by Julia Evans on June 30, 2012
Presented at the London Society of the New Lacanian School study day on ‘Autism’ on Saturday 30th June 2012 and programmed as:
Bruno de Florence & Julia Evans: French and English contexts of Autism in relation to Leo Kanner’s 1943 medical formulation of Autism
Addendum: In his summary Bruno de Florence pointed to the dismantling of the symbolic. I think this is the context within which we are positioned currently. This text should be read in conjunction with Bruno de Florence’s text (available here) as one informs the other.
English context of Autism in relation to medical and other political formulations
[Note: This text has emerged from within the New Lacanian School’s registered cartel ‘Jouissance & symbolic (dis)order’. The cartel is based on: The Symbolic Order in the XXI Century: Consequences for the Treatment: July 2010: Éric Laurent : information here [i]]
I have been involved in the politics of mental health since watching, with horror, the passage of the Health Professions Order through Parliament in 2000. Leonardo Gorostiza warning: ‘each time that we insert ourselves into the political field as psychoanalysts, we run the risk of slipping towards group phenomena or confusing the politics of psychoanalysis with party politics’[ii] is apt. Over the last 6 years, [iii]
I have been challenging this slippage, towards the certainty of groups, within Parliament, via a circulation list (regx2), my web-site – Lacanianworks and being a member of the Alliance. This position allows difference rather than the standardisation of groupings and works within networks of relationships, from the bottom up. Also involved is separation from the seduction of capture within the system or group.
As a result, I have been challenging the large professional groups as their position is fighting for Government recognition, approval and funding within the field known as ‘Mental Health’. I have also responded to many Government CON-sultations since 2007.
The challenge is given by Lacan [iv] : (psychoanalysis) should know how to formulate its duties in such terms as would safeguard the principles of truth.
My experience of autism is of an adopted family member living within my extended family for over 30 years.
The type of power the UK Government uses dehumanises both practitioner and recipient
My analysis of power relies on interpretations of René Girard’s [v] (the chief organiser of the 1966 Baltimore conference) work. The rivalrous or non-rivalrous desire he describes, is in relationship to the social other. If the social other is one of demand and rules and regulations, the rivalrous group is produced. [vi] This group’s boundaries are set and when rivalry becomes too much, someone is made to blame and ejected. The discourse of rights also sits here. The group then reforms around a new order and the cycle repeated. The non-rivalrous position involves separating or cutting away from the certainty of the group.
The rivalrous group is depicted in ‘Kant avec Sade’ [vii]. It is this use of power, enshrined in King Harry’s Privy Council [viii], which the Government uses in its high-risk health industry and Happiness Factories (IAPT) [ix] . The major players are seduced inside, by bribes, and then quarrel among themselves as to their conditions of enslavement.
The second way, based within networks of relationships, is where I hope I have situated my actions. This involves being within conversations in the Alliance, both Houses of Parliament and the NLS-registered cartel to which I belong.
How does the Government’s position work for autism?
This process is described by Lacan in Seminar X: January 16th 1963 [x]. The experimenter designs the limits or the stage on which everyone acts. The objective of a Canadian, 2006 paper [xi] : to demonstrate that the evidence-based movement in the health sciences is outrageously exclusionary and dangerously normative with regards to scientific knowledge. As such, we assert it constitutes a good example of microfascism at play in the contemporary scientific arena.
An example, from the Financial Times 2010 [xii], of the Government colonising Autism with its Agencies’ help.
The research claim is the development of the first simple biological test for autism.
The evidence: the test, based on a 15-minute brain scan, was 90 per cent accurate in identifying autistic adults.
The cost benefit analysis: Diagnosis costing around £2,000 per person reduced to under £200.
The certainty of diagnosis: Five aspects of brain volume and shape in combination are a reliable indicator. Use of “objective biomarker’ is alleged to be more certain or accurate than simply the opinion of a clinician.
Assumptions underlying this scientific research [xiii] :
The Medical Research Council, the funders, state (i) it is possible to reduce the financial burden of mental ill-health, (ii) a national mental health strategy is possible, and (iii) it is possible to prevent mental illness.
In the original paper, the summary [xiv] states that discrimination was not found between individual cortical features and the two experimental groups, and between other brain patterns across parameters. This contradicts the ft article.
I suggest that absolute certainty of machine-led diagnosis, even if based in biology, is a myth. There is of course a vast difference between this labelling and psychoanalytic diagnosis which informs the direction of the treatment.
So where did this mythical autism test originate? I suspect the experimenter’s compliance with the Medical Research Council’s politically driven allocation of research funding. Look at the savings & look forward to the early diagnosis and cure of the condition! This complies with medical discourse of disease prevention.
Quote from Éric Laurent [xv]: ‘Backing up this operation was a recourse to science. Science would affirm its ability to account for the phenomena through strict biological considerations, regardless of the relationship the subject has with the world.’
In the footnote is Freud’s account of the use of a scientific, physical therapy on nervous afflictions. [xvi]
Autism as a clinical diagnosis:
In DSM [xvii] autism is included along with mental retardation as a developmental disorder. NICE (National Institute for Clinical Excellence) clinical guidelines are set out for childhood autism [xviii] . Introduced thus: The signs and symptoms are a combination of delay in expected features of development and the presence of unusual features. They work to help professionals recognise a pattern of impairments in reciprocal social and communication skills, together with unusual restricted and repetitive behaviours.
A selection of the criticisms of this form of diagnosis from the group: Critical Psychiatry [xix] .
Psychiatric diagnoses are not valid.
Use of psychiatric diagnosis increases stigma.
Using psychiatric diagnosis does not aid treatment decisions.
Long term prognosis for mental health problems has got worse.
