Criticism of the psychoanalytic approach Criticism of psychoanalytically inspired "treatment" According to Casanova et al., the application of psychoanalytic theories, which often advocate for family separation, has exposed autistic children to interventions that can be distressing. Steve Silberman cites the example of one of
Ole Ivar Løvaas's autistic patients, who experienced both the consequences of interpreting self-harming behaviors through a psychoanalytic lens (parental separation and attribution of behavior to internalized
guilt) and the application of early
Applied behavior analysis (ABA), which used
punishment to stop self-harm. Psychoanalytic practice has historically viewed autism as an affective disorder requiring exclusively psychiatric intervention, sidelining other potential causes, such as genetic research. This exclusivity in treatment approaches over decades led to severe criticism from the
Haute Autorité de santé (French National Authority for Health) on 6 March 2012. Historian Richard Bates (2018) argues that France's lag in respecting the
fundamental rights of autistic individuals—such as access to education, independent living, and diagnosis—is due to the influence of psychoanalysis, particularly the theories of
Jacques Lacan and
Françoise Dolto.
Criticism of the application of psychoanalytic theories The concept of autism has faced significant shifts in clinical acceptance within
psychiatry, fluctuations in psychoanalytic conceptions, and conflicts between practitioners and parents, culminating in France with political intervention by the Haute Autorité de santé. Three intertwined issues have sparked intense controversy in the transition from theory to application: Internationally, autism is no longer classified as a psychosis but as a neurodevelopmental disorder. However, some French psychoanalysts argue that "there is neither clinical nor theoretical evidence to consider autism outside the scope of early psychoses." Bishop and Swendsen emphasize that autistic children are "defenseless against the analyst’s interpretation of their thoughts and motivations," which lack scientific validation. She concludes that adherence to Tustin's theories has led to "misconceptions of successful therapeutic outcomes." These separations caused significant suffering for autistic children and their families. In France, the Rachel affair is described by Christine Philip as emblematic of abusive placements justified by psychoanalytic frameworks, as "professionals in key positions are predominantly trained in the psychoanalytic approach, leading to significant difficulties for families."
From theory to etiology (criticism) British clinical psychologist Thomas Richardson, citing
Peter Hobson (2005), notes that many early psychoanalysts believed autism was psychogenic, a view that persists in some psychoanalytic approaches.
Donald Meltzer (1975) proposed an etiological model based on the dismantling of the ego, suggesting autistic children fragment their sense of self across different senses, impairing their perception of the world. In 1906,
Carl Jung suggested an indeterminate causality, possibly involving metabolic factors or organic brain predispositions. In 1943,
Leo Kanner described autism as an innate "autistic disturbance of affective contact," though he also contributed to the narrative blaming mothers.
On Kanner's "refrigerator mother" theory and its legacy Leo Kanner described autism as a disease akin to
phenylketonuria, characterized by an "innate disturbance of communication." By 1958,
Yale University's autism treatment unit was dominated by psychoanalytic teachings. Neurologist Mary Coleman suggests Kanner was influenced by the antifeminist aspects of psychoanalytic theory, leading to a strong bias against mothers. The "refrigerator mother" theory became closely associated with psychoanalytic approaches, particularly in France. This theory lacks empirical support, as demonstrated by Allen et al. (1971), which found no psychological differences between parents of autistic or intellectually disabled children and control groups. The theory fueled parental activism in the 1980s and 1990s, with media amplifying their revolt. The 2002 documentary
Refrigerator Mothers highlighted the emotional scars inflicted on mothers post-diagnosis, spurring further activism against psychoanalytic approaches. However, Bishop and Swendsen, commenting on a 2020 article by Didier Houzel, argue that claiming psychoanalysis does not blame parents is disingenuous, as the role of parents, especially mothers, as causal factors remains central to French psychoanalytic work with children.
