause of a handicap in social interaction. All autists have the same anomaly in one area of the brain, the upper temporal line1 identified in 2000 by Dr Monica Zilbovicius. In France, psychiatry, being very largely dominated by psychoanalysis, ignores these discoveries. To psychoanalysis, autism is a psychosis. In other words, a major psychic disorder resulting from a bad maternal relationship.
1 Comment by DVB: I assume this refers to the superior temporal sulcus. I regard the statement about anomalies in all autists as an over-simplification
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The Interviews
(Dr Alexandre Stevens) I think that autism is a mode of reaction of the subject that is obviously very early in his logical history.
It is that (xxx) response to what comes as invasion of the world and of the other.
He clams up.
He clams up, he gets into a bubble and refuses to enter the mechanisms of speech.
But (xxx) some autists speak, don't they
So it is more than speech, in the subjective mechanisms
I mean, speaking, yes, but without being really involved.
(interviewer) Do you make a structural distinction between psychosis and autism?
(AS) No, I don't.
(I) Are autists psychotic?
(AS) Yes. That is to say, autism is an extreme situation of something that is in the scope of the set of psychoses.
*****
(Professeur Pierre Delion) The structural distinction that one can make between autism on the one hand and child psychosis on the other hand
that is (xxx) the aspect of the description of the underlying structure does not stand up to analysis in the continuity of this first structure and the second one.
It seems to me that there are paths between the autistic structure, the psychotic structure, and the dysharmonic structure.
Now, when we say that, we upset many associations of parents of autistic children who think that autists have nothing to do with psychotics
To me, this is a mistake; there are many things in common.
*****
(Dr Genevieve Loison) It is the crocodile! (gets out toy crocodile)
So the crocodile tells us right away what it is all about.
They play with it and when they put the hand or an object in, I am worried.
(demonstrates with hand in mouth of croc)
When they get on top of it and hit it, I feel reassured. They are fighting!
(I) Why? What does it mean, the crocodile?
(GL) The crocodile is the mother's belly, the mother's teeth
(I) Is that what Lacan used to call the mother: a crocodile?
(GL)Yes, so the goal of our work is to forbid her to eat.
(I) To eat the child?
(GL) We put a stick in him
When the child starts getting out this, sometimes he puts his hand
(demo hand in croc mouth). Sometimes he puts a figurine in.
(I) And this pen, what does it stand for?
(GL) (Puts pen across croc jaws) So this means "You can't any more" It is the bar.
(I) Is it the father's phallus?
(GL) That's it. You can't do that any more.
(I) It is the father's law, that bars the child from his mother and that forbids the mother to destroy the child.
(GL) Right, and to devour him.
(I) Does this also relate to autistic children?
(GL) Of course, yes. For autists it is a matter of stage, you see.
We take the children at some stage.
The autistic children, they often put the child in there (has what looks like a tortoise in shape of a bag?)
They go in there. Then, we get worried, right?
(Interlude with family with autistic children)
(05:15)(I) Regarding both psychosis and autism, there is an explanation that is traditionally used is that a maternal depression during pregnancy or the first months of the baby’s life would have altered the mother-child relationship, and could be responsible for severe disorders.
(Prof Daniel Widlocher) So, this is what serious colleagues tell us, so consequently I listen to them.
*****
(AS) It can be the case, when the child comes in such conditions where the other, his first “other”, the mother is very depressed. I mean she will be absent from him, will be in another look at him, that it could sometimes make it so that the child chooses to withdraw.
Sometimes, when the mother is depressed, when she is pregnant or at birth, sometimes the child can be autistic.
*****
(GL)Woah, well, we have seen a few of them. I remember, it was when I was in a psychiatric clinic that I have seen them, mostly.
I have seen massive things, massive voids, disorders.
I have seen abandoned mothers! For each autist there was, I would say, a different cause.
I have seen many mothers abandoned at the end of their pregnancy.
And the child… depressive mothers too, mothers in the baby blues afterwards, abandoned at the end of pregnancy, who have a baby blues after delivery, who are themselves in the emptiness and who put the child in the relational emptiness.
*****
(DW) For example, deep deficiency
For instance, a mother who, for reasons of depression does not take any care of her child, stays mute in front of him, clotted, while the child is there, starting to hang on to her, looking for contact.
It can, if it lasts long during childhood have consequences on the young adult who will keep being very cold, inhibited from an affective perspective, because, when he was a child, he unfortunately had a very cold mother.
*****
(I) Is there a higher incidence of the cases of psychosis or autism in countries where there is a war?
In the favelas of Rio? In all circumstances where mothers have good reasons to be depressed?
(GL) I am not aware of that, I cannot answer.
