Autism in France
The treatment of autism in France is a source of much tension, particularly on the question of intervention, which pits supporters of a behavioral approach, represented by parents associations and certain cognitivist scientists, against those who use a psychoanalytical frame of reference, and the movement for the rights of autistic people.
Specifically French practices, such as the frequent use of the word "autistic" as an insult and the overmedication with neuroleptics, are a source of exclusion and suffering for the people concerned, who are affected by numerous social difficulties such as dropping out of school and unemployment.
According to the sociologist Lise Demailly, autism in France represents a social space where passionate debates and symbolic violence are the first things to be observed, with "ideological, epistemological, ethical, economic and practical conflicts" leading to court cases on an international scale.
[3] The cognitive psychiatrist Laurent Mottron notes (2016) that "on the whole, autistic people show a very poor adaptation to our society, but that a minority, perhaps a tenth of them, are perfectly verbal, relatively autonomous and fulfilled in adulthood.
[7] For the psychiatrist and neurologist Gilbert Lelord, practitioners who claimed that "it's all in the mind" had a powerful argument because "this echo of a superior race", linked to Nazi eugenics, explained the difficulty of accepting the genetic approach.
[50] According to sociologist Florence Vallade, the progressive involvement of French associations of parents of autistic children in favor of behavioral methods followed a classic path in three stages: realizing, reproaching and claiming.
[55] The deinstitutionalization policy, inspired by that of the United States, arouses opposition from health professionals, who see their conception of autism called into question, and fear that free interventions will no longer be guaranteed for the most vulnerable families.
[71] According to Jacques Hochmann, it was above all a television program by Daniel Karlin, in 1974, and the conferences and seminars that Bettelheim gave in France that year, which disseminated his vision of autism (theory of the mother refrigerator ) among health professionals and the general public.
[85][55] The circular is not applicable, due to lack of budget: Moïse Assouline, doctor-director of the service of the Santos-Dumont day hospital, in Paris, declared in the weekly L'Express that "the budgetary restrictions decided by Alain Juppé, at the end of 1995, passed like a bulldozer on autism, despite having been made a public health priority a few months earlier".
[55] Lawyer Évelyne Friedel, president of Autism France at the time, referred the matter to the Court of Justice of the European Union on the issue of the lack of access to education for autistic children.
[106] The CCNE's opinion on psychoanalysis was criticized[112] by the psychoanalyst Boris Chaffel and the child psychiatrist Anne-Sylvie Pelloux, who considered the history of conceptual theories described as "reductive and truncated", and that it amounted to no more than a caricature of The Empty Fortress, which had had terrible consequences on the families of autistic children.
[118] In March, the High Authority for Health recommended certain educational, behavioral and developmental approaches following an evaluation: the ABA method, the Early Start Denver Model and the TEACCH program, affirming that "their effectiveness on the intelligence quotient, skills communication and language has been demonstrated in the medium term compared to eclectic practices, with an improvement for approximately 50% of children".
For child psychiatrist and psychotherapist Anne-Sylvie Pelloux, the profiles of autistic children are extremely varied and the report reveals that "their evolving capacities also come in multiple variants which do not depend solely on their treatment methods", elements rarely highlighted in the media.
[170] A comparison with figures from British studies indicates a suicide rate nine times higher than that of the general population, double in women compared to men, and excess mortality due to epilepsy.
[173] Cases of extreme marginality are probably numerous, with autistic people supposedly autonomous being the most exposed to loss of home, particularly among men who have never been placed in a specialized institution, at the time of the death of their parents.
[187] Professor of language sciences Julien Longhi analyzes it as a short circuit of "the semantic richness of the word "autistic", to polarize it towards a negative meaning", as well as "the sign of an internalized verbal slippage from clichés".
[230] Henri Rey-Flaud wrote L'enfant qui s'est arrêté au seuil du langage,[231] a synthesis of "the history and genesis of the different approaches to autism" from a psychoanalytic perspective.
According to Brigitte Chamak, "by favoring the adoption of broader diagnostic criteria, [they] rejected psychoanalytic interpretations, and contributed to redefining autism as a disability of genetic origin involving atypical development of the brain [...] .]
[264] In November 2016, Dernières Nouvelles du cosmos by Julie Bertuccelli was released, featuring the non-verbal autistic poet Babouillec, who writes texts mixing philosophy and metaphysics.
[265] The romantic comedy Le Goût des merveilles, directed by Éric Besnard and released in 2015, features an autistic man who is both hypersensitive, close to nature, a genius in mathematics and computing, honest and disinterested in money.
[266] The director received advice from psychologists, and lead actor Benjamin Lavernhe was inspired by the autobiographies of Daniel Tammet, Josef Schovanec and Temple Grandin, to play his character with Asperger syndrome.
What chemical straitjacket is the scandal?Julie Dachez, a social science researcher known in particular for her videos on YouTube, has written a comic strip about her daily life as a woman with Asperger, La Différence invisible.
[85] In contrast to previously expressed opinions, television host Églantine Éméyé defends the practice of packing, which she states to have been beneficial to her son Samy in her autobiography The Toothbrush Thief (2015),[282] and during a report on France 5.
[289] Likewise, "the evolution of conceptions of the genetic determinants of autism in the specialized press intended for French social workers" is "not very representative of the emulation generated by this question in international biomedical literature".
[85] According to a government report by Christel Prado (2012), the question of interventions is the subject of numerous "chapel quarrels" between the proponents of all psychoanalysis and those of all education, of which autistic people and their families are prisoners for many years.
In her summary, CNRS emeritus research director Scania De Schonen recalls that CBT has been scientifically evaluated as effective in reducing (among other things) anxiety and anger specific to people with autism, which explains the HAS recommendation in their favor.
[318] Laurent Mottron is more critical, emphasizing that "in the French-speaking world, the legitimate desire to get rid of the psychoanalytic burden for autism, still largely dominant in France", has led to an uncritical promotion of behavioral therapies, and a bias in their favor in the HAS report.
[320] The psychoanalyst Hervé Bentata denounces "behavioralists who seek a hegemonic position to the exclusion of all other treatments, fighting against a largely imaginary adversary – "psychoanalysis" – and relying on studies of statistical results which we are beginning to perceive scientific limits and biases".
[323] In 2007, around 3,500 French autistic children were hosted in medical and educational institutes in Belgium, in Wallonia,[324] a consequence, according to Chamak, of an "undeniable lack of places" for the "most severely affected patients".
They emphasize the administration of high doses of medication to keep staff calm, and cite cases of autistic people being forcibly strapped to beds, or confined in 10m2 cells, or forced to defecate beneath them.
