Esther12
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Currently open access, but not sure how long this will be the case: http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)70290-1/fulltext
Despite the Ministry of Health's revised treatment plan, France recently faced criticism by the Council of Europe for its discrimination against those with autism. Some rights groups are calling the state of autism treatment in France a “scandal” and claim the government's plan doesn't go far enough. Others say the continued use of psychoanalysis to treat autism is keeping France from advancing.
Elodie Nourrisson, from the suburbs of Paris, first got answers about her son Thomas's behaviour when he was 26 months old. Since birth, he did not move or cry much, had difficulties walking, and was not troubled when separated from his parents. Lately, he had become hyperactive and was not sleeping more than 2 h per night. A doctor from one of the French public sector's Medico-psycho-pedagogical centres (CMPP) said that Thomas simply had developmental delays. “At the beginning, we felt reassured”, says Nourrisson. “[The doctor said] there was a significant overall retardation but that they could help him.”
Waiting lists, ineffective treatments, and frustration ensued for Nourrisson. It was not until she went to a private specialist, when Thomas was nearly 3 years old, that she finally heard the word “autism” in reference to her son.
Since the beginning, Nourrisson says she has been left by the public health system to “manage things on her own”. M'Hammed Sajidi, the president of the autism rights organisation Conquer Autism, says this scenario is all too familiar for families of the estimated one in 68 children with autism in France. “It's an absolute outrage”, says Sajidi, whose own son has autism. “France is the most delayed country in Europe when it comes to autism treatment.” According to Sajidi, medical professionals and teachers do not receive enough specialised training to treat autism, the government funds ineffective treatment methods—such as psychoanalysis—and families are often left to their own devices to treat their children.
Hope the quacks are held accountable, but pretty sure they won't be.Bonnet-Brilhault says each programme must be individually tailored to the child, and thus does not favour one method over another. The centre incorporates methods such as TEACH—a therapeutic tool that helps people with autism understand and navigate their surroundings—and applied behaviour analysis (ABA), which applies behavioural principles to everyday situations to increase or decrease some behaviours. She is not entirely opposed to the use of psychoanalysis to help families if it is part of an integrated plan, but not in the way it has been used in the past. “Blaming the mother for autism? That's finished”, says Bonnet-Brilhault. “We can no longer continue with this idea. Making the mother responsible is ignoring all the medical knowledge we have now. Parents need to be informed and accompanied, not put at the root of autism.”
As part of the HAS's 2012 autism recommendations, psychoanalysis is not recommended as an exclusive treatment method for people with autism. “We established that we don't have enough data on its effectiveness. And since there's a divergence between families and professionals—and among professionals themselves—no conclusion could have been drawn.” says HAS project leader Joelle André-Vert.
Still, psychoanalysis that is performed by a psychiatrist within the public sector is included in the national health coverage. And despite calls from the HAS and the health ministry to favour new methods like TEACH or ABA, it has been slow to take.
Nourrisson was told to begin psychoanalysis when her son Thomas was first diagnosed with developmental delays. Thomas was put on a waiting list at the CMPP while Nourrisson was told to meet with a child psychiatrist for psychoanalytic sessions. “The psychiatrist would ask me questions about my relationship with my mother and about my pregnancy”, says Nourrisson. “I was shamed in several sessions by the psychoanalyst…I would walk out in tears, while Thomas was left unattended and causing a ruckus.”
One Paris-based psychiatrist has been outspoken in his support for psychoanalysis to treat the early stages of autism. Charles Melman is the co-founder of the Association Lacanienne Internationale, which follows the principles of Freud and Lacan. He says, “it's not a question of blaming mothers, but allowing them to live their parenthood in a better way”. Melman says there is “no proof” that autism has genetic origins but instead results from a mother's emotional state or behaviour during pregnancy or in early parenthood. “[Autism] stems from a mother's incapacity to take her child's birth as a joyous occasion”, says Melman. He recently treated one woman whose son was diagnosed with autism at 6 months, using psychoanalysis with the mother and psychotherapy sessions for the child. He says that the child, now 18 months, no longer needs therapy.
Melman says that early detection is key, and that if children with autism receive therapeutic treatment between 3 months and 2·5 years, they can recover completely and return to “normal”. Detection of autism in France is happening too late, says Melman, whose organisation lodged an appeal against the government's Third Autism Plan.
Melman and fellow psychoanalysts—who traditionally wield great power in France when it comes to the treatment of mental illness—have been met with heated criticism in the face of the autism debate. But although opinions differ on the use of psychoanalysis, early detection and diagnosis is deemed essential by both sides. Child psychiatrist Deborah Cohen, who specialises in the treatment of children with autism, says giving a diagnosis is essential. “It allows for the child to receive the appropriate treatment and if it's an early diagnosis, it allows for a better understanding of the person and his specific needs”.