I can only answer about what happens in my practice, you see.
(07:55) (interlude)
(08:41)(I) How can one explain that a maternal depression could cause a child to be autistic?
To start with in utero?
(09.04)(AS) So, first of all, in utero some things already happen
I am not a specialist of in utero, but there are things happening.
The child moves, mothers speak
Mothers talk to him and react to a number of stimuli
In fact, what do children know about this link to the other, in utero?
It does not completely go through language.
But it goes through the whole environment of corporal sounds
Finally, a depressed mother, when the child is there in utero, does the child feel anything?
I am totally unable to tell you, but I do not feel like it is odd to think so.
*****
(Dr Aldo Naouri) Most of the time, the symptom of the child is no more no less than the symptom that allotted to have by the maternal unconscious mainly
Because children are in a relationship that is very very permeable in the communication with their mother
Gestation literally conditions a child and forms him.
And really gives him something entirely produced by the body, that comes from his mother's body.
This weakens the field.
It puts the child in a state where his resistance is altered by the conditions that come from his environment
*****
(10:22)(Prof Bernard Golse) For the baby, there is one half of his genes, of his chromosomes are from his mother the other half from his father
So, there is one part that is like the mother, this one does not pose any problem
but there is one part that is like the father and that immediately poses a problem
As soon as the baby is conceived, the motherly organism will immediately secrete a very strong wave of antibodies to expel the baby that is half stranger to the mother's body
It is a little sad to say, if I can say, the first thing that biologically, the mother cannot stand in her baby is the part that comes from the father
So what is anthropological in there is the double "no"
No, I do not recognise this baby; I want to eject him, and at once a no to the no.
Which we will find later in the language
There is a whole interesting question
and in language one will find such double negations.
This comes at the biology level.
(further interlude with family)
(I) Why don't severe autistics speak?
(Prof Daniel Widlocher) I don't know
My first idea is that they do not speak because they are not stimulated for speech.
Like children that are very little surrounded by a stream of language often have language difficulties even though they do not have autism
Consequently there is language stimulation, a parental stimulation of the environment that is very important
*****
(AS) We are not neurologically wired for language
Psychoanalysis does not belong here, if you want
We are not wired for language.
Of course it takes the capacity to speak but the essential thing is that precisely language is outside of the organism
*****
(GL) Why would they communicate, they are in fusion!
They communicate without words, there is no need to acquire speech
Speech implies access to the symbolic, access to the father.
I am not only with my mother
There exists a father who created me in the origin, who was the founder, with his paternal might, who has created a child.
Only progressively with the child discover this.
(I) In what does the father embody the symbolic?
(GL) Ha, this is difficult
He is access to abstraction, access to the distance
Access one has to speak when one is no longer glued
He comes to interpose between the mother and the child
*****
(Prof Bernard Golse) Speaking with the other means that one is no longer merged with the other.
As long as one is no longer separate, as long as one is combined in the other
which is the problem for autistic children, precisely for whom the other does not exist
but when the other starts emerging they are still in such a pathologic distance that they can't speak with the other
*****
(I) About autistic children it is said that their mother cannot catch their eye?
(GL)Yes, they are not at all in the relationship
they are staying in an egg
(I) They flee the mother because they are merged with the mother?
(GL) They have not taken off at all.
They have stayed in the egg, in the uterus
Why do you want them to look or speak?
*****
(14:22)(BG) You can not think of the other one, you can not speak with the other one unless you have some free range.
As long as you are still included, interpenetrated, merged with the other one, you can neither think to the other one, nor speak with him
this is almost a truism
If language touches us so much all our life long, and psychoanalysis goes through language it is that language is only about separation.
That is a vision.... very very well.... it is a vision of development that is extremely specific to the psychoanalytic vision of things
(interlude with family)
(I) The Psyche does not evolve independently of the brain. It does not wander alone in the void.
If we have one side a normal child with a well-functioning brain and on the other side an autistic child with a malfunctioning brain, doesn't it make a fundamental difference in its capacity to communicate with the outer world?
(Esthela Solano) This way of conceiving the causality of autism is very reductive.
What we can notice when we take care of autistic children is precisely that autistic children are sick of language
That autism is a way to defend themselves from language
 