It is a common result that the number of labelled sufferers increases [xx], with official labelling. I believe this labelling via NICE or DSM leads to increased recognition rather than something in modern societies making autism more common. [xxi]
The Guardian: April 2012 [xxii] joins in the labelling with a list of key difficulties in an article exploring how the Autism Act 2009 [xxiii] , affects the employment of those labelled as autistic. This description ends with: ‘They are usually scrupulously honest – they just don’t have the guile to be anything else, and they can’t lie.’
Judgemental or what?
So defining and labelling a group, Autism, differentiates them from us. The boundaries of the group are fixed by the ONE knowledge of NICE guidelines. The decision whether you are inside or outside belongs to a professional other who imposes the label on you. This group is defined by a set of symptoms held in common. They are therefore different to normal human beings. Standardised treatments are matched to the label.
I have heard this week of a 13 year old, who has been moved from daily schooling & living home-based to residential care, against the wishes of her parents. She has been diagnosed using NICE clinical guidelines and the prescribed treatment applied. This is our Social Work Secret Police at work. There is an appeal, through a court of law, otherwise the judgment is absolute. On appeal, the parents appear as criminals do, to defend their actions. Incidentally, the Government will now have to find at least £10,000 a week to support her within its high risk Mental Health Factory.
Quote from Jacques Lacan [xxiv] : The facility of Freud here is simply to make the decisive step of introducing the subject as such, which means that the mad are no longer sized up in terms of deficits and dissociative functions. … For to construct the subject by taking the unconscious as a point of departure is a matter of logic, as a glance at one of Freud’s books is enough to make clear…
The label, autism, may be further sub-divided into high-functioning autism [xxv] , described in Guardian April 2012 article, and autism. I suspect that high-functioning would have other diagnoses if viewed psychoanalytically. Example: One woman is diagnosed, aged 30 with Asperger’s, a form of autism. The diagnosis was a relief to her, probably as it imposed an identification or group label which orientates. Late diagnosis of women is common.
So why would anyone volunteer to be labelled? – the Government’s discourse of protection……
By 2001, legislation included the phrase ‘to safeguard the health and well-being of persons using…’ [xxvi] So the UK Government takes on the role of protector, acting in addition to the police. Autism has become a special case [xxvii]. The Autism Act 2009 is a response to those with autism and was the first-ever piece of disability-specific legislation to be passed by the UK government. It operates in England only. [xxviii] The explanation of what it sets out to achieve as explained by [xxix] autism.org. As the guidance is statutory, local councils and local health bodies have a legal duty to implement it. Where the guidance says something should be done, this means it has to be done by law, unless they have a strong reason not to. Lack of money will not necessarily be a strong reason.
NICE [xxx], has to produce a strategy for those defined within autism and produce guidance for local authorities to implement. This includes developing a clear, consistent pathway for diagnosis of autism across the country. (This increased diagnostic capacity should ensure an explosion of those labelled as austistic.) NICE also sets out a model care pathway. [xxxi]
So not only are the group defined by Autism separated off from normal groupings but their diagnoses and treatment are driven from a central standard which is testable in a court of law. Someone diagnosed as autistic, is defined in law, as in need of direct Government protection. Thus, those ‘high-functioning’ autistics in the April Guardian article, cannot be sacked as their inability to behave ‘normally’ is protected. No wonder they remain unemployed. [xxxii]
How else is Government-driven protection in operation?
To return to my family member who lived within my extended family from the age of 3 for over 30 years.
One morning at 8am, this bohemian household was awoken to a police raid, with some officers carrying guns. Every room was searched and the family member’s room was entered. No reason for the raid was given. Overnight the door was secured so that her location was known.
Two days later, there was a further raid and the family member removed for her own protection under the Safeguarding Vulnerable Groups Act 2006 [xxxiii] . Underwear from all the males was also removed.
In subsequent transactions over the next 18 months, it appeared that the only sense the police could make of a thin, inarticulate woman, who was shaking, was that she was being kept locked-up as a sex slave. Her appearance and behaviour were outside the boxes in which they had been taught to look.
No evidence was ever found to support the search warrant for the first raid. After years of fishing, this may have been suspicion of downloading of pornographic images.
The police dropped all charges from the second raid, relating to false imprisonment and abuse, after 18 months of investigation following her removal.
The current situation is that the family member remains in institutional care (at a cost of £10,000 a week) and controlled by drugs. Her former carers are banned from contact with children, vulnerable adults and are not allowed to take even cleaners’ jobs within Retirement Homes. Social Services hold the black list on which they appear, and because it is driven by Sadeian power, there are no appeals. The home where she had lived for over 30 years did not tick the boxes on one social worker’s list, even following the Police’s reluctant admission of holding no evidence.
No room for relationships. No room for bringing the system into question. Judgment is absolute. When you force entry into a house, then you search the rule book until you find a situation which makes sense what confronts you.
As Patricia Hewitt MP, then a Minister of State, stated 2007: the system is able to judge clinically and is never wrong. [xxxiv]
However, I view the system as inhuman in that it guards the One Empty knowledge and has no doubts about its truth and efficacy. I define the authoritarian use of this absolute form of knowledge as abusive.
It denies our common humanity.
So in England, autism is diagnosed, treated and protected by Government decree.
I suggest that Government prescribed and mandated systems of ‘care’ for those of us with government-defined mental ill- health labels are much more abusive than existing practices supported by the diversity of over 570 [xxxv] training organisations working within relationships of care and trust.
[i] Web-links to Éric Laurent’s text are available on www.LacanianWorks.net
[ii] Because each time that we insert ourselves into the political field as psychoanalysts, we run the risk of slipping towards group phenomena or confusing the politics of psychoanalysis with party politics. That is why with regard to the WAP Council meetings last January I convened the councillors to present their ideas on this point in the texts of our working document and I proposed to hold a WAP soirée at the headquarters of the ECF under the title “Psychoanalysis in today’s politics”. From Leonardo Gorostiza’s report: Moral and Administrative Report from the President of the World Association of Psychoanalysis: Buenos Aires: 27th April 2012: as circulated by the EuroFederation of Psychoanalysis: on 24th June 2012.
