NLS-Messager: "Lacanian psychoanalysis and Autism: 'Our Convictions'"

Messager 354 - 2011/2012

Lacanian psychoanalysis and autism: 'our convictions'17 février 201217 February 2012Lacanian psychoanalysis and autism: 'our convictions'We are publishing here a text of orientation and of taking a position on psychoanalysis and autism. This text was written by our colleagues in charge of the Psychoanalytic Institute of the Child, created under the aegis of the Popular University Jacques Lacan. It affirms in a clear and precise manner the 'principles that govern our action' and thus offers secure reference points for all those who subscribe to the Lacanian orientation, and have to answer for their analytic practice with autists in the different regions of the NLS.I wish for this text and others we will circulate, to constitute a common basis of work and reflection in the NLSAnne Lysy,NLS PresidentThe Psychoanalytic Institute of the Child - Popular University Jacques LacanAUTISM AND PSYCHOANALYSISOur convictionsThe Psychoanalytic Institute of the Child has noted in these recent months a strange campaign aimed at excluding psychoanalysis from the care of autistic children and adolescents. This campaign has culminated in a proposal for a new bill, to which all professional representatives (1) and also the largest family associations (UNAPEI) have reacted.The campaign is the result of intense lobbying, allegedly with laudable intentions: to improve the livingconditions of one group of the population. In fact, for its promoters it isabout obtaining massive government subsidies to the sole benefit of methods of conditioning, offering ready-madesolutions to families who are looking anxiously for solutions where there is a real shortage of institutional care.The Psychoanalytic Institute of the Child unites psychoanalysts, and other participants of specialised institutions such as psychiatrists, psychologists, nurses, speech therapists, psychomotor therapists – as well as other professionals in the field of children, such as teachers, educators, lawyers, doctors… - all working for many years with children in distress, oriented by psychoanalysis, Freudian and Lacanian, and by the most recent advances in clinical research.It is for this reason that the Psychoanalytic Institute of the Child, through its Initiatives Commission, wants to take position. We affirm here the principles that govern our actions.1 – Let us remember that in France, since the 60s and 70s, it was child psychiatrists and psychoanalytically trained psychologists who started to be interested in the kind of autistic children that had previously been placed in psychiatric hospitals or closed institutions, where the dimension of deficit was predominant. They leant on the Anglo-Saxon psychoanalysts like Frances Tustin, Margaret Mahler or Donald Meltzer, and on the Institution of Maud Mannoni "The Experimental School of Bonneuil", with the work of Rosine and Robert Lefort, students of J. Lacan.All this work gives practitioners – psychiatrists, psychologists, nurses, educators, speech therapists, psychomotor therapists - the idea of a possible treatment and of a way of learning that takes into account the symptom of the subject, beyond any form of coercion. The Day hospitals, in the movement of sectoring in psychiatry, are created in this perspective.It is about offering a reception that is not based on deficit but takes into account the particularity of each subject. The family situation is part of this particularity, because the family constellations are far from identical. The parents are received and listened to. The children and adolescents are received into small groups, invited toparticipate in "workshops" where their interests can be discovered. During meals, games, and study, they can experiment new relationships with objects and demands, with what is structuring the world of all children, but against which autistic children defend themselves.2 – This long experience of diagnosis, support of families, establishing a path that is specially woven for each person, has been the subject of many publications and collections of work. It could not be sustained without the daily reference to psychoanalysis, to its textual corpus, and vibrant teaching. How to situate today's place ofpsychoanalysis in the treatment of the autistic child?We propose 5 axes of a response:- The analytical training, that is to say the experience of a personal psychoanalysis, gives to the people involved a powerful tool to situate their actions towards autistic subjects, from a good distance, keeping a distance from ideals of normalisation, or a normality incompatible with the professional accompaniment of suffering subjects.- This respect for the position of the subject is indeed the compass that guides this action. It is by no means about letting the child or adolescent be the object of his own stereotypies, repetitions, echolalia, for example, but to consider them as a first treatment elaborated by the child to defend himself, and to introduce, through a discrete presence, new elements that will make "the autistic world" be more complex.- The challenge is first of all how for the child, anxiety could be localised, or the perplexity that the interpellation of an other triggers in him and to put into play the bodily functions in connection with this demand – to eat and be fed, losing urinary and anal objects, to watch and be watched, to hear and be heard. Psychoanalysts have for a long time noted the dimension of rituals of interposition that constitute many invalidating symptomatic traits. The creation or the child's discovery of an "autistic object", of whatever form, is often a fruitful resource to create new links and spaces, more freed of the"autistic" constraints.