 (interlude with family)
(voiceover) The Austrian-American psychoanalyst Bruno Bettelheim was the precursor of the psychoanalytic treatment of autism.
Bettelheim compared autistic children with concentration camp prisoners that were swinging back and forth, staggered by terror, waiting for an imminent death.
Reasoning by analogy, he was convinced that autistic children were the victims of torturer parents, freezing mothers who had desired the death of their child.
Bettelheim's work has been largely rejected in the USA since more than thirty years.
But how is it in France?
*****
(PD) Bruno Bettelheim is a victim of injustice of contemporary history.
I think that he did his work at a time when no one cared for autistic children, an absolutely exemplary pioneering work.
He got interested in autistic children because he was coming out of an artificial deficiency experience that he had gone through in concentration camps.
He arrived on the autistic planet thinking that finally here are children that maybe suffered from deficiencies in a manner similar to what I have lived myself.
I will try to treat them from this hypothesis, meaning by separating them from their parents.
*****
(GL) There was absolutely no tie.
Mothers who have them so fear them, even during pregnancy
And after, there is absolutely no tie.
And the child is abandoned and can even wonder how he has been conceived.
But the fact is that they were conceived.
He is totally empty, pregnancy is only organic, the child does not exist as a person.
He is totally in the relational emptiness.
And this gives what Bruno Bettelheim, yes, of course
*****
(Yann Bogopolsky) No no, Bruno Bettelheim has said much more than that.
This is the caricature.
I do not say this for you but for those who well
It is not only about mothers, it is also about the father's place in the mother's desire.
And it is about a certain amount of data, not only those with which the child is born, and the link that has been created, or the desires of death that such mother could have had for this new born child.
But all the mothers who have desires of death for their child, all these desires will not necessarily make their child psychotic!

