Agnes Aflalo, psychiatrist and psychoanalyst, clarifies what is at stake and what remains unsaid in the recent report on autism.

“Non-consensual” and not “relevant”. This is how the new report on autism considers psychoanalytic and psychotherapeutic approaches to autism. The Higher Authority for Health (HAS) recommends rather an “educative, behavioural and developmental” approach. Concretely : it is not recommended to refer people with autism to psychoanalysts, or practitioners orientated by the Freudian discipline, but the advice is to refer them to CBT practitioners.

Agnes Aflalo, psychiatrist and psychoanalyst, head of the CMP for children and adolescents at Bagnolet and author of L’assassinat manqué de la psychanalyse (éd. Cécile Defaut) clarifies what is at stake and what remains unsaid in the recent report on autism.

Martin Quenehen : Agnes Aflalo, could you first clarify in a few words what are the differences between the psychoanalytic approach and the behavioural approach to autism?

AA : The CBT model is Pavlov’s dog, conditioned by training to obey orders. This is where the CBT idea to do the same with humans comes from… particularly with autistic people, like in the ABA method. And today they want to impose these methods on everyone!

Psychoanalysts, on the other hand, do not offer training. They put their faith in human dignity. They start from what exists to invent with each patient the answer that suits him, and only him. This includes patients with autism. Don’t get me wrong, psys are not opposed to medication, but only when it is necessary and for those for whom it is useful. So it is not for the entire “autistic spectrum”, as the term has been manufactured today. A bespoke approach goes against the supposedly scientific approach claimed by CBT.

With regard to the psychoanalytic approach to autism, I encourage our readers to look up the Ecole de la Cause Freudienne press conference, published on the website of La Règle du Jeu.

MQ : Following the outrageous documentary “Le Mur” [The Wall], which has recently had a court judgement against it, it’s down with psychoanalysis (once again). Why such obstinacy?

AA : Quite simply because psychoanalysis disturbs certain people’s good business…or at least does not favour them. For 30 years, public health has been reduced, more and more, to a market where the logic of profit reigns and no longer a domain orientated by the logic of the common good. And the great artisans of this drift are the pharmaceutical laboratories and their “friends” in the psy field: the CBT practices that “slice up” illnesses with questionnaires and where a medication corresponds to every symptom…

MQ : Could you give examples of this drift?

AA : When the DSM-III was published in the United States in 1980 (the 3rd edition of the diagnostic manual for mental illness, used as a reference throughout the world on the questions of mental health) autism was judged to be very rare: it only affected 2 to 4 people out of 10 000. However, in the DSM-V (not yet published but for which a preliminary version has been ‘leaked’ in 2010) the field of autism has been considerably expanded under the name of Autistic Disorder Spectrum and is now affecting more than 2% of school children… So, we’ve gone from 0.02% to 2% of children!

MQ : Who benefits from this increase?

AA : We know that in order to tackle autism the HAS today recommends CBT in conjunction with various medication strategies, “useful to decrease or to eliminate inappropriate behaviour”, based on neuroleptics, opiates, lithium carbonate, beta-blockers, anti-depressants, ‘obedience pills’, anti-fungal, hormonal treatments, vitamins, calcium… In short, a juicy market for drugs companies. In 2010, didn’t Carol Bernstein, president of the APA (American Psychiatric Association) state that one had to “make the patients accept the recently released pharmacological treatments” (1)?

As I said earlier, psychoanalysts are not opposed to use of medication to accompany the treatment of autism. However, when one increases the field of autism, one as a result increases the market quite opportunely. But there is more. In nowadays claiming and promoting a ‘genetic autism’, the DSM creates a new market: one of genetic testing – costing a few thousands of euros, which I am sure will be soon offered by the same drug companies…

MQ : What of the independence of the HAS and of the medical experts of France who have just released this report? Isn’t this virtue a cardinal principal? Isn’t the one who swears the Hippocratic Oath declaring: “I will preserve the independence necessary to accomplish my mission”?

AA : Remember the scandal of Mediator…This case revealed the conflicts of interest between “independent” experts and the companies like Servier and about which Alain Bazot from l’UFC- Que choisir? [‘Which?’ in the UK] said that the French pharmaceutical system was a “rotten system”. As early as 2009, Professor Philippe Even, formally the Dean of the faculty of medicine at Necker in Paris and emeritus professor of the University of Paris V (2) stated that the French medical experts face the same “conflicts of interest” as the American experts (3): “It is the academic doctors that guarantee the promotion of medication (…) and this is how it works in the USA. Out of 1200 experts from national medication agencies in France, more than half declare links with industrial companies. 20% claim not to have any but this has not been verified. Others do not make any declaration despite it being mandatory. Like in America expert committees are both judges and parties at the same time (4)”.

More recently still, remember when the Director of the HAS, Prof Jean-Luc Harousseau himself had to admit (after having signed a public statement of interests without any links to the pharmaceutical industry) that he had received in excess of 200 000 euros from various pharmaceutical firms during the three years prior his arrival at the head of the HAS. And I am not talking about the sums received by the research structure he supervised.

MQ : This professor Harousseau, who declares loudly that he wants to “evaluate” psychoanalysis, deserves then to be evaluated too when it comes to his independence! Having said that, when he states that this report on autism “marks a step” and that with regard to autism, “nothing will be quite the same”, one tends to believe him…Just like one tends to believe the Deputy Daniel Fasquelle – author in January of a law proposition aiming at “the cessation of psychoanalytic approach when working with autistic people” (to the exclusive profit of CBT…) – when he says that he will not back down against the psys, being a member of the Hippocrates Club, a parliamentary club (whose site is bizarrely no longer available), notable supported by GlaxoSmithKline, a pharmaceutical company that manufactures, amongst others, anti-depressants … recommended to treat autism!

From ECF-Messager – 11.3.12 – translated by Betty Bertrand–Godfrey (Via l’AMP-NLS)

Interview with Agnès Aflalo by Martin Quenehen on Le Huffington Post :

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