Partager l'article ! How French psychoanalysts describe autism: Since the film called " The wall-psychoanalysis put to the test for ...
Autism : excessive withdrawal within
oneself, being locked inside a relational shell
of which the main effect is to protect the autistic person from external contacts. The autistic subject will therefore put the
emphasis on an intense inner life, refusing the harrowing experience of the world around
This pathology of relationship, heavy and extremely debilitating, is addressed in psychiatric care by relational therapies of corporeal and psychoanalytic types: corporeal for the contact, exchange and support they can bring to the patient, and psychoanalytic for the relevant insights and deep understanding of the experienced situations.
As with most psychiatric illnesses, there is no real cure for autism: the various therapeutical approaches will seek to improve exchanges with the autistic patient to let him open up to the outside world, while helping him to overcome the anxiety from which he protects himself in a pathological way.
In the medium to longer term, the therapy will aim to maintain and to consolidate the various relational, social and behavioral gains. Accompanying the patient will then proceed, according to his autonomy, with a return to the his family, placement in a foster home, or admission into a suitable institution. "
Development of the psychic apparatus
How to contact the internal world of the autistic child?
What's in a psychic space?
What types of anxiety faces on?
It is a concept that has to do with the vacuum, flow, evaporation, the explosion. The substance must have a psychic container does not evaporate, not empty. This container, which will allow the child to live over, the mother and the maternal environment.
0 to 2 months: autistic position. The child is focused on himself and his feelings;
2 to 8 months: position symbiotic. There is confusion between the Self and the Other;
After 8 months: depressive position. " I am me and there is the Other . "
Dice is the position that autism should be given primary importance to the container. The baby's perceptual experiences are not related. He lives for moments when he feels content, and other times when he feels down. All this is no different from other sensations (touch, heat, to be worn or not to move, contact ...). All feelings are mixed and bad. He got rid of by tapping feet and shouting. Note that these phenomena are found in adults, a much less intense.
The child was soon faced with the fear of death. He clings to life through psychological defense mechanisms.
Dismantling : it is a passive mechanism of making sure that the I early suspended, ceases to exist. The instinctual manifestations have disintegrated and the child no longer feels the anguish . It becomes pathological when the mechanism is used excessively, massive stereotype. The dismantling seems to be the basis of everything that has to do with the fact suspend all ties with the outside (for example in drug addiction ). This can be seen in autism when he cuts all contact with his eyes into space, elsewhere;
Adhesive identification : the surface form of identification. This is seen in echolalia when just the surface of the attitude and behavior is reused. It's meaningless. It's actually all that is of the order of mimicry, shackling to a feeling of anxiety to avoid the fall (note for example that the eye is fixed on a point ...). This includes body contact and psychic. The mechanism of adhesive identification is intended to avoid extinction.
Institutional pole ...
... in the daily life of every day.
When the child arrives at the day hospital, there is recognition of the parents of psychiatric problem. The supported are often in small groups. These are mostly children who do not speak. The implementation defined what happens depends on the feelings of the caregiver. It should identify the intensity of anxiety experienced by each child. It will cause them to abandon their archaic defenses, and for this to provide an outer container .
Note that the autistic children, as babies have a mind confronted with anxiety.
It will be important to be with the child in an enclosed, so he can put it somewhere, and live in the moment. The child needs to be kept, content. For some, when the link is cut, it is the collapse. The regularity of the reunion creates a story that helps children .
There is no onecause for autism, but rather a " telescoping"between factors from two sources.
As for the mother, we can see a non-postpartum depression-contained for not perceived by those around. This causes a non-investment psyche of the baby;
With regard to the child, we may retain organic elements, or excessive sensitivity. The child feels as soon as another detached from its mother, is confronted in this case, failing which a mother can count on him to restructure.
One function is to restructure the baby her mother. The depressed woman who finds a smiling baby on the way home (a baby responds and asks his mother), can count on the relationship induced by the child to restructure the ego fails to repair itself. Gratifies the baby, the mother meets narcissistically depressed. We can therefore speak of circumstantial events that result in autism.
Note that autism affects mostly boys, at 80% against 20% of girls .
Henri Rey-Flaud Psychoanalyst - Distinguished Professor at the university of Montpelllier, France
Author of “The children of unspeakable fear, a new look at autism” (2010) Translation of several chronicles on psychoanalytic web sites about this book
The media echoing distraught parents too often turn autism into a "handicap" of genetical nature. However, for the last 10 years no entirely convincing result has been recorded in this field. The thesis of this book is simple: autism is a withdrawal reaction shown by children who, at birth, have been the victim of an unspeakable fear that has developed and has maintained them over the years in its grasp. This fear, Henri Rey-Flaud has identified it: for the child, it is the fear of being destroyed if a relation to the Other (originally, the mother, but later extended to all others) were to be established -through the eyes, voice or touch.
Under this terrifying threat, the autistic child adopts a position of withdrawal, which maintains him away from all communication, all contact, forces him to look away, to retain his voice and block his ears to avoid receiving anything from the Other. When this principle is recognized, the autistic behaviour is not incomprehensible or absurd anymore. It explains the pathetic faces of these children locked in their own world. Whether it is Sébastien, searching for extraordinary visions in the puddles of the road, or Sara interacting endlessly with her hand, or Mary who listens carefully to the music of her fingers, the identification of the secret logic that governs this behavior generates successful therapeutic approaches which let us envisage opening the doors of the fortress. Henri Rey-Flaud is sure of it: the missed opportunity, causing a condition that is no longer to be blamed on mothers, can be "caught up."