 (interlude)
(voiceover) At the end of the 60s, psychoanalysis is starting to decline everywhere in the world.
But it takes a phenomenal success in France, with the impulsion of an ambitious and charismatic psychiatrist.
For Jacques Lacan, psychotic and autistic children are victims of the alienation by a psychogenic mother.
A woman who refuses to stop her pregnancy because she is unable to split from a child who is a substitute for a penis that she has not received when she was born.
*****
(YB) At the beginning, the child thinks that he is his mother's phallus.
Namely that he is this object that would give everything, fill his mother with joy, make her have orgasm.
*****
(I) Therefore autism is maternal fusion?
(GL) Wait, there are a lot of theories, right?
To me, I have either fusion or total abandon and emptiness.
It's one or the other. The two poles. It's not the same.
But when they are totally in emptiness
but what I deal with here at the practice, is rather fusion
For total abandons, I do not see them, they go to institutions.
(I) Bruno Bettelheim says that autistic children are victims of mothers that are too cold, and on the other side we have Jacques Lacan who theorizes psychosis and autism as maternal fusion, through some sort of a relationship that is almost incestuous between the mother and the child?
(GL)Yes, yes, absolutely
(I) So on the other side, we have a mother who is too warm?
(GL) Yes, too warm or too cold is not good.
It takes a mother, as Winnicott says, good enough.
Neither too good too warm, neither totally empty of course.
If there is nothing, no relationship, it will not give anything good.
(I) How can you explain that two attitudes, two totally opposed behaviours, could yield the same result?
(GL) There are different mechanisms; it is our job to put things back in the middle.
 *****
(voiceover) The English analyst paediatrician Donald Winnicott is the author of the concept of "good enough mother", according to which a mother who wants to do too well is toxic for her child.
He claims that motherhood would take mothers and infants through a transitional madness stage, prototype of forthcoming psychic disorders.
*****
(GL) (approaching with scary toy spider) Unconsciously, this is what you are doing to me, in your legs.
*****
(voiceover) With Winnicott, we have come full circle
Motherhood is psychogenic by nature.
*****
(I) Do you agree with the idea of maternal madness?
That every woman, every mother goes through the first months after delivery a stage of madness that can later be problematic for the infant if it lasts?
(AS) Yes, yes ,but this name maternal madness does not disturb me at all.
(I) You are a psychiatrist, madness is definitely something with a negative meaning isn't it?
(AS) Not for me
*****
(Laurent Danon-Boileau) There is this idea that is usually called the maternal madness of the first times
There is a moment when the mother is so glad to have her brat that she is the one with the brat and there is no way anyone could intervene
(I) Why call this madness, by the way?
(LD) Because of this idea of some sort of wholeness that gives some kind of powerful might.
There is this idea that, starting when you have done such a thing, you are almighty, nothing can reach you, etc etc.
*****
(GL) You know, madness, it's the first  month of life
But the thing is we have all been mad, or almost
(I) Why call this thing, this capacity for the mother to decrypt and understand her child's behaviour without language, why call this madness?
(GL) Because if we stopped there, the child would go into madness
Madness is precisely what you were asking about earlier about autism; they stopped there
*****
(LD) Maternal madness, is maternal madness a major roadblock to the emergence of language?
Said like that, of course, yes!
*****
(25:40)(AN) The mother is one the side of nature.
and from this standpoint, she is animal, if you want.
whereas the father was the one who founded culture
This is what made Claude Levi Strauss say this superb definition when he speaks about the couple.
He says that it is the dramatic union of nature and culture.
You see, when law supports culture, claiming that there is something fatherly, it means we are in the culture, return to nature shall not happen.
(interlude)
(voiceover) In the course of my interviews, several psychoanalysts had asserted that autism was the consequence of a maternal incest
*****
(AS) The maternal function consists of intervening in two ways
On the one hand saying no to the fusion between mother and the child
The father is the one forbids the mother
(I) He forbids sexually? Right?
(AS) Who forbids the pleasure of the mother
Namely, without ambiguity, who forbids that the child takes pleasure exclusively with his mother
as well as the mother takes pleasure exclusively with the child
*****
(Jacqueline Schaeffer) At the child's birth there is a honeymoon, right?
Sometimes, it is not so much of a honeymoon, it can be dramatic
But there is a honeymoon, there is a fusion, there is an extraordinary
Well, at the same time, there is a huge pleasure together
The baby very quickly, well, there is what we can say
There is not sex difference but there is a big erotic pleasure taken together
*****
(I) The fact that a mother takes care of her child like a human being, this is not sexual
(YB) Well, yes it is!
Sexuality, in a first place, is not in the sense that all take it, as genital sexuality
It is everything that, to Freud, because he is the one who theorized this, will be the body's parts that will give pleasure to the child
So the child and mother bodies are there in a tight unison and even the infant child does not know that he is not his mother's body.
He thinks they are one.
Well, he thinks - we attribute t his to him - he thinks he is one with his mother.
(29:36)So, it is a work of separating the bodies.
And the pleasure that the child will get in his relationship with the other, who is first his mother, will happen, one, in a clinch
And two, the pleasure will be related to the different orifices of the body.
*****
(LD) There are psychoanalysts who, a long time ago, have talked about something they called the lover's censorship.
This means something very simple.
It means that the mother is changing the infant and that all of a sudden; she takes too much pleasure by touching the infant
And she feels, oh la, this is strange