- Psychoanalysts do not contest in any way the inclusion of autistic children in learning systems. They value on the contrary that the autistic subject is often already "at work". The so called "high level" autistics attest to a massive investment of thought, of language, and the cognitive domain, where they find original resources. More generally, for all children, practitioners seek to focus on educational and pedagogical approaches that can adapt and make room for the social and cognitive singularities of autistic children. Teachers and educators within the Psychoanalytical Institute of the Child, bear witness to what they have developed with the child or the adolescent.– By contrast, psychoanalysts rise up against methods of so-called "intensive learning" with the utmost force, which are actually methods of behavioural conditioning, which use massive lobbying and even intimidation, to promote totalitarian and totalising "support", proclaiming themselves as the only valid treatment for autism. Far from this reduction, we must differentiate the different approaches of learning. Psychoanalysts and other participants, regrouped within the Psychoanalytic Institute of the Child, representing all categories of professional groups present in the field of childhood, concerning autistic children and adolescents, declare to be especially attached to the systems of care existing in France, in so far as they allow for the separation of the respective responsibilities and differences between the professionals of care, of education, and the parents.3 – The current classifications of mental disorders - especially the DSM – throw a lot of confusion into the debate, by making appear at the same level of diagnosis, childhood symptomssuch as stuttering or enuresis, the "disorders" that refer to a social normality (such as "oppositional defiance disorder" or "conduct disorder"), and autism ("autistic disorder"). Autism and its various forms, is thus isolated as the only true clinical picture of the category of "Pervasive developmental disorders" (PDD). The on-going debate on the continuity of "the autism spectrum", on the advisability of maintaining in the same series of PDD's the so called "Asperger's syndrome", shows how much this category is unstable. Within this "spectrum" we must examine in detail the phenomena of invasion of the body and locate thestrange and disturbing events it is prey to. Many psychoanalysts and practitioners of the Lacanian orientation accompany so many children and adolescents in this elaboration, which allows them to keep or find a place in social and family links. The parents can then allow themselves to talk about certain traits of their child, to understand their value, despite their strangeness. This is necessarily long work, as it supposes that we involve the difference of the child, which goes against expectations and desires that surround his presence in the world. The psychoanalyst, in the place of gathering this suffering, must be attentive to the suffering of the parents and support them in their ordeal.4 - Multiple etiologic hypotheses – genetic, immunisation, neurocognitive, etc. – presented as scientific truths often as a result of one single article in one journal, of which one learns a few months or years later the one-sided character, circulate in various media and alarm families. These causal hypotheses strictly refer to the reduction of autism to a developmental disorder, presented as a geneticdisease or even an epidemic. They are reinforced by the 2005 law on disability, which only featured a sentence of the type: "this is a disability, so it is not a disease", to allow an orientation adapted for the child and a help for the family. Much on this point remains to be done, and parents' associations are an indispensable force and essential to advance suitable projects, especially for very young children and for the older teenagers and young adults. In this sense, the announcement of autism as a great national cause can only rejoice those who are mobilised in the care of autistic children and adolescents.5 – The psychoanalysts follow all scientific debates on the causes of infantileautism. Whatever the causes may be, they cannot reduce the subject to a mechanical object. Psychoanalysts take into account the suffering they encounter and they promote the institutions and practices that ensure that the child and his family will be respected in the subjective moment they are in. They facilitate, wherever possible, the inclusion of the child into social links that do notharm them. They are not holders of a "psychological" truth about autism, they are not proponents of a special "educational method". They convey a clear message to the individual with autism, to the parents, and anyone who, in an institution or at a special home, take sides and take the challenge to accompany them – the psychoanalysts belong to those: it is possible to build a different world from the world of defence and protection that the autistic child is enclosed in. It is possible to build a new alliance between the subject and his body. Everyone's effort aims at clinically demonstrating that possibility.The initiatives Commission of the Psychoanalytic Institute of the ChildMrs Judith Miller (Paris) - Dr. Jean-Robert Rabanel (Clermont-Ferrand)Dr. Daniel Roy (Bordeaux) - Dr. Alexandre Stevens (Brussels)1 - The collective of 39: http://www.oedipe.org/fr/actualites/autisme39Union of Psychiatric Hospitals: http://www.sphweb.info/spip.php?article937Translated by Francine Danniau

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