[iii] The following principles for action have been devised:
regx2 works in relationships with others to:
Enable sufferers from symptoms of psychic or mental distress to choose the treatment or practice which works for them rather than the One prescribed by the government.
Resist the top-down imposition by the law of the One Standard driving practitioners’ training, development, practice, ethics, complaints procedure, etc that produces unhealthy uniformity. N.B. The DoH Scoping Project (July 2005) found 570 training organisations. This strategy seeks to support this healthy diversity rather than protect or prioritise one or a section of its variants. [Interim Report to Department of Health on Initial Mapping Project for Psychotherapy & Counselling: Sally Aldridge and James Pollard: July 2006: available here or here]
[iv] The last sentence of Jacques Lacan: British Psychiatry and the War: 1947: translated by Philip Dravers and Veronique Voruz: Psychoanalytical Notebooks of the London Circle: vol 4, Psychiatry and Psychoanalysis: Spring 2000:p9-34. Also availability indicated on www.lacanianworks.net at here.
[v] Canon Dr Giles Fraser, then of St Paul’s Institute, St Paul’s Cathedral first drew my attention to René Girard’s work on 1st May 2011 during one of his talks. I also have consulted James Alison. (Girard’s breakthrough: James Alison: The Tablet: 29th June 1996 Also available on the internet at www.jamesalison.co.uk). I intend to read René Girard’s book: Things hidden since the foundation of the world: 1978 over the summer 2012…
René Girard was the key organisers of the 1966 Baltimore conference at which Jacques Lacan spoke. Kanner, the inventor of autism (see Bruno de Florence’s paper), was previous to Girard, at the John Hopkins University, Baltimore.
[vi] I refer you back to Eric Laurent’s mention of Russell’s paradox in his 2010 paper for the impossibility of this position. This text, given in July 2010, led to the VIII Congress of the World Association of Psychoanalysis in April 2012: text available here or here.
[viii] King Henry VIII invented the Privy Council when Parliament interfered in his plans too much. This is documented elsewhere on LacanianWorks.net. This works differently to the form of law in general use in the UK. It does not use ‘causa sui’ or case law. It is an exact judgment against the standards as defined in the law. Any appeal is outrageously expensive as it goes directly into the House of Lords.
[ix] ‘high-risk health industry’ was coined by the then Chief Medical Officer, Lord Donaldson, in his paper: Good doctors, safer patients: Proposals to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients: Published date: 14 July 2006: available here
IAPT is the Government’s contracted-out provision of services to those categorised through NICE clinical guidelines as mentally ill. Further information about ‘Improving Access to Psychological Therapies’ is available here.
Seminar X: January 16th 1963: Chapter VIII: page 9
This phenomenon of edge, in what opens like this window on privileged occasions, marks the illusory limit of this world of recognition, of the one that I call the stage. That it should be linked to this edge, to this framing, to this gap which is illustrated in this schema at least twice, in this edge here of the mirror and moreover in this little sign, <> , that this is the locus of anxiety, is what you ought always to retain as the signal of what is to be sought in the middle.
[xi] Deconstructing the evidence-based discourse in health sciences: truth, power and fascism by Dave Holmes RN PhD, Stuart J Murray PhD, Amélie Perron RN, PhD(cand) and Geneviève Rail PhD: International Journal of Evidence Based Health part c: 2006; vol 4: p180–186: available here
British scientists have developed what they say is the first simple biological test for autism.
A study at the Institute of Psychiatry, London, showed that the test, based on a 15-minute brain scan, was 90 per cent accurate in identifying autistic adults. The researchers, funded by the UK Medical Research Council, expect it to be even better at diagnosing autism in children.
Until now, diagnosis of adults has been a drawn-out process involving a day-long assessment of the patient, plus personal accounts from his or her family and friends. For young children, the process takes longer.
“The current lengthy process costs around £2,000 per patient”, said Christine Ecker, an author of the study, published on Wednesday in the Journal of Neuroscience. “Our approach costs £100 to £200 for a brain scan.”
Autism and related disorders such as Asperger’s syndrome, which impair the ability to relate socially, affect an estimated 1 per cent of the UK population. About three-quarters are male.
The incidence has risen substantially in recent years, although it is not clear if something in modern societies is making autism more common or whether it is simply becoming more widely recognised.
While autism appears variable in its causes and symptoms, the scientists found five aspects of brain volume and shape that in combination are a reliable indicator of the disorder. They developed a computer programme to identify these characteristics on an magnetic resonance imaging brain scan.
Decian Murphy, professor of psychiatry at the institute, said the research would enable doctors to diagnose autism “based on an objective ‘biomarker’ and not simply on the opinion of a clinician which is formed after an interview”. “Being diagnosed means patients can take the next steps to get help and improve their quality of life,” he said.
The technique will need further validation before it is used routinely on adults. “Clearly the ethical implications of scanning people who may not suspect they have autism needs to be handled carefully and sensitively as this technique becomes part of clinical practice,” said Prof Murphy.
Paul Matthew, a professor at Imperial College’s Centre for Clinical Neurosciences, who was not involved in the study, said: “This work now needs to be extended to say affected children, for whom the impact of more certain prognostic information could be much greater.”
Dr Ecker said she was confident of success in this area because research suggested autism caused greater brain differences in children than in adults.
[xiii] Abbreviated from ‘Challenges to Government’s principles used to define the care of mental ill-health’ circulated widely in Parliament and to regx2 group in July 2010.