It is not logical; I am not treating him like
(I) An incestuous thing?
(LD) Something a little incestuous, what's going on?
Well, she will think of the man with whom she conceived him, in other words her lover.
And therefore, this will create a distance between herself and the infant.
This is what we call the lover censorship.
(I) She has to have a man on her mind for her not to be in an incestuous relationship with her child?
(LD) It's not "she has to" - one cannot avoid it!
*****
(JS) During maternal care, the mother can very well arouse the penis of a little boy.
I mean, maternal care, and the little boys do not avoid this!
We see many little boys who, when they get changed, when they get washed by the mother, the little penis reacts
*****
(YB) The father is there to forbid and at the same time protect the child.
That is, to protect the child from the incestuous desire of the mother.
(I) Do you think that all mothers have incestuous desires towards their child?
(YB) Oh yes, whether they are aware of it or not! Yes!
(I) Why are you so sure?
(YB) Well, first from psychoanalytic writings.
I mean, desire is not forbidden, its fulfilment is.
(I) But, that the love of a mother for her child is an incestuous desire, this is-
(YB) Well yes, because she already has some trouble to separate from her child.
There is a unity that gets done only if the father of the child, or the one in charge of this who is not necessarily the genitor, does not come and tell the mother that enjoyment has to happen between them.
Does not remind his desire to the mother, and the pleasure that she will be able to have through the desire that ties them together.
The mother will have pleasure by caressing her child
By having him on her body all day, what else, she will have pleasure
And, back to your previous question, this is how the body will present and that sexuality, insofar as it is related to body pleasure, and that is reused in language, is naturally present in the questions of psychoanalysts.
(I) Then, why are most of the incests perpetrated by men?
*****
(AN) First we have to notice that father-daughter incest is definitely more frequent than mother-son incest
And why are there not, or no more, mother-son incests?
For a very simple reason, which is that the motherly attitude to children, whether they are boys or girls, is spontaneously an attitude of incestuous essence.
Every mother's dream is that her child does not lack anything
The motherly tendency towards the child is an incestuous tendency
And there is no need to act. In her attitude, there is already enough, she does not act.
*****
(JS) Paternal incest does not cause so much damage. It makes the girls a little moronic.
But maternal incest creates psychosis. That is, madness.
There cannot be a maternal incest between a boy and his mother without an enormous mental disorder. It is not possible.
Precisely because of this barrier.
But the daughter with the father, she did not come out of the father, right she has not been in the father's belly
So there is something, you see. I'd say it is a secondary incest.
Whereas the primary incest, the real one, it is the mother
It is to penetrate the mother.
And boys who penetrate their mother are psychotic.
Whereas the daughter is not.
The girls can, we have many experiences with daughters with a paternal incest, they can manage somehow.
Now, I can't say that it works very very well
Some of them are very very bad, some a little less so
And there are those who manage by some other way
What I was saying, a little moronic.  But it is very different.
(interlude)
(voiceover) To psychoanalysts, the father is guilty too.
Guilty of being absent or transparent, guilty of being submissive to his wife.
Guilty of having been unable to intervene between the child and the maternal ogre.
*****
(GL) He failed.
Often, do you know how many times we see fathers who would have liked to?
and this is what we call forclusion
Forclusion of the father’s name
(I) What does it mean?
(GL) Good question!
It means that the father, in simple terms has made the child but that he (the father) does not exist.
It is denied, his existence is denied.
(I) Does the mother deny his existence?
(GL) Denies his function, his existence. There is only her and the child who count
The father does not exist.
Maybe he is there to bring some money in, he is here like an extra
He does not have the function of the husband, loved, considered in his speech
When the mother considers the father’s speech, the child discovers speech.
(I) If the child does not speak, it is because the mother discredits the father’s word?
(GL) Well, there are not so many here; it is mostly in institutions; in psychiatric clinics, where I had severe autists.
*****
(ES) Fundamentally, the father’s function is symbolic.
And sometimes the real father does not carry this symbolic function.
He can be adorable and nice, but nevertheless the child faces a symbolic deficiency on the side of the paternal function.
*****
(36:26)(GL) Either he does not have room or he only exists through violence, or he is violent himself.
We sometimes realise that he is violent to exist.
And that he pries doors open in a way, when no one opens them for him!
*****
(ES) When on speaks about the paternal function it is about something that drives you in your life.
It is like a highway, a compass.
(I) Why wouldn’t the mother, as a woman, provide the child this basis? Even on her own?
(ES) There are some mothers who can transmit a paternal function.
(I) But why isn’t it a maternal function? Why isn’t it a maternal symbolic? Why give it a gender?
(ES) The law of the mother is the law of whim.
*****
(AN) In 1984, a biologist established this extraordinary proof that placenta is from exclusive paternal origin.
So that it is under the control of genes brought by the spermatozoon.
In other words, the placenta is what prevents the mother from destroying her child, and a child from killing his mother.
(I) What enables the mother to feed her child?
(AN) Yes, that allows, that transfers and filters all the food the mother brings him.
In other words, it is a regulating element between them, this placenta it is an interposition.
I mean it feels like the father’s attitude within the decisions he takes, this patriarchy that he sets up, this male domination, etc., has always been the empirical search of the function that the placenta holds.
