Psychoanalyze and autism

For the psychoanalyst S, the Autisme is regarded as a disorder of earliest, that of the strongest deficiency in terms of symbolization. In particular, the comprehension of the absence of the mother is thought like defective; from a point of view Lacan IEN, meant of the mother would not have been integrated (while the Psychose is there failure as for the name of the father). Michael Fordham developed a point of view of jungien by putting forth the assumption of a cleavage of the Oneself whose share would be cold.

Causes of the autism, according to the psychoanalytical theories.

Upon the departure, the question of the etiology of the autism generated certain difficulties, on the one hand because of the innovation of the apprehension of these problems making difficult a clear position for lack of scientific data, on the other hand because of the way in which some of these ideas were diffused or médiatisées.

Thus, before slicing on the end of its life for a genetic etiology, Léo Kanner, one of the precursors of research on the infantile autism (Bruno Bettelheim was already interested there) had initially privileged an psycho-emotional origin by evoking a maternal coldness likely to involve difficulties of contact with the baby.

This material change of prospect met thereafter, and especially in France, a popularization of the ideas of Bruno Bettelheim which was more carried out by the media (television programs) that by its books, which could maintain certain confusions. The creation of Orthogénic School in 1947 pennies the shape of a boarding school where only met to him the families with the assumption of a function psychotisante of the medium (extreme situations) probably also fed the idea according to which the parents could be directly responsible for the appearance of the autistic disorders in their child.

However, after having privileged a pure psychic origin, the psychoanalysis today integrated the data of the neurophysiology and of the genetics and, as of the beginning of the year 1970, Frances Tustin affirmed that there could be a genetic sensitivity of the children to becoming autistic. In fact, Margaret Mahler, Frances Tustin, Donald Meltzer, Francoise Dolto or Maud Mannoni without ceasing questioning the direction which the autism in the relation parent-child can take, left all opened the question of the origin of the disorders. This imposes a plurifactorielle approach or the share of psychogenesis is variable, even if a psychic access of the disorders remains essential some are the fundamental causes.

The existence of important differences between the autistic subjects accredits the idea of a complex etiology. However varied causes can lead to the same central fact to know that these children made too precociously, and/or there with insufficient equipment, the experiment of the loss of the object and that they could not face differently than by working out autistic defenses. Those aim, in particular with the autistic object (cf Frances Tustin) with stopping the hole of separation by denying the bonds and can thus prevent the autistic child and his agent maternant to be reciprocally within a sufficiently satisfactory primary relation for them (the dyad).

If the causes of the autism can be multiple and combine between them: genetic, infectious or neurophysiological problems, difficult childbirth, diseases néonatales involving maternal hospitalizations, but also depressions, absence of paternal support, mournings of parents or children, transgénérationnelles violences, cultural uprootings, reviviscence of old family problems… the end result is the difficulty for the partners of living a happy symbiosis however essential to the normal development of the baby i.e. to the process of humanization and individuation (Margaret Mahler). That secondarily involves impossibility to work out a psychic separation which is at the origin of the deficits symbolic systems (play, elaborate language…) that one notes thereafter in the autistic child (Melanie Klein, Jacques Lacan).

The psychoanalytical care of inspiration in France

In France the centers of consultation and institutions for the autistic children and psychotics are relatively recent. They are psychoanalysts: Serge Lebovici, Philippe Hinge plate, and Rene Diatkine which created in 1958 the Association of Mental health of the 13th district of Paris, with in 1961 the first center of public consultation (the Center Alfred Binet which proposes psychoanalytical therapies) then the creation of the first Hospital of Day in France. In 1969 Maud Mannoni creates the school of Bonneuil on Marne while taking as a starting point the work of Jacques Lacan but also by the originators of institutional psychotherapy Jean Oury, Felix Guattari, François Tosquelles who had worked, but with adults, at the Holy Hospital Alban and/or the private clinic of Borde. To also note the observations of young autistic subjects made by Fernand Deligny as from 1967 in Graniès, in the Cevennes. In province the creation of the first Hospital of Day for children (IRP of Bègles) date of 1970, under the aegis of the Professor Blanc, President of CREATED of Aquitaine, and Doctor Jacques Loisy. Gradually of other structures are created for the young children on the territory, but often of insufficient number, as the psychiatric sectorization, started in 1968, is set up little by little. That did not prevent that until worms years 1975 much of autistic children continued to endure dramatic living conditions in old asylums where some were placed, and where they died very young people of despair and absence of care (hospitalism), others remaining hidden in the residence of the parents in consequence of an absence of structure adapted and immense family distress vis-a-vis such strange disorders.