Assumptions used in the Mental Health Review Group’s for the Medical Research Council’s research strategy
Some of the unfounded assumptions in a recent Lancet article:
Reference: ‘A UK strategy for mental health and wellbeing': www.thelancet.com: Vol 375: May 29th 2010: pages 1854-1855: by Barbara J Sahakian, Gavin Malloch, Christopher Kennard: on behalf of the Mental Health Review Group, Department of Psychiatry and MRC/Wellcome Trust, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK (BJS); Medical Research Council and Department of Clinical Neurology, University of Oxford.
The numbers game. There are lies, damned lies and statistics…..
‘16% of adults in the UK have a common mental disorder such as depression at any one time.
Nearly 10% of children aged 5-16 years have a clinically diagnosable mental health problem which can often persist into adult life.
Mental health problems are also an enormous financial burden to society and the economy.
To ensure an economically competitive and flourishing society, we have to reduce the burden of mental ill-health’
Challenges: What is the Government’s evidence for this statement which connects an economically flourishing society with a reduction in the burden of mental ill-health? How do they define a flourishing society? One where individual difference and the right to be miserable, are removed? What is your definition?
I remind you that the Third Reich also thought it knew how to reduce the burden of ill-health.
Is this reduction really a proper concern for a Government?
‘An innovative vision for a national mental health strategy’
Challenge: Is a national mental health strategy possible?
If yes, do you start at the top and define what a Government-approved standard unit of wellbeing is, or at the bottom, with the individual sufferer?
‘ The prevention of mental illness is a long-term aim’
Wow! A history lesson is in order.
The following is based in Wikipedia’s description of Melancholia on June 30th 2010, here.
Conclusions: Symptoms of mental ill-health have been written about since the 5th century BC – 7,000 years. The causes of mental ill-health have been a matter of conjecture throughout this time. The symptoms of mental ill-health as described in NICE clinical guidelines are just the latest futile attempt to rigidly classify signals which vary with each unique human being. The NICE prescribed treatments are cost-limited sessions of cognitive behaviour therapy or being coshed with drugs. I think that the 17th century prescription of music and dancing more matches with the Archbishop of Canterbury’s view as expressed to the new Parliament on Tuesday 8th June, 2010.
The MRC report sets out to eliminate mental ill-health using techniques from preventive medicine – techniques which have been very successful in eliminating polio, scarlet fever, and so on. I do not think the elimination of mental ill-health either possible or desirable. Symptoms of mental ill-health have been with us for more than 7,000 years and I agree with Dr Williams that taking steps to make the mentally ill disappear diminishes what it is to be human.
So how is this Government going to show their responsibility for those who they define as unproductive?
Are they going to continue supporting research based on the factory method of producing wellbeing, as above?
Or listen to alternative approaches to the problem?
[xiv] Neurobiology of Disease: Describing the Brain in Autism in Five Dimensions—Magnetic Resonance Imaging-Assisted Diagnosis of Autism Spectrum Disorder Using a Multiparameter Classification Approach: Authors, Christine Ecker, Andre Marquand, Janaina Mourão-Miranda, Patrick Johnston, Eileen M. Daly, Michael J. Brammer, Stefanos Maltezos, Clodagh M. Murphy, Dene Robertson, Steven C. Williams, and Declan G. M. Murphy : The Journal of Neuroscience: 11 August 2010: 30(32) here
[xv] ‘Storytelling and Judgment’ by Eric Laurent From Lacan Quotidien, No 142 – 28th January 2012, English translation circulated on NLS Messenger no 396 on 15th March 2012 : available on the New Lacanian School’s web-site from: Recent NLS-Messager, English: here & French: here
[xvi] Freud’s conclusion from his neurological researches into the effects of electric stimulation.
Sigmund Freud’s 1914 paper ‘On the history of the psychoanalytic movement. ‘ On the 3rd page in (p65 Penguin version), I quote:
It is well known, too, that after Breuer made his first discovery of the cathartic method he let it rest for a number of years, and only took it up again at my instigation, on my return from my studies under Charcot. [Footnote: Freud worked at the Salpétrière in Paris during the winter of 1885-6. See his ‘Report of my studies’ (1956a)] He (Charcot) had a large consulting practice in medicine which made great claims on him; I myself had only unwillingly taken up the profession of medicine, but I had at that time a strong motive for helping people suffering from nervous affections or at least wishing to understand something about their states. I had embarked upon physical therapy, and had felt absolutely helpless after the disappointing results from my study of Erb’s ‘Elektrotherapie , which put forward such a number of indications and recommendations. If I did not at the time arrive on my own account at the conclusion which Moebius [Footnote: Paul J. Moebius (1853-1907) was Lecturer in in Neurology at Leipzig University, and specialized in diseases of the nervous system.] established later, that the successes of electrical treatment in nervous patients are the effects of suggestion, there is no doubt that only the total absence of these promised successes was to blame.’
So Freud in his early career as a medically trained physician failed to establish the efficacy of ‘physical’ therapy – the use of the then new-fangled electricity.
[xvii] Available at DSM: here: Axis II: Developmental Disorders and Personality Disorders: Developmental disorders include autism and mental retardation, disorders which are typically first evident in childhood
The signs and symptoms in tables 1–3 are a combination of delay in expected features of development and the presence of unusual features, and are intended to alert professionals to the possibility of autism in a child or young person about whom concerns have been raised. They are not intended to be used alone, but to help professionals recognise a pattern of impairments in reciprocal social and communication skills, together with unusual restricted and repetitive behaviours.