And that lets every child come into the world without being destroyed.
(interlude)
(voiceover) Since Bruno Bettelheim, the major psychoanalytic principle for the treatment of autistic children consists in separate children from their parents.
Parents are sometimes subject to pressure to undergo therapy because they are considered the source of the problem.
Today still in France and Belgium a number of psychiatric institutions are places that are not accessible to families, who are not informed of what goes on.
What does the psychoanalytic treatment of autistic children consist in?
*****
(ES) Let’s say that when we receive an autistic child we practice a psychoanalysis that is pure invention.
We are facing a subject who, most of the time, cannot speak.
*****
(LD) I am rather like in an observation attitude.
I mean, with an autistic child, I do very little.
What does very little mean?
That I sit my butt down close to him, and I wait for something to happen.
And I forget, I try to forget everything.
I forget time, I forget that we are pressed by time for him to acquire language, I forget everything.
Because I tell myself that, since I am in this kind of weightlessness, there could well happen something that I can not foresee.
*****
(41:20)(AS) You have authors like Tustin or Magaret Mahler who explain how it is first about winning over the child.
Here we are in a practice, but it is the same in an institution.
Winning over the child. I do not remember which of them describes this.
It is about stepping a little back, not in his line of sight.
Not speaking too loud, rather following what he says than anticipating it.
*****
(ES) No willingness of control, no educative willingness
No compelling of anything.
*****
(BG) We finally try by all means to make the autistic child feel that another one exists who is not threatening.
*****
(ES) It is precisely about taking into account the most insignificant details and figure out that this insignificant detail can be interpreted with some meaning.
And bit by bit we can proceed by supposing that there is a sign and we take it as something like the intent of a speech.
*****
(LD) Personally, if the kid does not do anything during the session, if I drowse beside him, I don’t care.
I am used to that in my work as a psychoanalyst.
But this implies a few things.
One, it implies not getting bored when we think with our own ideas.
Two, it implies rowing against this whole social thing that pushes you to be pressed by time it is all very nice, but if nevertheless if the child is still like that in ten years, it’s not on you to … etc.
All this is true; I stay in the position of a psychoanalyst, which means having no memory, no expectation.
And starting from then, something happens.
And that is an attitude, I believe, that is a deeply psychoanalytic attitude.
*****
(BG) When… Perhaps… Well..
I am sensitive to what you tell me that the audience should feel that we accept to fully endorse our convictions.
*****
(LD) If you sing a little song, and that the autistic child doesn’t feel bad with it there is something happening.
So you’re going to tell me, there is no need of a psychoanalyst for that.
Yes, if you are not using it as an educative method.
Yes, if you that that after all I don’t care about what the child will do with it.
It seems like he seems interested
We do that and we’ll see what happens then. Or we won’t see then.
The fundamental point in my attitude as a psychoanalyst with respect to these children it is to abdicate the idea of a progress.
And this is not easy, you can believe me.
My analytic ideal demands to abandon this dimension, but it turns out that I belong to a society in which I am paid to give care.
Consequently, I am in a conflict.
But this, a situation of conflict an analyst must be able to endure it or he takes another job!
Because this is the basis of our analytic practice.
*****
(I) What is the impact of psychoanalysis on autistic children?
What can an autistic child reasonably expect in terms of result?
(PD) But I can’t answer this, this is not a matter for a psychoanalyst!
*****
(I) What can an autistic child reasonably expect from an analytic work?
In terms of results?
(45:20)(LD) (very long pause) the pleasure of taking interest in a soap bubble.
I can’t answer anything else.
(interlude)
(voiceover) Nevertheless, there are solutions.
they are called PECS, TEACCH, and ABA.
These educative and behavioral methods have been set up in the USA over thirty years ago to enable people with autism to communicate, open up to the world.
Thanks to these tools that are appropriate to their handicap, young autistic children make, in a few months, significant progress.
Unfortunately, psychoanalysts fiercely stand in the way of their establishment in France.
*****
(AS) In the French speaking world the invasion of cognitive behavior techniques is a new invasion.
Recent, but very present today.
Psychoanalysis fights against this invasion
A number of colleagues, in particular Jacques Alain Miller have taken the lead of this struggle, this fight.
Others too in others organisations.
It is a very important fight to keep alive the dimension of subjectivity or the singularities of each subject with respect to the behavioral idea of managing by squares.
*****
(Eric Laurent) You know, it is for psychoanalysis to be this device of disenchantment.
there are hopes that come from biology, it could be marvellous to believe in them!
If one can believe that tomorrow, tomorrow we will have the solutions!
Well, psychoanalysis, as a speech that illuminates all beliefs tries to enable humanity to live without believing too big whims, it’s part of our effort.
So, the dialogue with neurosciences, is not only to inform ourselves of the results and let know that it does not alter our fundamental practice, the orientation of our practice, it is also about trying to make humanity live without having too big hopes in the various good news that are published every day that are intended to keep a rate of good news in an environment that has so little.
*****
(voiceover) In the 80’s, 100% of the French psychiatrists and psychologists were trained in psychoanalysis.
Since the 90s this trend is declining, but they are still near 80% today.
This situation, unique in the world, except Argentina, has tremendous consequences in the care of the handicapped.

