On Neglect for those Impacted by Autism in France
In the late nineteenth century, France adopted its national slogan: Liberté, Égalité, Fraternité. Yet, these words have not always applied to France’s treatment of its own citizens, especially, as has come to light in recent years, of those who are disabled or neurodivergent—particularly people on the autism spectrum.
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterised by a range of signs including, but not limited to, deficits in communication and understanding of nonverbal cues, stereotyped behaviours, and restricted interests. The Institut Pasteur estimates that one to two percent of the global population may be on the autistic spectrum, hence its place at the centre of global public health discussions. Autistic traits have a very varied presentation and affect every individual differently. Hence, current therapies to help autistic individuals are equally varied and range from speech and behavioural therapies to psychoeducation or, in some cases, residential treatment.
In recent years, France has accrued notoriety from the international medical community and human rights organisations for its treatment of its autistic citizens. These condemnations include five convictions by the Council of Europe (Langloys), a Report of the Court of Auditors (Cour des Comptes), a Report of the Commissioner for Human Rights of the Council of Europe, and a Notice from the National Consultative Ethics Committee for its mistreatment of autistic citizens (Alliance Autiste). Even President Macron, in April 2021, addressed France’s, “…delay in the area of autism.” (Thiebaux).
France’s heavily preferred form of therapy for austistic individuals is psychoanalysis, a therapeutic technique which places strong emphasis on the hidden meanings behind behaviours as opposed to techniques that aim to help autistic individuals process and navigate an unpredictable, overstimulating daily life more comfortably (Bates). Psychoanalysis of ASD directly implicates parents in “causing” their child’s autism through blaming difficult parent-child interactions for autistic communication difficulties. French leading professionals in the discipline stated that “…autism stems from a mother's incapacity to take her child's birth as a joyous occasion.” (Davidson). The prevalence of this technique in France is largely due to its training methods for psychologists who occupy numerous positions in clinics treating autistic children: Bishop and Swendsen wrote that, at the time of their report, half of all French universities that trained clinical psychologists provided psychoanalytic training in management of mental health conditions and neurodivergence. A third of these universities provided exclusively psychoanalytic training after which there were no standardised national French examinations or professional licensing criteria that psychologists were required to earn before assuming specialist treatment roles.
Approaches in the U.K. and America regard autism as having a mostly genetic origin. Few scientists would contest that, despite autism’s complex aetiology, ASD has a mostly organic basis. Therefore, interventions focus on making social communication easier for autistic individuals. Here, the doctors' goal is to improve the child’s developmental trajectory instead of trying to glean any deeper psychological meaning to the symptoms. Approaches like these are based upon the international medical community’s current perspective on autism through the social model of disability, where an individual’s environment disables them rather than their innate developmental differences (Bates). Thus, the current general medical consensus favours helping to make (often overstimulating) daily life more comfortable and navigable for autistic individuals through disability accommodations and therapies tailored to their personal strengths and difficulties.
In 2020, the Review for the Convention on the Rights of Persons with Disabilities stated that, “France has gradually become one of the European countries that confines the most persons with mental disorders,” (Alliance Autiste) and that outcomes for autistic citizens often amounted to long-term “residence” in a hospital under copious medication for years at a time. The Convention called for the necessity of ending long-term hospitalisation because it often leads to significantly poorer outcomes for patients as no notable interventions occur in these hospitals which can cost up to €1,000 a day (Alliance Autiste). These are judged as highly detrimental not only to autistic individuals but also to their familial and social support systems.
Failures like these have led to complaints like the Council of Europe’s 2004 and 2014 condemnations that France had failed in providing autistic children with any education (Davidson). Indeed, since around 2000, France’s situation was such that thousands of parents routinely sent their children to specialist schools in Belgium, which France lacked. Parents found themselves separated from their children for long periods of time (Bates). During this decade, only 20-30% of autistic children attended mainstream schools as compared to 70-80% in the U.K., and many were forced to reside long-term in general hospitals with no specialist training in helping neurodivergent patients.