They are said to be locked in their bubble, cut off inside their inner fortress, separated from the world and unable to be open up to the presence of the Other. Observation, however, shows that autistic children are not what they seem. This one catches an insect in flight, another one endlessly examines a pool of water, again another one climbs the stairs backwards. They are thought mad, they just live in their world. "I used to play alone, climbing the “monkey cage” on the playground, I watched my images, I climbed trees, plucked flowers, I spinned like a spinning-top staring at the sun to fall while watching the world go round. I loved life while remaining cruelly alone," tells Donna Williams in a moving testimony. For it must be made clear, the world of the autistic child is not an integral subjective vacuum. Though he is separated from the world, he expresses a reluctance that is not meaningless. The autistic child is indeed a living paradox. He senses a threat and is afraid of being captured by a malevolent presence, but if that presence is lacking, he is afraid of being wiped out. In order not to be engulfed by a fatal void, not to be sucked into a drain hole, they live perpetually on the watch and experience a psychic life of unknown intensity.
Thanks to psychoanalyst Henri Rey-Flaud, who has just published a wonderful book, autistic children have become brothers and sisters of soul. They have recovered dignity.
He is not the first to have contributed to this rehabilitation. Since its recognition in 1943 by American child psychiatrist Leo Kanner, autism has retained a character of mystery. Even though some great clinicians, whom the best known is Bruno Bettelheim, showed concern for it, today’s Vulgate tends to impose the idea that autism would have a genetic origin. We live in the messianic expectation of the revelation of the organic causes of this condition. Then, according to Henri Rey-Flaud, the question then is: "how is it possible to have overlooked the thousand and one fascinating and disconcerting behavior exhibited by these children of another world ?". The unspeakable terror that strike these children, however, should beseech us. Glenn Gould, who could not play the piano if the audience coughed or if he heard the rustle of a dress, however, puts us on track. And Cézanne who said he wanted "to find back the confused sensations that we bring from birth," also. The world of autistic children is a great opening on humanity and we should rather seek to understand it than trying to protect us from it by treating it as an object of science.
The contribution of this author thus appears considerable. First there is his extremely precise and litterary way to introduce case studies. Autism calls for a clinical look, you have to be attentive to the slightest gesture of the child and try to understand his reluctance. For the autistic child is like a puppet enslaved by its emotions, he is a captive of the original sensory chaos of the baby, from which a simple exchange of affection can help him tear away. For an infant, not catching the eye of his mother can be fatal. Thus it is necessary to watch out for this predisposition to autism. The reverie of the mother also plays a fundamental role. But we must immediatly correct. There is also a secondary autism. Children who verbalize can suddenly stop speaking. And there is no readily available path to understand the causes. The second contribution of this book will reassure many parents. Henri Rey-Flaud does not charge the parents with the onset of the disease. "The child, he writes, is not soft clay in the hands of the Other." He has his own share in the choice he makes of reluctance and withdrawal. A relationship of love and trust is not a universal guarantee. Against ancient ideas, we must now conceive the introduction of the human child to language in terms of a dialectic between the child and the Other which involves the responsibility of both partners. The failure is not unequivocal. By looking too much for an external cause to the child's condition, this had been forgotten. It is because he has been dumbfounded by the calls of the Other, that the Other will remain a stranger... All this has a basis only within himself.
Having understood this is a big step towards this new look at autism that the author invites us to share... A great book...
About the packing therapy
Packing therapy in children and adolescents with autism and serious behavioural problems
J.L. Goeb, F. Bonelli, R. Jardri, G. Kechid, A.Y. Lenfant, P. Delion.
Department of Child and Adolescent Psychiatry, University Hospital
Centre of Lille, Lille, France - European Psychiatry 2008;23(Suppl. 2):S405-S406
Packing therapy is a part of therapeutic approach for children and adolescents with autistic disorder,
especially in the case of self-injurious behaviour, and who do not respond to usual psychotropic drugs or who cannot tolerate them. This method consists in wrapping the patient with his
under-clothes several times a week, using towels previously wet in cold water. The patient is then wrapped with blankets to help the body warm up in a few minutes. Members of staff are always
looking after the patient and are carefully attentive to the quality of the relation with the patient who achieve a greater perception and integration
of his body, and a growing sense of containment.
Self-injurious behaviours have previously been related to pain reactivity in autism. The effectiveness of packing could rest on the mobilization of thermo-algic sensitivity. There is a short-circuit of thepainful sensations on which the child seems to focus his attention.
A sensation, to which the patient has become particularly dependent,is therefore replaced by another type of sensation, which uses the same neuro-physiological pathway.
As there is currently no scientific data available, a randomized,blind and controlled study (supported by the National Grant ‘‘Programme Hospitalier de Recherche Clinique PHRC 2007/1918’’) is taking place to confirm the effectiveness of packing in clinical practice. We have chosen the methodology used to verify the effectivenessof risperidone in children with autism suffering of severe behavioural disorders.
This study should help us specify the therapeutic indicationsof packing in autism.