Social interaction and reciprocal communication behaviours
Language delay (in babble or words, for example less than ten words by the age of 2 years)
Regression in or loss of use of speech
Spoken language (if present) may include unusual: non-speech like vocalisations; odd or flat intonation: frequent repetition of set words and phrases (‘echolalia’); reference to self by name or ‘you’ or ‘she/he’ beyond 3 years
Reduced and/or infrequent use of language for communication, for example use of single words although able to speak in sentences
Responding to others
Absent or delayed response to name being called, despite normal hearing
Reduced or absent responsive social smiling
Reduced or absent responsiveness to other people’s facial expressions or feelings
Unusually negative response to the requests of others (demand avoidant behaviour)
Rejection of cuddles initiated by parent or carer, although may initiate cuddles themselves
Interacting with others
Reduced or absent awareness of personal space, or unusually intolerant of people entering their personal space
Reduced or absent social interest in others, including children of his/her own age – may reject others; if interested in others, may approach others inappropriately, seeming to be aggressive or disruptive
Reduced or absent imitation of others’ actions
Reduced or absent initiation of social play with others, plays alone
Reduced or absent enjoyment of situations that most children like, for example, birthday parties
Reduced or absent sharing of enjoyment
Eye contact, pointing and other gestures
Reduced or absent use of gestures and facial expressions to communicate (although may place adult’s hand on objects)
Reduced and poorly integrated gestures, facial expressions, body orientation, eye contact (looking at people’s eyes when speaking) and speech used in social communication
Reduced or absent social use of eye contact, assuming adequate vision
Reduced or absent joint attention shown by lack of: gaze switching; following a point (looking where the other person points to – may look at hand); using pointing at or showing objects to share interest
Ideas and imagination
Reduced or absent imagination and variety of pretend play
Unusual or restricted interests and/or rigid and repetitive behaviours
Repetitive ‘stereotypical’ movements such as hand flapping, body rocking while standing, spinning, finger flicking
Repetitive or stereotyped play, for example opening and closing doors
Over-focused or unusual interests
Excessive insistence on following own agenda
Extremes of emotional reactivity to change or new situations, insistence on things being ‘the same’
Over or under reaction to sensory stimuli, for example textures, sounds, smells
Excessive reaction to taste, smell, texture or appearance of food or extreme food fads
Abolish the use of formal psychiatric diagnostic systems like ICD and DSM
Psychiatric diagnoses are not valid.
Use of psychiatric diagnosis increases stigma.
Using psychiatric diagnosis does not aid treatment decisions.
Long term prognosis for mental health problems has got worse.
Psychiatric diagnosis imposes Western beliefs about mental distress on other cultures.
Alternative evidence based models for organizing effective mental health care are available.
To read the full evidence based arguments view the ‘No More Psychiatric Labels’ paper here
[xx] Quote from: The bipolar explosion: Psychiatry is at last asking the right questions about a remarkable shift in mental health diagnosis : by Darian Leader : guardian.co.uk : Wednesday 20 June 2012 : available here
‘In the early 20th century the prevalence of manic depression was put at less than 1% of the population, but this figure exploded with the ramification of the bipolar categories. If bipolar 1 was often equated with classical manic depression, bipolar 2 lowered the threshold dramatically, requiring merely one depressive episode and one period of increased productivity, inflated self-esteem and reduced need for sleep.
Bipolar 2 and a half, 3, 3 and a half, 4, 5 and 6 soon followed. Today there is even “soft bipolar”, which means a patient “responds strongly to losses”. The World Health Organisation deems bipolar the sixth main cause of disability for people aged 15-44. In children, the diagnosis has increased by over 400%.’
This has also been noted in ADHD and other conditions labelled by NICE. If diagnosis is within a Lacanian practice, then labeling becomes meaningless. A diagnosis informs the direction of the treatment, not expands or contracts by political will. Éric Laurent argues this point further in: The Chronicle of Éric Laurent – Autism: Epidemic or Ordinary State of the Subject?: Lacan Quotidien 194: 10th April 2012: and circulated, in translation, on New Lacanian School’s Messager no 490: 1st July 2012
[xxi] From ft 2010 op. cit., The incidence has risen substantially in recent years, although it is not clear if something in modern societies is making autism more common or whether it is simply becoming more widely recognised.
[xxii] Quote from: Our lives shaped by autism : Charlotte Moore’s autistic sons George and Sam are now 22 and 20. Is there anything she would have done differently? by Charlotte Moore : The Guardian : Saturday 24 March 2012 or here
Autism is as yet undetectable before and immediately after birth. The average age of diagnosis is about five. Therefore nearly all parents of autistic children have a period of expecting that their child will develop neurotypically (non-autistically). It’s hard to shake off the assumptions of those early months or years, and take in the fact that your child will do everything differently.
Quote from: Autistic workers: loyal, talented … ignored, Employers could recruit a whole army of unique workers. But ignorance and fear get in the way. Lynne Wallis looks at why autism is so misunderstood and what sufferers can offer: guardian.co.uk, Friday 6 April 2012 or here
The key difficulties are social interaction, establishing relationships, lack of emotional reciprocation (which can give an impression of indifference), difficulty with flexibility of thought, forward planning and thinking in abstract ways. The upside, however, is equally considerable.
According to Jane Asher, who is president of NAS, autistic people often make better employees than those known in the word of autism as “neuro-typicals” – ie, the rest of us. She explains: “People with autism tend to be very reliable and punctual. They like routine, and most won’t mind doing repetitive tasks. Many are very good with maps and figures. They are usually scrupulously honest – they just don’t have the guile to be anything else, and they can’t lie.
[xxiv] Presentation of the Memoires of President Schreber in French translation: Jacques Lacan: translated Andrew J. Lewis: 1966: published in Analysis: vol 7: p1-4 1996: For availability see www.lacanianworks.net at here.
[xxv] An aside: this label, autism, is increasingly being divided into high-functioning autists, and autists. A high functioning autist from the Guardian – see below for full quote: ‘Penny age 31: “I never fitted in. I was an observer rather than part of the team – ‘the tribe’ as I thought of them – because I never understood the unwritten rules.” The source of her difficulties was a mystery to everyone including her, until she was diagnosed with Asperger syndrome – a form of autism – aged 30. Penny always knew she was different. The diagnosis was a relief.’