France’s efforts to attenuate this situation, including its four “Plans Autisme,” have focused on improving autistic children’s access to education, diagnosis, and family support (Bates). The fourth plan, with an operational timeframe of 2018-22 and €400,000,000 budget, specifically focuses on achieving early diagnosis.
These plans have so far shown multiple significant successes, as according to the Cour des Comptes, the number of autistic children attending mainstream schools more than doubled from 2008 to 2020—growing from 12,500 to 41,000 (Bates). Encouragingly, French politicians have spoken out more and more against the use of psychoanalysis in treating autism, calling it both ineffective and detrimental to both patients and their families (Bates).
There is now significant research that views autism as a neurodevelopmental condition instead of the emotional result of a supposed lack of parental affection. However, remaining supporters of psychoanalysis, a lack of general awareness about neurodiversity, and overwhelmed medical infrastructure all mean that France still has a long way to go before it can do right by its autistic citizens. Today, nonprofit organisations such as Le Silence des Justes, the subject of the 2019 film Hors Normes, still pick up many of the pieces left behind by French medical infrastructure to support the basic inclusion and accommodation of autistic people into mainstream activities, sports, and education. Though initiatives such as the Plans Autisme provide significant improvement from the previous plight autistic individuals in France faced, current initiatives represent a drop in the ocean of efforts that still need to be made to provide a truly equal and accessible society for all French citizens.
Photo: AF
Works Cited
Alliance Autiste, and CLE Autistes. Questions d'associations d'autistes pour l'Etat français au sujet de l'application de la Convention relative aux Droits des Personnes Handicapées. Alliance Autiste & Collaboration pour la Liberte d'Expression des Autistes, 26 July 2019. Convention relative aux Droits des Personnes Handicapées.
Bates, Richard. "France's Autism Controversy and the Historical Role of Psychoanalysis in the Diagnosis and Treatment of Autistic Children." Nottingham French Studies, vol. 59, no. 2, June 2020, pp. 221-35. Edinburgh University Press, https://doi.org/10.3366/nfs.2020.0286.
Bishop, D.V.M., and Joel Swendsen. "Psychoanalysis in the treatment of autism: why is France a cultural outlier?" BJPsych Bulletin, vol. 45, no. 2, 17 Dec. 2020. Cambridge University Press, https://doi.org/10.1192/bjb.2020.138[Opensinanewwindow].
Cour des Comptes. Évaluation de la politique en direction des personnes présentant des troubles du spectre de l'autisme. Cour des Comptes: Chambres régionales et territoriales des comptes, www.ccomptes.fr/sites/default/files/2018-01/20180124-rapport-autisme.pdf. Enquête demandée par le Comité d'évaluation et de contrôle des politiques publiques de l'Assemblée nationale
Davidson, Colette. "Management of autism in France: 'a huge job to be done.'" The Lancet Psychiatry, vol. 1, no. 2, 1 July 2014, pp. 113-14, https://doi.org/10.1016/S2215-0366(14)70290-1.
Institut Pasteur. "Autisme: Fiche Maladie." Centre Medical de l'Institut Pasteur, www.pasteur.fr/fr/centre-medical/fiches-maladies/autisme.
Langloys, Danièle. L'Autisme, la France et le Conseil de l'Europe : la France n'est pas aux normes européennes. Autisme France, Sept. 2014. Translated Title: Autism, France, and the Council of Europe: France is not up to European standards
Thiébaux, Anaïs. "Stratégie nationale pour l'autisme: bilan et actions 2021" ["National Strategy for Autism: Results and Actions 2021"]. Journal des Femmes: Santé, 14 Apr. 2021, sante.journaldesfemmes.fr/quotidien/2710336-strategie-nationale-autisme-tnd-france-education-intervention-consultation-bilan-2021/.