(updated 24th January 2012)

16 comments:

  1. I have permission to reproduce this section of an email that I received in response to this post. The sender wishes to remain anonymous.

    I studied Psychology for 4 years in France and ALL that you transcribed was actually TAUGHT to us exactly the way you posted it on your BLOG. Quite shocking really!! We had one class that was basically ALL about autism. I was quite excited to take the course as I was doing an internship at an institution for very low functioning children diagnosed with autistic spectrum disorder. It was clear to me that autism could not be caused by the mother so I was keen to learn more. What I learned were all the theories of Bettelheim, Lacan and so forth - nothing about cognition!! During one lecture we were taught that it is possible "that one day the child decides to step out of his autistic bubble" - Thinking of the poor parents of children with autism that these stupidities are communicated to I was so upset by this statement that I left the class. Needless to say that I was quite unpopular with the teachers because apparently I contested the psychoanalytical view of autism too much. They taught I was drawn towards "the dark side" - cognitive psychology. This terrible course actually helped me to finalize my decision to leave my studies in France.

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    1. Certainly fewer psychiatrists use Freudian analysis these days. And none of them still try to convince mothers of autistic children of their “maternal rejection” (except in France, I understand.) Nevertheless many psychiatrists, and much of the public, still believe mental illness is caused by a damaged psyche – whatever that might be -- damage usually caused by a parent.

      Homosexuality was still considered a mental illness just a few years ago. How do psychiatrists determine which behaviors are pathological and which are mere deviations from average? Actually, they do it by ballot. The psychiatric profession publishes a list (presently numbering 374) of mental illnesses in a “Diagnostic and Statistical Manual of Mental Disorders”. Psychiatrists add to, and delete from this list every few years by popular vote. Not long ago a woman who considered herself the mental equal of men would have been viewed as an abnormal female. In fact, just a few hundred years ago, a man could have his wife committed to a mental institution for being too independent. (Feminism is still probably considered a mental illness in most Muslim countries.) Some of the listings in the current DSM Manuel include: antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder, avoidant personality disorder and dependent personality disorder. Psychiatry hasn't found cures for the more debilitating forms of mental illness. Most mental illness was once called dementia praecox. What was once regarded as manic depression might now be called schizophrenia. However there is no evidence that Ids, egos, or psyches even exist anywhere outside the imaginations of psychologists and psychiatrists.
      Berthajane Vandegrift
      A Few Autistic Questions about Freud, Marx and Darwin
      http://30145.myauthorsite.com/

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  2. What happened to the spirit of Enlightenment in French psychiatry?

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  3. More enlightened: Fernand Deligny and his circle. He lived with severely autistic children/ adults in the Cevennes mountains, broke with those French attitudes towards autism, as well as with the institutions. Unfortunately not much of Deligny or his collegue Jacques Lin has been translated into English, I am afraid. Very interesting, though, if you can read French.

    Also highly recommendable: the documentary "Her name is Sabine" by Sandrine Bonnaire, about the difficulties of finding a good home for her sister in France.

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  4. Thanks for this post! I have also studied in France, for a year, and saw a large gap between the clinical psychologists (who taught me that babies hate their mother and want to destroy them) and the social & neuro psychologists who were more experiments oriented.

    Once, during a clinical psychology lecture on assessing child drawings, a fellow student asked the professor a question that was on my mind as well: How do you know that a river represents emotions (and that black rivers are a bad, very bad sign, while white rivers are a good sign...) and that a house represents identity?

    I hoped that the prof would tell us about how they had interviewed children about what they meant by certain elements of their drawings, what they were thinking of during drawing, or at least some sort of research.

    The prof answered the following: If you don't believe it, you shouldn't go to the movies, you shouldn't read poetry, and you definitely shouldn't study clinical psychology. That year did make me reflect on what I thought Psychology was... Apparently my paradigm wasn't a universal one.

    One of the things that struck me during the year, was that clinical psychology students and researchers/lecturers almost only read French literature. Textbooks were all either by French authors or translated into French. It precluded exchange with Anglo-Saxon & other paradigms and I think that's one of the main reasons why there is an entire different perspective on clinical psych. It has developed on its own. This was back in 2003 though, I have the impression that it's changing. Would be good to have more interaction between the different language domains.

    One last note: During that same year in France, I had the best biological psychology lectures of my entire study.

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  5. Nicolas Caresmel27 January 2012 at 23:22

    Hi, from France. A trial is currently taking place around this film. Three analysts believe that their words have been changed by editing the documentary. The verdict in their favor.

    https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B7s8QJ-76JxVYTkyNTkzODUtMGQxMy00ZTM4LWJmZGEtZDY0MzUyOTQyOGU4&hl=fr&pli=1

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  6. I am a British mother, living in Paris, of a child on the autism spectrum. I can confirm that the English translation is a faithful representation of what is said in the film - and also that the film is a faithful representation of the attitudes of "specialists" (for want of a better term) in France. I even enrolled in an on-line course to study autism at an English University (Birmingham) since the information available in this country is - at best - outdated and highly inaccurate.

