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French autism treatment disputed

28th August 2007

A French treatment for autistic children with psychiatric problems which involves wrapping the patient in cold, wet sheets from head to foot is undergoing a clinical trial for the first time, which critics hope will see an end to the controversial practice.

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The treatment, known as "packing", involves wrapping a child in wet, refrigerated sheets in order to produce a feeling of bodily limitation and holding, before psychiatrically trained staff talk to the child about their feelings.

Critics have called the procedure cruel, unproven and potentially dangerous, but its proponents say they have seen results.

Pierre Delion is head of the child and adolescent psychiatry unit at Lille Regional University Hospital in northern France, and pioneered the technique, which has its roots in other envelopment or encasement therapies, for example those using mud or clay.

He says that packing reinforces childrens' consciousness of their bodily limits, which in some psychiatric conditions becomes fragmented.

Delion says the technique is indicated for severely autistic children who self-harm; psychotic children; and, more rarely, children with anorexia. He has claimed that it often results in a disappearance of self-harming behaviour.

The process was brought to France by a US psychiatrist, Michael Woodbury, where it was taken up by the psychoanalytic movement founded by Sigmund Freud, which wields strong influence in French psychiatry. In developmental psychological theories, "holding" and the sense of the skin's limitations that it brings, is conceived as a key component of the infant's sense of itself and its relationship with its mother.

However, this model has been subjected to recent challenges, most notably by the French National Consultative Ethics Committee for Health and Life Sciences, which published a report in 1996 stating that there was no evidence to substantiate psychoanalytic models of autism, nor that therapies based on this model were effective.

The authors were also concerned that, in France, childhood autism was classified as an infantile psychosis, rather than as the now internationally recognised description as a pervasive developmental disorder.

At the the Pitié-Salpêtrière Hospital in Paris, where the psychologist Pierre Janet once developed an extensive classification system for psychological disorders and dissociation, packing is used alongside specialised education and medication for some severely autistic and schizophrenic children.

David Cohen heads the child and psychiatry service at the hospital, and he views packing as a form of bodily mediation like massage, which relaxes the child while they receive psychotherapy. It combines, he says, the body and the image of the body, both of which are crucial to each other for psychological integrity.

Experts are awaiting the results of the clinical trial, taking place at Lille, with interest.

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