Debates on the effectiveness of psychoanalysis In 2004, psychotherapist Paula Jacobsen's comparative study concluded that psychoanalytic approaches were ineffective for
Asperger syndrome. In 2008, Thomas Richardson compared psychoanalytic and cognitive approaches, noting that neither can claim to cure autism, though cognitive approaches show greater potential for improving outcomes. The
Haute Autorité de santé’s March 2012 report found the efficacy of psychoanalysis for autism "unproven," classifying psychoanalytic approaches and institutional psychotherapy as "non-consensual global interventions" due to a lack of efficacy data and divergent opinions. Since then, three studies have supported the efficacy of psychoanalytically inspired approaches for autistic children, cited below (Thurin, Cornet, Touati). Psychoanalyst Sébastien Ponnou described the methodology as rigorous, meeting the
American Psychological Association’s standards for intensive case studies. The study reported significant reductions in autistic behaviors, improved developmental skills, and enhanced intrapsychic functioning, suggesting increased emotional security and better engagement with the world. However, Franck Ramus criticized the study for methodological flaws, including the lack of a control group and conflicts of interest, arguing it would not meet the standards of an international psychiatric journal. A 2017 study in
L’Évolution psychiatrique evaluated a Lacanian institutional approach at La Coursive in Liège, Belgium, involving 24 autistic children (average age: 7 years, 5 months). After two years, significant progress was reported in communication, autonomy, motor skills, and socialization, though no control group was included. A third study (2016), also without a control group, examined a psychoanalytically oriented eclectic pediatric psychiatry practice in Paris's 13th arrondissement. Among 138 patients diagnosed with pervasive developmental disorders, 62% were classified as having "predominantly psychotic functioning," and 38% as "predominantly autistic." After an average treatment duration of 4.3 years, 20.8% showed highly positive outcomes, 39.6% positive, 30.2% moderate to low, and 9.4% no significant progress. The authors deemed these results "excellent" compared to other methods. Tony Charman (King's College London) stated there is "no evidence for a psychoanalytic approach in treating young autistic children."
Theoretical and social confrontation A battle for autism exists internationally. It involves organized movements with dogmatic boundaries, though these may be more permeable than they appear. Sociologist Lise Demailly describes the controversy as a
cultural specificity of France. In France, the debate is often oversimplified as a binary opposition between
CBT and psychoanalysis, though it involves broader actors, including autistic self-advocates. French psychiatrist-psychoanalysts face strong criticism and disavowal from public authorities. In 2019, Claire Compagnon, overseeing the Fourth Autism Plan, declared on
Public Sénat that "psychoanalysis is not a therapeutic approach for autism." Demailly notes that psychoanalysts continue to produce significant intellectual output, though not in "scientific" journals. Since 2005, the French Psychiatric Federation requires alignment with international standards (ICD-10) alongside CFTMEA. Autism is widely covered in French literature, including parental testimonies, autobiography, fiction, and comics. Notable works addressing psychoanalysis and autism include Laurent Savard's
Gabin sans limites (2018) and the comic
Le psychanalyste parfait est un connard (2016). In 2016,
Psychologies Magazine editor Arnaud de Saint Simon defended psychoanalysis in an editorial.
Parent associations Historian Jonathyne Briggs notes that French parents, especially mothers, initially collaborated with professionals, including those using psychoanalytic approaches, but later resisted as they were blamed for their children’s conditions. Demailly highlights that most French parent associations denounce mistreatment by psychiatrists, psychoanalysts, and the state. Valérie Lödchen, former director of AFG Autisme, described it as using
reductio ad absurdum to highlight the disconnect between psychoanalytic discourse and scientific knowledge. The documentary critiques the psychoanalytic orientation of French psychiatrists, attributing it to deficiencies in autism care and maternal suffering. Its initial ban in January 2012, later overturned, intensified the controversy. Psychoanalyst Alex Raffy notes that autistic autobiographies provide "damning testimonies" of psychoanalytic experiences, describing them as outdated Freudian dogma. Swedish autistic advocate
Gunilla Gerland campaigns against psychoanalysis, stating in her 1998 manifesto that many high-functioning autistic individuals found psychoanalytic therapy unhelpful, degrading, or harmful. She describes personal suffering from four years of psychoanalytic therapy due to misinterpretations.
Temple Grandin, who avoided psychoanalytic therapy, adopts a purely biological model of autism, rejecting psychodynamic theories. In his autobiography
Je suis à l’Est! (2012),
Josef Schovanec recounts the "psychoanalytic coldness" and misdiagnosis of
schizophrenia during five years of treatment by a prominent Parisian psychoanalyst, leading to
neuroleptic-induced apathy. He denounces inappropriate psychoanalytic techniques and compares psychoanalysts to
shamans. Hugo Horiot's family resisted psychoanalytic influence, as seen in
Françoise Lefèvre’s novel
Le Petit Prince cannibale, where a phrase was
censored to avoid accusations of
incest. Horiot's
L’empereur, c’est moi (2013) critiques psychoanalysis, particularly in the chapter "
Cannibale toi-même." In
Carnets d’un imposteur, he describes psychoanalysis as leaving him "defenseless" during school, with theater serving as his true therapy. In
L’autisme expliqué par un autiste (2021), Thibaud Moulas argues that psychoanalysis has had a "catastrophic impact" on autistic lives, citing abusive placements misdiagnosed as
psychosis or
child abuse, such as the Rachel affair. He notes that French psychoanalyst Michel Botbol claimed in 2015 that
Munchausen syndrome by proxy could cause autism, a belief Moulas says remains prevalent. Brigitte Chamak cautions that interpreting autistic testimonies requires context, as some may reflect external influences, such as anti-psychoanalytic parent associations. She cites an autistic individual critical of psychoanalysis yet positive about their own psychoanalytic therapy. Chamak also notes positive testimonies from autistic individuals about psychoanalytic sessions in CMPP or
day hospital settings.
