Thursday, February 8, 2018

Autism and Psychoanalysis in France

Some of you know that I have an interest in the comings and goings of French psychoanalysis. I know the world. I belonged to it for decades. I left it years ago, but I still like to see what its practitioners are up to.

I have also, on this blog and in my most recent book, followed the story of the struggle over the treatment of autism in France. On the one side, filmmaker Sophie Robert, whose film, The Wall, was shut down for two years by a lawsuit brought by three psychoanalysts. And also, we have lawyer Sophie Janois, who is one of the very few attorneys defending autistic children when the government, prodded by psychoanalytic experts, forcibly removes autistic children from their homes and places them in institutions where they do not receive any treatment. Full disclosure, both Robert and Janois are friends of mine.

Today, we have comprehensive story about autism in France, published in the Guardian, which, need I say, is not a right wing publication. If psychoanalysis is too radical for the Guardian, that tells us something, n'est-ce pas?

It begins with the story of Rachel’s son:

A reliance on psychoanalysis sees autistic children going undiagnosed, being placed in psychiatric units and even being removed from their parents.

Like thousands of French children whose parents believe they have autism, Rachel’s six-year-old son had been placed by the state in a psychiatric hospital day unit. The team there, of the school of post-Freudian psychoanalysis, did not give a clear-cut diagnosis.

Rachel, who lived in a small village outside the alpine city of Grenoble, said she would go elsewhere to assess all three of her children. But the hospital called social services, who threatened to take the children away from her.

A consultant psychiatrist said Rachel was fabricating her children’s symptoms for attention, that they were not autistic, and that she wanted them to have autism spectrum disorder in order to make herself look more interesting.

Rachel’s children were taken and placed in care homes.

The children were subsequently diagnosed with autism and other issues, proving Rachel right. But despite a high-profile court battle in which parents’ groups denounced the “prehistoric vision of autism in France”, Rachel, who herself has Asperger syndrome, has still not won back custody of her children two years later. They remain in care with limited visiting rights. Local authorities insist the decision was correct.

Apparently, the government of President Emmanuel Macron has expressed its intention to remedy the situation… the better to erase a blot on France’s reputation as a civilized country:

The crisis is so acute that the centrist French president Emmanuel Macron has deemed it an urgent “civilisational challenge”, promising a new autism action plan to be announced within weeks.

The United Nations has offered an opinion about the problem:

The United Nations stated in its most recent report that autistic children in France “continue to be subjected to widespread violations of their rights”. The French state has been forced to pay hundreds of thousands of euros in damages to families for inadequate care of autistic children in recent years.

The UN found that the majority of children with autism do not have access to mainstream education and many “are still offered inefficient psychoanalytical therapies, overmedication and placement in psychiatric hospitals and institutions”. Parents who oppose the institutionalisation of their children “are intimidated and threatened and, in some cases, lose custody of their children”.

Autism associations in France complain that autistic adults are shut away in hospitals, children face a lack of diagnosis and there is a persistence with a post-Freudian psychoanalytic approach that focuses not on education but on the autistic child’s unconscious feelings towards the mother.

In England, the Guardian reports, 70% of autistic children are in school. In France the number is closer to 20%.

Lawyer Sophie Janois explains the problem:

“Underlying this is a cultural problem in France,” Janois says. “France is the last bastion of psychoanalysis. In neighbouring countries, methods in education and behavioural therapies are the norm and psychoanalysis was abandoned a long time ago. In France, pyschoanalysis continues to be applied to autistic children and taught in universities.”

She said parents were forced to fight a constant administrative battle for their children’s rights. “There are suicides of parents of autistic children … at least five in the last couple of years.”.

Take the case of 20 year old Adrien Chavy, one of the few people who have escaped from the psychoanalytic approach:

Catherine Chavy’s son Adrien is 20 years old. As a small child he was treated part-time at a state psychiatric hospital that used a psychoanalytical approach. His autism went undiagnosed for years. Chavy fought for a diagnosis and entry to primary school, later finding a centre that used educational and behavioural methods, where Adrien flourished. When he reached 15, there were no provisions at all. She privately organised permanent support for him at home. “He cooks, does sport, goes to his grandma’s for lunch. He has a lovely life, going out every day. If I hadn’t have done this on my own, I think he would be in an adult psychiatric hospital, tied up, on medication,” she said. “The situation in France is a health and education scandal.”

Unfortunately, such opportunities are rare, and are mostly reserved for those who can afford them.

As Janois points out, France is one of the very few places where psychoanalysis is still respected as a treatment. French autistic children are paying the price.


James said...

Once you say "France", there's not really anything to add.

Anonymous said...

We've problems in American with Asperger syndrome, AKA high functioning Autism. A country of ~1.4M citizens & over 200,000 K12 kids has nothing to offer them but EBD (Emotional Behavior Disorder) classes which are composed of nearly all bad, rough & hard to handle boys. There is such a young girl there with very high IQ, but very hard to control. By 2nd grade they transferred her to another school offering EBD classes which had a "safe room" where they lock the kids alone sometime. She was in this class, locked in isolation from time-to-time, and the class was, but for her, ONLY boys, rough boys with medium to low IQ's. The boys frequently taunted her & hit her & the education level was far below her level. By 3rd the state outlawed "safe rooms" & her behavior caused such trouble the County DoE decided to xfer her to a central, end-of-the line EBD school composed only of the worst of the worst kids in the county. Nearly all boys, many over aged very rough boys & not too bright. Her parents pulled her out of public school & found a private one equipped to handle her & she is doing well there, but the school is primarily behavior training & the academics are subpar for normal kids & far below the childs ability. The parents now plan to augment her education at home. At 3, she started reading on her own with no prior coaching or attempts to teach her & appeared to do some small number (<10) addition & subtraction in her head.

Shaun F said...

I find autism quite perplexing.

I can understand how it might be genetic - an alcoholic mother whose binge drinking can give birth to a schizophrenic child. Similar to a mother who smokes crack or takes uppers - read prescriptions.

I also understand that the world can be a window and a mirror to our soul and exposure to certain circumstances can created abnormal behaviour. With the more restrictions we have on children(no gym, no competition, etc.), would that contribute to behavioural problems?

Do families that divorce have higher rates of autism than families that don't?

Do children that are placed in day care develop autism at a higher rate than those that don't?

I'm generally more curious about metrics that aren't said. It's always the absence of information that makes me wonder if something isn't being overlooked (deliberately).

Stuart Schneiderman said...

Autism is generally considered to be a neurological condition, one that is not cause by psychological factors.

Shaun F said...

Thank you. During child birth and at pregnancy I presume(speculate) biological conditions of the mother can influence her neurological conditions (or vice versa?). Which could pass on genetically the neurological conditions to the child.

Unknown said...
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Ares Olympus said...

It certainly seems weird that autism should be treated at all with psychoanalysis. I'm not sure I even want to see that case argued since it could only be argued by someone looking to keep a racket going. I'm sure people with Autism need extra attention by adults, but not clearly attention by professionals who are paid in the dollars per minute level of compensation, although I'm sure many parents of autistic children might take a tiny fraction of that to care for their own children.