My comments: This firm diagnosis may be operating as a semblant, to enable the subject to operate. In my clinic, I often find that internet diagnoses may also give a means of group identification. If diagnosis is within a Lacanian practice, then this division of the label becomes meaningless. A diagnosis informs the direction of the treatment, not expands or contracts by political will. Éric Laurent argues this point further in: The Chronicle of Éric Laurent – Autism: Epidemic or Ordinary State of the Subject?: Lacan Quotidien 194: 10th April 2012: and circulated, in translation, on New Lacanian School’s Messager no 490: 1st July 2012
Quote from: Autistic workers: loyal, talented … ignored, Employers could recruit a whole army of unique workers. But ignorance and fear get in the way. Lynne Wallis looks at why autism is so misunderstood and what sufferers can offer: guardian.co.uk, Friday 6 April 2012 or here
‘Penny Andrews has a chequered CV for a 31-year-old. She struggled in her first job as an editorial assistant, which ended in redundancy. Her next employer disciplined her for publicly discussing colleagues’ pay rises, while another let her go for lacking initiative. Others insisted she had no common sense and was “ditzy”. Both descriptions are inaccurate, she insists.
Andrews comes across as sharp and self-aware, with a perceptive intelligence. Currently studying for a degree in IT and communications with the Open University, she recalls: “I never fitted in. I was an observer rather than part of the team – ‘the tribe’ as I thought of them – because I never understood the unwritten rules.”
The source of her difficulties was a mystery to everyone including her, until she was diagnosed with Asperger syndrome last year – late diagnosis is typical of females with autism which includes Asperger syndrome. Andrews says she always knew she was different and that the diagnosis was a relief.
“I just thought I was a terrible person who couldn’t make a job, or anything else, work out. I dropped out of two previous university degree courses because of similar problems around fitting in and communication,” she says.
“Now that I understand more about myself and my autism, I want to raise awareness among employers of what it is; that it isn’t a bad thing, just a different thing. I would love a job that took my skills and harnessed them, because of who I am, and what I am, rather than in spite of it.”
She says she can be “bubbly” if she tries really hard, but it exhausts her as it is learned behaviour rather than something that comes naturally. “If I was myself, everyone would think I was a boring cow.”
[xxvi] Health Professions Order 2001: available here: The main objective of the [Health Professions] Council in exercising its functions shall be to safeguard the health and well-being of persons using or needing the services of registrants.
[xxvii] From Guardian 6th April 2012, op. cit.: The Autism Act 2009, a response to continued poor employment rates for people with autism, was the first-ever piece of disability-specific legislation to be passed by government. The Department for Work and Pensions and the NAS have since published a guide for employers, Untapped Talent, on taking on autistic people which highlights their aptitude for problem-solving and attention to detail, high levels of concentration, reliability, loyalty, excellent memory and detailed factual knowledge, retention, resourcefulness and technical ability.
Everyone is different, however, and the minister for Welfare Reform, Lord Freud, recalled a well-worn quote during his speech at the launch of the Undiscovered Workforce, namely “Once you’ve met someone with autism … you’ve met someone with autism.”
[xxviii] From Guardian, 6th April 2012, op. cit.
[xxix] A guide for employers, Untapped Talent, on taking on autistic people and the minister for Welfare Reform, Lord Freud, has recently launched Undiscovered Workforce. The explanation of their use is explained in autism.org: here
Quote: We have also produced a separate guide for people with autism and parent/carers specifically about the statutory guidance published on 17 December 2010. Read the guide here.
What is the Autism Act? The Autism Act 2009 was the first ever disability-specific law in England. The Act did two key things: The first was to put a duty on the Government to produce a strategy for adults with autism, which was published on 2 March 2010. The second was a duty on the Government to produce statutory guidance for local councils and local health bodies on implementing the adult autism strategy by the end of 2010. This guidance was published on 17 December 2010.
The Act, strategy and the statutory guidance relates only to adults with autism living in England.
What is the adult autism strategy? The adult autism strategy is the Government’s plan to make sure that adults with autism get the help that they need. This might be things like help to get a job or help at home.
What does the adult autism strategy say? The adult autism strategy explains the different things that the Government will do to make sure adults with autism get the help that they need. The strategy also tells local councils and health services how they can help people with autism.
There are five things in the strategy which the Government has decided are the most important: (1) making sure that more people understand about autism (2) making it easier for adults to get a diagnosis of autism – a diagnosis is when a doctor tells someone that they have autism (3) making it easier for adults with autism to choose how they live and get the help that they need to do this (4)helping adults with autism to find jobs (5) helping local councils and health services to write plans so that the adults with autism who live in their area get the help that they need.
What is the Autism Act statutory guidance?
The statutory guidance has been published to ensure the implementation of the adult autism strategy. This guidance tells local authorities, NHS bodies and NHS Foundation Trusts what actions should be taken to meet the needs of people with autism living in their area.
It clearly states that local authorities and the NHS: (1) should provide autism awareness training for all staff (2) must provide specialist autism training for key staff, such as GPs and community care assessors (3) cannot refuse a community care assessment for adults with autism based solely on IQ (4) must appoint an autism lead in their area (5) have to develop a clear pathway to diagnosis and assessment for adults with autism (6) need to commission services based on adequate population data.
As the guidance is statutory, local councils and local health bodies have a legal duty to implement it.
Where the guidance says that a local area should do something, this means that they will have to do it by law, unless they have a strong reason not to. Lack of money will not necessarily be a strong reason.
What difference will the statutory guidance have?
Things will not change instantly. The passing of the Autism Act was a fantastic first step and the publication of the statutory guidance marks a turning point for people with autism. But now, it is important for local authorities and NHS bodies to implement the strategy and statutory guidance so that change actually happens on the ground.