Josef Schovanec (EHESS) dismisses concerns about autistic communitarianism as a French
fantasy, noting that Anglo-Saxon societies do not exhibit such fears.
On professionals The distinction between
psychiatrist, psychologist, and
psychoanalyst is often unclear, and consensus on psychoanalysis is far from unified, particularly regarding autism. From
Eugen Bleuler’s rejection of Freud's sexual symbolism in creating the term "autism," strong oppositions and varied perspectives have persisted. He described interventions with infants showing autistic potential, conducted in the presence of parents and sometimes filmed, requiring tact to reconcile families with their child. Melman acknowledged that uncovering repressed issues has provoked organized parental backlash via internet lobbies, which he criticized for their "persecutory and vengeful passion" against psychoanalysis. Mathematician and psychologist Nicolas Gauvrit criticizes psychoanalysts for evading questions of efficacy by shifting discourse to emotional or ethical realms, perpetuating a caricature of human-focused psychoanalysts versus chemical-focused cognitivists. Jacques Van Rillaer denounces
Lacanian claims of autism as a "psychosis" and their opposition to
cognitive behavioral therapy without empirical validation.
Autism and anti-psychoanalysis (perspectives of psychiatrists and psychoanalysts) Neuropsychiatrist and psychoanalyst Paul Alerini (2011) views autism as a signifier in the history of
child psychiatry, derived from
Eugen Bleuler’s truncation of "autoeroticism." He argues that autism, initially created within psychoanalysis to contrast with infantile psychoses, now opposes it through powerful academic, medical, scientific, and political forces, making autism a "symptom of this reversal." The
Comité consultatif national d’éthique noted France's lag in abandoning psychoanalytic theories, unlike other developed countries in the 1980s. Perrin and Druel-Salmane argue that educational approaches like
TEACCH are mobilized by anti-psychoanalytic coalitions to "liberate autistics from psychoanalysis," which is deemed archaic from a
scientistic perspective. They note that a 1978 work by Rutter and Schopler shifted autism's etiology from environmental to organic causes, though without conclusive evidence. Such
organicist views, they argue, deny the autistic individual's voice. According to Jacques Hochmann, cited by Vincent Flavigny, the "great reversal" in autism's history occurred when psychoanalytic and psychopathological approaches, dominant for 30 years, gave way to an organicist perspective and a shift from mental illness to
mental disability.
"Battle for Autism" in France "Hatred of psychoanalysis" in France: on the film Le Mur (2011) Psychoanalyst and psychiatrist Anna Konrad describes a pervasive "hatred of psychoanalysis" in France, expressed through publications, appeals, blogs, and collectives, amplified by mainstream media. The documentary
Le Mur by Sophie Robert, featuring interviews with psychoanalysts, is described as an "audiovisual attack" using satire and deliberate distortion. Psychiatrist Loriane Brunessaux labeled it a "propaganda film" lacking rigor and honesty.
Cultural resistance to psychoanalysis Jacques Hochmann argues that the "anti-psychoanalytic violence" of some parents, expressed on Internet forums and in media, can be explained historically and psychologically. He credits early psychoanalysts with attempting to rescue autistic children from segregation and
eugenics but acknowledges that "triumphalism, technical errors, and unproven psychogeneticism" caused misunderstandings with parent associations. These were exacerbated by inevitable resistances to psychoanalysis and fears of "child theft," leading to attacks on French
child psychiatry. Hochmann criticizes the "sectarian communitarianism" of parent groups advocating
behaviorism and their effective lobbying of the
Haute Autorité de santé, resulting in the disavowal of psychotherapeutic practices developed in France over half a century. He argues that psychoanalysis is inherently "non-consensual," invoking
Sigmund Freud’s notion of a
narcissistic injury to humanity. Hochmann claims that few parents criticizing psychoanalysis online have had sustained contact with an "authentic psychoanalyst" providing regular sessions. He suggests their criticisms stem from "fantasmatic dangers," hearsay, or misconceptions about psychoanalysis as a dismissive, guilt-inducing theory they have not studied. == See also ==