It is allocated incontestably to the people well trained to the psychoanalysis to have humanized the care of these children: in France (Serge Lebovici and its team) like abroad, (Bruno Bettelheim the first was interested in these questions while accommodating at his place of 1932 to 1938 two autistic children) by more stressing the psychic treatment that on the handicap and by privileging an access very individualized of the situations, all different, which are presented. Whatever the cause of the autism a care based on the human relation, and not on forcing, is essential in the respect of the maturatives stages of the child and his suffering what supposes a thorough knowledge of psychism initiated by the psychoanalysis. All looking after them insist on an earliest possible catch of the load.

If the weather is difficult to today be a precise assessment of the contribution related to these methods attentive with the typical location of each child and entire family group of which it forms part, one must however indicate that many autistic young children and psychotics, even if one cannot speak about cure, see their situation improving concerning a better use of the language, an important reduction their anguishes, easier communications with their entourage as well as an access to the knowledge and the play which was most of the time impossible before for them. But it still too often misses adapted reception facilities where the teenagers and the young adults could continue the evolution started in institution which remains often irreplaceable because of the therapeutic need for a multi-field access and multifocal of the suffering of these children and their family.

Today the psychoanalytical approach of the autism is done mainly in three directions:

with the child in standard specialized institution hospital of day around the concept of " contenance" (cf Wilfred Bion) with many verbal and nonverbal techniques: varied therapeutic workshops, individual therapy or groupale, pataugeoire, psychomotricity, orthoepy… to help it to open with a subjective relation, in complement of the educational and teaching techniques which have all their place provided that they are flexible and respect the evolution of the child, which requires a coordinated team work and a " setting in account of the soin" (Jacques Hochmann).
with the family thanks to various discussions with the members of the team and/or the outside contributors for better accompanying their child and to find an operation as satisfactory as possible, the presence of an autistic child in his center being a test of more destabilizing for its balance.
with looking after thanks to the meetings of team and supervisions for better including/understanding the very antiquated interior movements than can wake up in them the assumption of responsibility of autistic children, and the institutional dimension of the care.

Principal concepts

Following the term of autism created by Eugen Bleuler in 1911 and in princeps descriptions of the infantile autism realized by Léo Kanner in 1943, a great number of researchers of psychists and psychoanalysts were interested at the origins of the thought (observations of infants), in the psychopathology of the child and the perceptivo-sensory activities and the earliest motor coaches to work out many useful concepts for psychotherapies of the autism, the infantile psychoses or the limiting states, but also, in a broader way, for the knowledge of the bases of psychism as well in its individual dimension as groupale: why and how the human subject thinks, which are the basic psychic tools necessary to the appearance of the thought, and for what it is used?

One can only enumerate here their principal authors to show the richness of these contributions which often overflows very largely the strict field of their discovery: Marie-Dominique Amy (accordance), Piera Aulagnier (pictograms), Didier Anzieu (psychic envelopes, Me-skin, sound mirror), Gregory Bateson (double bind), Bruno Bettelheim (extreme situations), Esther Bick (adhesive identity, adhesive position, skin container , method of observation of the babies), Wilfred Bion (function alpha, container-contents, avoid-excitation, maternal daydream, catastrophic anguishes, elements beta), Jose Bleger (tallies, bound cores, symbiosis, ambiguity), John Bowlby (attachment), Thomas Berry Brazelton (wrap reciprocal interactions, competences of the infant), Jean-Pierre Caillot (adhesive narcissistic position), Francoise Dolto (image inconsiente of the body), Michael Fordham (oneself primary, defenses of self, oneself cold), Sigmund Freud (oral stage, body origins of ego, family romance, denial, fort-da… etc), Evelyne Granjon (rough objects), Genevieve Haag (body cleavages, mantèlement, intracorporelles identifications of junction, basic rhythmic structures), Paula Heimann (enkystés objects), Jacques Hochmann (put in account of the care), Eliott Jaques (defenses against the anguish primitives), Rene Kaës (psychic apparatus groupal, function container, pacts dénégatifs), Melanie Klein (projective identification, good and bad object, positions paranoid-schizoid and depressive), Leon Kreisler, Bertrand Cramer and Serge Lebovici (fantasmatic interactions), Jacques Lacan (preclusion from the Name of the Father, mirror stage), Rosine Lefort and Robert Lefort (Other perforated/not perforated), Margaret Mahler (normal autistic phase, symbiosis, separation-individuation), Donald Meltzer (dismantling, Bi-dimensionnalité, intrusive identification), Gisela Pankow (space and temporal body lived), Paul Schilder (image of the body), Hanna Segal (equations symbolic systems), Rene Spitz (anaclitic depression, dyad, hospitalism, primitive cavity, organizers of ego), Daniel Stern (emotional tuning), Rene Thom (theory of the catastrophes, attractile), François Tosquelles (tranferential constellation), Frances Tustin (autistic forms or traces, normal primary education autism, black hole of psyché, postnatal matrix, autistic and confusional objects, feelings objects), Walloon Henri and Rene Zazzo (the mirror stage), Donald Winnicott (setting, transitional holding, handling, breakdown, objects and phenomena, capacity with being only)… etc

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