To help these local authorities and NHS bodies, the Department of Health commissioned the NAS to develop a central online resource. This resource has been developed to support health and social care professionals in the implementation of the strategy and can be found at here
Local campaigning is so important. If you think that your local council or health service is not doing what the strategy or statutory guidance says it should do, you might want to try to do something to change this. You can email email@example.com or call 020 7923 5799 for advice about what you could do.
Why does the Autism Act, autism strategy and statutory guidance not cover children?
At first, the Autism Bill was about adults and children. But the Government told us that they would help children with autism in other ways.
The NAS is continuing to campaign in other ways for better services for children with autism. For more information on what we are doing on education in particular, visit: http://nas-education-update.blogspot.com/
What nations does it cover? The strategy only covers England.
Quote: NICE to play key role in national autism strategy
NICE is developing a clinical guideline to help improve the care of adults with autism that will contribute to achieving the aims of the first ever autism strategy for adults in England.
The strategy, Fulfilling and rewarding lives, was launched today by the Department of Health in order to kick-start a fundamental change in public services helping adults with autism to live independent lives and find work.
Autism is a lifelong developmental disability and although some people can live relatively independently, others will have high dependency needs requiring a lifetime of specialist care. There are approximately 400,000 adults with the condition in England, around half of whom have a learning disability.
The first, and fundamental, step of the strategy is to increase awareness and understanding of autism across all public services.
The second strand of the strategy is to develop a clear, consistent pathway for diagnosis of autism across the country. To support this, NICE is developing a clinical guideline which will include diagnostic processes.
The overall aim is to increase capacity around diagnosis so that in every area of the country people have easier access to diagnosis if they want it and a clear, consistent pathway for diagnosis.
The forthcoming NICE guideline will also set out a model care pathway, which will form the foundation for local commissioners to develop referral and care pathways in their areas, supported by their strategic health authority where necessary.
Care Services Minister Phil Hope said: “I want the autism strategy to be the foundation for change in the way our whole society treats adults with autism. They have a huge contribution to make – shutting them out deprives everyone.
“It is unacceptable that adults with autism are not getting the support they need to live independently and find work. This strategy will start a fundamental change in public services with better awareness and understanding. It puts more momentum into tackling social exclusion among adults with autism alongside other work, including new NICE clinical guidance and research.”
NICE is also working to produce a clinical guideline for children and young people with autism later this year.
The Government will publish a first year delivery plan in March 2010, followed by statutory guidance for health and social care by December 2010. The strategy will be reviewed in 2013.
3 March 2010
This page was last updated: 14 April 2010
[xxxi] Rules and regulations being moved to the position of gods to be obeyed, is repeated in the case study offered by Cathy Glass. The rules seem to offer the comfort of complete certainty and drive the professionals decisions.
It seems to me that Lacan is exploring being judged by rules in the opening chapter of Seminar XI.
Case study circulated on regx2 listing in November 2010:
Attempting to switch my brain off whilst on holiday, I picked Cathy Glass’s ‘I miss Mummy': Harper Collins: 8th July 2010: from the bookshelf. This was a big mistake.
The first time through I could not put it down and started to ask why. It did not make sense. The second time through a very different story emerged.
1st story: 4 year old Alice is taken into care and does not understand why she cannot stay at home with her grandparents (Mother’s family). It transpires that her social worker panicked on learning that Alice has had contact with her Mother over Christmas. This is against the rules so she is removed. Alice was placed with G/ps when her Mother became too ill to cope. It is thought that drugs were involved. Initially, it is going to be a short – 4 week – placement and Alice will go and live with her biological father and his new wife. Social workers turn over rapidly so no moves are made to transfer Alice. No-one except the foster mother, Glass, notices that there is no relationship between Alice and her father/step-mother. They have access meetings twice a week and the g/ps once a fortnight. There is already a gap between what the rules state is going on and what is going on. After 10 mnths of this pattern of access, Glass manages to get contact with the Mother re-established and after a further 2 months Alice is returned to the g/ps who have had the rules re-explained to them to prevent further transgression. The hero is Alice who never wavers from her position of wanting to live with her mother and/or g/ps. So the events all have a reasonable, rational decision-taking process behind them. To the end, the father is believed – he still has access twice a week despite Alice telling of his abuse to her mother, manipulating a drug test, violence towards his current partner, the non-relation between Alice and her father/step-mother and the consistency of the g/ps story. These themes are handled by the book.
The second time through I was trying to make sense of why the father and his current partner who have no children of their own, were pursuing Alice. The father, except for the weeks leading up to the mother’s breakdown, did not live with Alice’s mother. On the surface, they were rescuing Alice from an unstable Mother. Offering all sorts of gifts – doll’s prams, etc. Alice was unimpressed. She had seen her father make her Mother crawl on all fours like a dog and lick his shoes when she was desperate for drugs – Alice called it icing sugar. Many times the current partner was reporting to social workers that she had been physically attacked. Once she arrived at the Mother’s flat who let her in, complained of an attack, telephoned the father and ended apologising to him for upsetting him so much he had attacked. Clearly, the father is abusive. So why is Alice being pursued ostensibly by her step-mother. The father is always in the background. I suggest that the step-mother is procuring Alice for the father to sexually abuse. Alice is a very bright, attractive child. This explanation does not occur to the many social workers (4 in the first 6 weeks), legal Guardians, judges and so on involved. Why? Because they are trying to find a way out which will be supported by the rules. A safe option which will have their backsides covered. The outcome: a child settled with one of her birth parents. The rules do not tell them to investigate why this parent wants control of her. The rules do not tell them to scratch the surface of what they are being told, and see if it still holds together. I suspect that the writer/foster Mother has put this together, though this is not stated overtly. She is able to think outside the box.
[xxxii] From Guardian, 10th April 2012, op. cit.: Job interviews are a huge barrier to employment because of the requirement for good communications skills. Just 15% of those with autism have full-time jobs according to NAS research, while another 9% are in part-time work. These figures compare unfavourably with the 31% of all disabled people in full-time work in the UK, while more then a quarter of all graduates with autism are unemployed, the highest rate of any disability group nationally.