    Unfortunately, aside from those directly involved in ASDs few are aware of this documentary or the furore surrounding it - it is a well documented fact that the influence of the Freudian thinkers extends beyond psychiatry into the media, politics and education.

    It will be interesting to find out whether Sophie Robert wins her appeal against the ban of her film.

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    1. I have worked professionally as a teacher with ASD for the past 9 years. I deal with a full mutlidisciplinary team including psychiatrists and psychologists. Autism is a neurobiological disorder impacting upon development and is clearly nothing to do with Freudian quackery.
      France should stand up and apologise for this barbaric treatment of vulnerable children, rather than banning the documentary.
      Disgusted!

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  7. For those who have participated in this debate and feel strongly about it, I would like to direct your attention to 'Live Company' by Anne Alvarez (1992; Tavistock/Routledge), which describes, amongst other things, psychoanalytic therapy with an autistic child. Perhaps a more subtle treatment of the issue? Perhaps an equally misguided underlying thesis? Not for me to say, but I thought it belonged in this debate. At the very least, it will temper the view that the problem is 'with the French.' (Hi Doroty!).

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  8. Many thanks for all comments, and hello Marc - nice to hear from you. It's good to be reminded that it isn't just a French phenomenon, but there's no doubt that psychoanalysis holds sway in France to the exclusion of almost everything else. This is quite different from the UK, where a range of options is available, with an emphasis on those that have some kind of evidence base. And my French colleagues tell me that psychoanalysis pervades many aspects of French intellectual and political life, almost like some kind of cult.

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  9. Quote: "psychoanalysis pervades many aspects of French intellectual and political life, almost like some kind of cult.'

    This is very true. Politicians seem unable or unwilling to address the issue, and this despite being condemned THREE(!!) times by the European Council for discrimination against people with autism. It is frustrating to say the least for parents and other family members, as you may imagine.

    There was an article by AFP on this subject doing the rounds a few days ago - did you see it? It also mentions packing, a 'treatment' used on children on the spectrum which could possibly qualify as torture.

    http://www.guardian.co.uk/world/feedarticle/10247902

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  10. Hi, the link in each comment to reply does not work.

    To Eva. The professor may have explained better but probably he meant the black river was a metaphor, like writers use in poems, so if you don´t like/understand metaphors you should not read.

    Clinical psychology can´t use the same methods as experimental. I wold think that if honest psychologists observe in clinical practice such type of graphic production is frequent in patients with certain problems they assume when they see a drawing like those the person cold have same problems observed before.

    This is not to say there are universal simbols. The discussion is old in psychoanalysis: Jung, Freud, Lacan

    BTW, I am argentine and know about psychoanalysis here. I will comment more as I read.

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  11. In the translation I don´t see a distinction between Other/other

    Please read this to have an idea:
    https://en.wikipedia.org/wiki/Jacques_Lacan#Other.2Fother

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  12. I saw a video on packing and it seems based on a reflex that cold causes and the child calms. I am not a physician so I can´t affirm the veracity of this.

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  13. The feed for comments in this post does not work.

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  14. How might Freudian psychoanalysis enable someone to understand other people’s thoughts and emotions. We all make personal evaluations of people we meet. Unlike psychiatrists, most of us, quite aware of the fallibility of our judgments, tend to keep our opinions to ourselves. But what makes such an evaluation by a psychologist or psychiatrist more “scientific” than the opinion of a layman? I am vaguely aware of many of the details that allow a chemist to understand chemistry. I've seen the formulas that allow a physicist to claim authority in physics. I'm aware of the type of information that might allow an anthropologist to claim specialty in that field. But what specialized information renders a psychologist an authority on other people's thinking? I know they conduct experiments to determine which thoughts and reactions are average. But what enables a therapist to understand individuals? What, other than arrogance would enable a psychologist to claim to be an authority on love. The phrase “maternal rejection” means exactly what it appears to mean; psychologists claimed the ability to determine that children become autistic due to a lack of love. Certainly all those psychology books I read never gave me the ability to measure how much love someone might feel. Nor did those books give me much insight into how people think - much less make me an authority on how people are supposed to think. Let us never forget that during all the years that psychiatrists believed mental illness was caused by bad parenting, when they interrogated the parents they saw pathology. Whenever they looked for pathology in a patient, they found it.

    Berthajane Vandegrift

    A Few Autistic Questions about Freud, Marx and Darwin

    http://30145.myauthorsite.com/



    Berthajane Vandegrift
    bertvan@aol.com

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