French film takes issue with psychoanalytic approach to autism

From The NY Times:

PARIS — “Le Mur,” or “The Wall,” a small documentary film about autism released online last year, might normally not have attracted much attention.

But an effort by French psychoanalysts to keep it from public eyes has helped to make it into a minor cause and shone a spotlight on the way children in France are treated for mental health problems.

The documentary, the first film by Sophie Robert, follows two autistic boys: Guillaume, who has been treated with the behavioral, or “American,” approach; and Julien, who has been kept in an asylum for six years and treated with psychoanalysis. Guillaume, though challenged, is functioning at a high level in school. Julien is essentially silent, locked out of society.

Since Sept. 8, when the film first became available on the Web, it and Ms. Robert, 44, have been the targets of criticism from both the analysts who appear in the film and from within the country’s psychoanalytic establishment. Three of the psychoanalysts whom Ms. Robert interviewed for the film have sued her, claiming she misrepresented them in the 52-minute documentary, which has not yet been screened in cinemas or on television.

On Jan. 26, a court in the northern city of Lille will decide whether Ms. Robert must remove their interviews from the documentary if she wishes to keep screening it. The plaintiffs are also seeking damages of €300,000, or $384,000. The lawsuit might be futile, since the film is widely available on the Web (with English subtitles), having been viewed on YouTube more than 16,000 times. (Ms. Robert argues that the plaintiffs, all of whom appear in the film, signed detailed releases.)

Ms. Robert is planning to screen the film in Philadelphia at an autism conference on Jan. 27, the day after the court is to rule. If she wins, a local channel in the north of France, Weo, has agreed to screen it, as has Télévision Suisse Romande, a Swiss channel.

The film makes no pretense of objectivity, juxtaposing interviews with psychoanalysts with scathing criticism of the field’s precepts. Ms. Robert, 44, describes herself as an anthropologist and said she once wanted to be a psychoanalyst herself.

“I would have never imagined what I discovered,” she said of her first few interviews for the film. “Then I thought, wow, what I hear is just crazy.”

Christian Charrière-Bournazel, the lawyer for the three plaintiffs — Esthela Solano Suárez, Éric Laurent et Alexandre Stevens — did not respond to requests for comment.

But in court filings, Mr. Charrière-Bournazel said the film had been edited to make his clients look absurd. Ms. Robert, he said, presented the project to the analysts as a documentary, though “it was in reality a polemical enterprise meant to ridicule psychoanalysis in favor of the behavioral treatments that are so fashionable in the United States.”

“The film is unfair,” Élisabeth Roudinesco, a French historian of psychoanalysis at the University of Paris VII, said. “It is fanatically anti-psychoanalysis. But I don’t think she’s manipulated the film to make them look ridiculous; rather, I think she chose to talk with very dogmatic psychoanalysts who come across as ridiculous.”

Professor Roudinesco said the French psychoanalysis community was actually quite divided by the question of autism, with some “fanatics who believe that autism is caused by a frigid, cold mother. But you don’t attack an entire discipline of medicine because of a scandal involving a few practitioners.”

“Even if it is proved someday that autism is a genetic malady,” she asked, “why abandon the idea that the talking cure could help the patient?”

The idea that children with autism spectrum disorder should be treated with the “talking cure” employed in psychoanalysis may sound outdated to some viewers, since many medical scientists believe that underlying physiological problems are at least partly responsible for the disorder. In the United States, the National Institutes of Health recommends that it be treated with behavioral and other therapies.

Ms. Robert said the version of psychoanalysis that is most prevalent in France, particularly the post-Freudian school championed by Jacques Lacan, takes it as a given that autism and other mental health problems are caused by children’s relationship with their mothers, or by “maternal madness.”

“Sometimes, when the mother is depressed, in utero, I mean when she is pregnant or at birth, sometimes the child can be autistic,” an analyst tells the camera in one scene. Another explains that autistic children “are sick of language — autism is a way of defending themselves from language.”

To the question of what an autistic child can expect to gain from psychoanalysis, yet another analyst responds, “The pleasure of taking interest in a soap bubble. I can’t answer anything else.”

“Many mothers here live in fear of the social services,” Ms. Robert said. “If you refuse psychoanalysis for your child, they say: “You’re refusing care,” and they can put the kid in an asylum if they want.”

Whatever the reason, the Council of Europe found in 2004 that France had failed to fulfill its educational obligations to children with autism, and, according to Le Monde, only about one-quarter of children with the disorder attend school in France, compared with three-quarters in Britain.

Critics like Ms. Robert argue that there is also a stigma about “American” diseases. In the United States and many other countries, for example, attention deficit hyperactivity disorder, or A.D.H.D., is treated with medications like Ritalin in combination with behavioral therapy. In the French system, simply getting a diagnosis is difficult, some psychologists and parents say.

Christine Gétin said that she started looking for help for her son when he was 4 years old but that it took 10 years just to learn that there was such a thing as A.D.H.D. and that there was medication to treat it. “I saw that my son was suffering,” Ms. Gétin said, becoming disruptive in class and falling behind. Mental health workers told her there was nothing they could do. It was only nine years later that a doctor finally diagnosed A.D.H.D., and the child got a prescription for Ritalin.

After only one day on the medication, she remembers him saying that he no longer had to write everything down in order to get through the day. “My brain did it for me!” her son exclaimed after arriving home.

Ms. Gétin has since gone on to start up HyperSupers TDAH-France, an organization to support families of hyperactive children. In the French system, she said, A.D.H.D. is seen “as an American disorder, or that it doesn’t exist,” Ms. Gétin said.

Ms. Robert notes that the autism treatment that Guillaume used to learn speech — called picture exchange communication system, or PECS — was developed in the United States, something she said has made it that much harder for the French to adopt.

“If you say it’s American, that’s a very bad thing,” she said.

Michel Lecendreux, a psychiatrist who advocates a medical approach to treating A.D.H.D., said there was a fear “that the U.S. mistakes — especially too much drug prescription — will be repeated. We’re trying to avoid that.”

There are signs of change. Ms. Robert was recently lauded in the National Assembly, after François Fillon, the prime minister, announced that autism would be “the Grand Cause of 2012.” Parents have more options for seeking treatment information than in the past, and doctors are being exposed to the latest treatments at international conferences.

The dominance held by psychoanalysis is also showing signs of eroding: Ms. Robert says that while about 80 percent of those in the mental health field are required today to study psychoanalysis, that compares with 100 percent as recently as the 1980s. “Ideas are penetrating from outside, slowly,” said Ms. Robert, who is hoping to make a second instalment on psychoanalysis and sexuality. “I’m very optimistic.”