[xxxiv] Quoted from Julia Evans’ reply to the ‘CON-sultation: Equity and excellence: Liberating the NHS White Paper July 2010’ : October 9th 2010. The full reply is available here: Reply to CON-sultation: Equity and excellence: Liberating the NHS White Paper July 2010 or here.
Reference: White Paper: Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century Presented to Parliament by the Secretary of State for Health, The Rt Hon. Patricia Hewitt, MP, by Command of Her Majesty February 2007 available here.
Examples of the reliance on inhuman knowledge from the Foreward of ‘Trust, Assurance and Safety’ written by The Rt Hon. Patricia Hewitt MP, Secretary of State for Health
Professional regulation must create a framework that maintains the justified confidence of patients in those who care for them as the bedrock of safe and effective clinical practice and the foundation for effective relationships between patients and health professionals.
It is all too easy to focus on the incompetent or malicious practice of individuals and seek to build a system from that starting point, …….
We need a system that understands the pressures and strains under which all professionals operate and shows understanding, compassion and support where these are appropriate.
It also means a system that is better able to identify people early on who are struggling – perhaps with personal problems of mental health or addiction – and supporting them,
It means a system that is better able to detect and act against those very rare malicious individuals who risk undermining public and professional confidence.
This reminds me of the tale, The Emperor’s New Clothes: I am the child saying: But have you noticed the system is bare?
Has no-one else noticed the UK Government is making a complete fool of themselves whilst systematically showing off their new clothes?
Comments on the Foreward:
Two unconnected statements are joined together to produce: The system becomes Big Brother.
The system is the foundation of the relationship of care between two human beings. Please note: The system becomes humanised.
The system provides the framework which produces trust.
The system understands pressure and strains.
The system is more able than the police to detect those about to commit criminal acts.
What is the evidence that weak systems cause unsafe care within the practice of talking therapy involving two human beings?
What is the evidence that systems can better treat distressed humans than another human being?
Has anyone in the government read ‘Animal Farm’ or ‘Brave New World’?
The system is inhuman in that it guards the One Empty knowledge and has no doubts about its truth and efficacy. I define the authoritarian use of this absolute form of knowledge as abusive.
It denies our common humanity.
I suggest that Government-prescribed systems of ‘care’ for those of us with government-defined mental ill- health are much more abusive than practices supported by the diversity of training organisations (the DoH’s
2005 scoping project counted in excess of 570). Where is your evidence that I am wrong?
[xxxv] The Department of Health’s 2005 scoping project counted in excess of 570 existing, flourishing training organisations. Interim Report to Department of Health on Initial Mapping Project for Psychotherapy & Counselling: Sally Aldridge and James Pollard: July 2006: available here or here.
Circulation list to both Houses of Parliament
Rt Hon Dr Vince Cable MP – Julia Evans’ constituency MP
Rt Hon Andrew Lansley CBE MP , Secretary of State for Health
Mr Paul Burstow MP, Minister of State for Health (Care Services)
Rt Hon Andy Burnham MP, Shadow Secretary of State for Health
Baroness Thornton, Shadow Minister for Health, Health Spokesperson – the House of Lords
Lord Beecham, Shadow Health Spokesperson, House of Lords
Lord Carlile of Berriew, Former Lib-Dem Spokesperson & member of the Joint Committee on the draft Mental Health Bill
House of Commons Select Committee on Health
Rt Hon Stephen Dorrell (Chair)
Mr Andrew George MP (Lib Dem)
Dr Daniel Poulter (& Member of Mental Health All-Party Parliamentary Group)
Mr Chris Skidmore MP
Mr David Tredinnick MP
Dr Sarah Wollaston MP
Ms Rosie Cooper MP
Ms Barbara Keeley MP
Mr Grahame M Morris MP (& Member of Mental Health All-Party Parliamentary Group)
Mr Virendra Sharma MP
Ms Valerie Vaz MP
Member of the Constitution Committee
Baroness Falkner of Margravine Lib Dem
Former member of the Merits of Statutory Instruments Committee
Viscount Eccles Conservative
Title: Mental Health All-Party Parliamentary Group
Purpose: To inform parliamentarians about all aspects of mental health.
Chair: Mr Charles Walker MP Conservative
Vice-Chair: Ms Alison Seabeck MP, Labour
& Ms Nicky Morgan MP Conservative
Secretary: Baroness Murphy of Aldgate, Crossbench
Sir Peter Bottomley MP – Conservative
Mr Chris Heaton-Harris MP – Conservative
Mr Damian Hinds MP – Conservative
Mr Guy Opperman MP – Conservative
Mr James Morris MP – Conservative
Ms Penny Mordaunt MP – Conservative
Ms Jo Swinson MP – Lib Dem
Mr David Wright MP – Labour
Ms Kerry McCarthy MP – Labour
Mr Mike Gapes MP – Labour/Co-operative
Mr Alun Michael MP – Labour/Co-operative
Mr Jim Dobbin MP – Labour/Co-operative
Dame Anne Begg – Labour
Mr Russell Brown MP – Labour
Mr Jon Cruddas – Labour
Mr Hywel Williams – Plaid Cymru
Sponsors of the House of Commons debate ‘Mental Health’ on 14th June 2012
Mr Charles Walker MP, (See Select Committee on Health above)
Sir Peter Bottomley MP, (See Mental Health All-Party Parliamentary Group above)
Jon Cruddas MP, (See Mental Health All-Party Parliamentary Group above)
Mark Durkan MP, – Social Democratic and Labour Party
Dr Julian Lewis MP – Conservative
Nicky Morgan (See Mental Health All-Party Parliamentary Group above)
James Morris (See Mental Health All-Party Parliamentary Group above)