During this time it was commonly believed that autism was caused by bad parenting — bad mothering, in particular. This idea, known as the "Refrigerator Mother" theory, claimed that cold and emotionally distant mothers drove their children into an emotionally frozen state, and that only through intense and often abusive forms of psychotherapy and other treatments could autistic children be cured of their disorder. This awful approach had dreadful implications for treatment, and for the parents of children with autism.
A controversial new film by French documentary filmmaker Sophie Robert, screened last week at an autism conference here in Philadelphia, reminds the world that in France these thoroughly discredited and dangerous ideas still hold considerable sway. The film, Le Mur or The Wall, already viewed tens of thousands of times on YouTube, is calling attention to the ongoing stranglehold that psychoanalytic theories still have over autism treatment in France.
The film's interviews with prominent French psychiatrists leaves the viewer wondering whether in France treatments for pediatric developmental disorders are stuck in some sort of bizarre Freudian time warp. These ideas have been so thoroughly debunked in the rest of the world (not that in the U.S. we don't have our equally controversial theories of autism—Exhibit A: the rise of vaccine related hypotheses) that its persistence from a non-French perspective seems farcical. Listening to the talking heads in Robert's film reinforces that feeling.
For example, to explain the maternal origins of autism, one of the psychiatrists in the film suggests (and it is worth quoting at length here) "the symptom of the child is no more, no less than the symptom that is allotted to have by the maternal unconscious mainly because children are in a relationship that is very, very, very permeable in the communication with their mother. Gestation literally conditions a child, and forms him and really gives him something entirely produced by the body, that comes from his mother's body."
Another of the psychiatrists interviewed believes that Bruno Bettelheim, the man credited in the United States with popularizing the now discredited "Refrigerator Mother" theory, "is a victim of injustice of contemporary history." Finally, when pushed to explain what a child and their family should expect from their work in psychoanalysis, another of the French psychoanalysts bluntly and bizarrely answers: "The pleasure of taking interest in a soap bubble. I can't answer anything else … ."
The film is under attack in France and three of its subjects—Esthela Solano Suárez, Éric Laurent and Alexandre Stevens—sued the filmmaker, claiming that they were misrepresented in the film. Last week a court in Lille ordered Robert to remove from her film the likenesses of the three plaintiffs and pay them significant damages. At issue in the case is whether Robert edited the film to manipulate her subjects. Robert will be filing an appeal and told me that the plaintiffs signed a detailed release prior to appearing on camera.
Despite the intense pressure on her following the court's decision—she is financially liable and is likely to shutter her company while she appeals—Robert is committed to her film and believes it is drawing a spotlight on the stranglehold psychoanalysis has in France. To Robert, who herself once wanted to be an analyst, "psychoanalysis has an hypnotic effect" and is a "cult antithetical to science."
Evelyne Friedel, vice-president of Autism-Europe and the lead lawyer in a 2003 complaint filed with the Council of Europe against France's treatment of autistics, agrees that the power of psychoanalysts in France is "the real root of the issue." "It is an extremely strong lobby," Ms. Friedel told me, herself the mother of autistic children, and their power "doesn't only hurt autism, but also hurts many other disabilities like autism."
It was not until 2004 that France's Classification Française des Troubles Mentaux de l'Enfant et de l'Adolescent, the French equivalent of the Diagnostic and Statistic Manual of Mental Disorders, stopped classifying autism as a psychosis. According to experts in the United States, the French continue to think about autism as a disease of the mind, not of the brain, and as a result there remains a critical shortage of behavioral treatment specialists and centers throughout France.
Just as troubling are the lingering effects of psychoanalytic treatments in France. Currently, in Lille, the same city where a court ruled against Robert, a clinical trial is underway to examine a treatment for autism called packing, which "involves wrapping a child tightly in wet sheets that have been placed in the refrigerator for up to an hour. When children are encased in this damp cocoon—with only their head left free—psychiatrically trained staff talk to them about their feelings."
In 2003, following the complaint lodged by Ms. Friedel on behalf of Autism-Europe, the Council of Europe ruled that "France has failed to achieve sufficient progress in advancing the provision of education for persons with autism." The ruling called on France to "take measures that allow it to achieve the objectives of the Charter within a reasonable time and with measurable progress." The Council of Europe issued follow-up reports on the progress, or lack thereof, in France in 2007 and 2008, concluding that the situation there still does not grant equal access to education for autistic children. Another follow-up report is due from the council in late 2012, which is the "Year of Autism" in France.
Though much has changed in France in the last few decades, the nation still does not provide adequate care for its autistic citizens and their families. "From 2003 until today, France moved from the neutral position to first gear," Friedel points out, suggesting that France still has a long way to go in its attitudes about and treatment of autism.
One of the challenges for France in the coming years is that it lacks the infrastructure to provide non-psychoanalytic treatment for autism. "France needs people with credentials for behavioral therapy," said Diane Fraser, Ed.D., from the Association Française de l'ABA. Fraser's practical suggestion is that until the French are able to train their own mental health professionals to provide care for autistic children and adults, the country should create specialized visas for foreign therapists to help develop the needed infrastructure.
In the meantime, Robert's film, the controversy it has generated, and her ongoing legal issues have, at the very least, succeeded in drawing growing international scrutiny to the historical anomaly that is psychoanalysis in France. "By suing her," Friedel believes, "the psychiatrists have offered great publicity for the film. This is a victory for the film. But not for her. Though the film should help things change."