Abstract. Institutional therapy includes a vast and heterogeneous set of practices, ideas, thoughts, writings which are particularly inspiring at this moment in time. This article illustrates thoughts about institutional work in an out-patient hospital receiving adolescents and young adults with symptoms from autistic spectrum.
Abstract. In France, psychiatry and psychoanalysis are seen as dominant in the support given to austitic persons. There is a gap between the role both plays which is in reality marginal and the dominant representation described by some of its partisans and opponents. Both those disciplines are still seen by parents with the fear of a corporatist influence that can be harmful to their kids’ life and the support they receive. In France, child psychiatry was the instigator of the con-asylum movement between 1955 and 1975. It was then inspired by the “restoration of the subject”, a psychoanalytical ideal. Later on, parents had also to maintain a con-asylum perspective against psychiatry and psychoanalysis. Since 1980, those two disciplines have not always support with discernment the development and the demands of modernisation asked by the family or the society. Those development have widened the useful technical propositions, far beyond the “taking care”, the drug only treatment, and the institutionalsupport ranging from childhood to adulthood, which isfragmented by desertion and rejection by society. For as long as there are discourse from psychiatric and psychoanalytical point of view which purport a so called supremacy concerning the origins of autism or on how to support those individuals, psychiatry and psychoanalysis will provoke hostility.
Abstract. Since the years 1960, although not represented in support units per se, psychiatry and psychoanalysis have occupied a dominant position in French sanitary and medical-social institutions. In opposition, other disciplines have brought new support modality for autistic persons. Yet, the “everything is therapeutic” era never really existed. This was a fiction that was maintained by psychiatric and psychoanalytical point of view, that didn’t take into account other part of support such as simple childcare in asylum, or, on the other, schooling, or social and educative activity. “Supremacy” of psychiatry and psychoanalysis has declined, but it remains in the vocabulary of many support unit. For family there is a large confusion between “treatment”, “care”, “therapeutic”, “psychotherapy” and “institutional psychotherapy”. The later is not a single approach to analyse actions and interactions in the teams, and forge a constructive criticism which lead to innovation.
Abstract. Psychiatry and psychoanalysis have dominated the clinical discourse about autism for a long time. Then, those disciplines have reluctantly accepted inputs form other disciplines. More recently, those disciplines have integrated some innovation, risking of obliterating the interdisciplinary view that is imposing itself.
Psychiatry and psychoanalysis now need to:
- Select carefully its useful clinical insight and its actions in the support of persons depending on the age and type disorder.
- Learn how to federate the observations of the other disciplines of the technical propositions when asked to. This includemedical innovations (genetics, child neurology), developmental psychology, cognitivism, psychomotor re-education, and education.
Learning this way of thinking takes time because it is not promulgated during psychiatric, psychological, or “specific method” training. Field teams that support people with autism, that are educative, social, therapeutic, or mixed approachneeds to take in account this way of thinking to apprehend the complexity of the clinical approach in autism.
Summary. The contribution of psycho-analysis in institutions taking care of autistic persons
Among the different, complementary approaches, psycho-analysis has a specific contribution in an individual setting, in the relation with families and in team work.
Meeting with an autistic person with regard for his sensorial interests, without imposing a direct glance and welcoming his sponaneous glances, facilitates communitaion, prevents states of sensorial or emotional saturation and diminishes the spacial anxieties. Before insisting on socially adapted behaviour, it is indicated to work in psychotherapy on the feeling to exist in his body and environment; this helps the launch into a spontaneous relationship and prepares a better availability for the proposed activities and social requirements. Putting words to and talking about bodily difficulties, playing with sensorial variations as well as understanding and making limited behaviour meaningful, will reduce the violent behaviour, hyperagitation, states of emotional saturation, mental clivage and muscular tension. The institutional work based on the analysis of the effects of transfer pays attention to complementary approaches with the families, thus preventing clivages. The tranquility and appeasing effect of this approach diminishes the behavioural problems of autistic persons, makes less medicin is needed and assists in their development. Read more
Abstract. This article sketches out a metapsychology of psychosis, by focusing on the description only of the psychic processes that are specific to each psychotic disorder, so as to reveal what kind of logic is specific to it, and to hignlight the space or time dimension that is passed over by the patient. Indeed, speeches and behaviours in psychosis often seem inconsistent to us, but they follow logical psychic processes that are specific to each disorder, as this article intends to show from patient cases. It deals with how missed experiences of space and time lead psychotic patient to follow imaginary logics, also called formal logics by logicians as they ignore one of the space and time dimensions in their experience, whereas nevrotic patients would follow empirical logics in similar situations. Thus, each psychotic disorder follow a specific imaginary logic : the psychic process specific to autism follows a trivalent or fuzzy logic, that of schizophrenia follows a epistemic or non-monotonous logic, that of paranoia follows a repetitive or fractal logic, and that of bipolar disorder follows an associative logic, which psychosis clinicians respectively call indeterminacy, delusion, ritualization and disjointed speech.