“Packing” Autistic Kids: A French Scandal

By Neuroskeptic | January 24, 2011 8:35 pm

Back in the bad old days of autism they thought it was caused by “refrigerator mothers”.


Well, right now, some psychiatrists have decided that the best treatment for autism is something not that far removed from sticking them in a refrigerator – literally. Enter “Le Packing”, which is the target of an unprecedented consensus statement just out from a list of 18 big-name autism experts (available free here).

This alleged therapy consists of wrapping the patient (wearing only underclothes or naked in the case of young children) several times a week during weeks or months in towels soaked in cold water (10°C to 15°C). The individual is wrapped with blankets to help the body warm up in a process lasting 45 minutes, during which time the child or adolescent is accompanied by two to four staff persons.

The alleged goal of this technique is to “allow the child to rid him- or herself progressively of its pathological defense mechanisms against archaic anxieties,” by achieving “a greater perception and integration of the body, and a growing sense of containment.”

No, really. Frankly, they could have stopped there, because the description is condemnation enough, but they go on to write:

We have reached the consensus that practitioners and families around the world should consider this approach unethical. Furthermore, this “therapy” ignores current knowledge about autism spectrum disorders; goes against evidence-based practice…and, in our view, poses a risk of preventing these children and adolescents from accessing their basic human rights to health and education.

Le Packing, as the name suggests, originated in France, and its use seems to be confined to France and other French-speaking areas. This is the first I’d ever heard of it. Little has been written about it in English (though see this long article and this piece from 2007) so here’s my loose translation of the the article on the French Wikipedia:

  • Packing is used in children with autism, but also in others: psychotic adults (specifically when they’re recovering from an acute psychotic episode), in the elderly, etc.
  • It’s intended to restore “awareness of the body image”.
  • It’s extremely controversial. Well, duh.
  • The technique was invented, in France, by a “controversial American psychiatrist” called M. A. Woodburry. It was intended for the treatment of severely autistic children and adolescents, especially those with severe behavioural problems such as self-harm, aggression, and refusal to eat.
  • The patient is wrapped in towels covered in cold water: two towels for the torso, and one for each arm and leg. They’re then additionally wrapped in a sheet and then blankets, over the towels. The cold water quickly warms up thanks to body heat: the child is never actually hypothermic.
  • After this session, the child is “frictionné” (I guess this means massaged) and taken to their living quarters and offered a snack “in a friendly atmosphere”.
  • Le Packing is intended to recover a physical sense of their own body. It should be used as part of a wider package of care, and only with the consent of the patient’s parents.
  • The cold water is optional; some, e.g. a Dr A. Gillis, use warm water nowadays. The key point is the restraint, i.e. the fact that their attempts to move their body are restricted temporarily. Hence “le packing”, huh.
  • The scientific status of Le Packing is controversial. A group called “Léa pour Samy” say it should be banned, and replaced by the (much more orthodox) method of ABA. However, in 2007, authorities approved a randomized controlled trial led by a “Dr Goeb” of the CHU hospital in Lille.
  • Critics accuse Le Packing of being an unethical, inhuman and degrading treatment, maybe even torture. There are allegations of cases in which the towels were much colder than 10°C, e.g. straight out of the freezer.
  • There are also allegations of its use without parental consent. A Professor Pierre Delion, of the CHU in Lille, reportedly defended this in remarks to The Lancet if a child is in danger following a road accident, you do not wait for the parents’ agreement to give him a transfusion.” But this is actually a misquote. In the Lancet piece, he was referring to the patient’s consent and said parental consent was always sought.
  • In 2009 a government minister told the French Senate that Le Packing should only be used under strictly controlled conditions according to a protocol – but others, e.g. the “Léa pour Samy” group, want it banned altogether.

This rather speaks for itself, but I’ll say this. If someone is suffering these kinds of severe behavioural disturbances, the temptation to do something dramatic must be intense. Indeed, if someone’s disturbed to the point of trying to mutilate themselves, or refusing to eat, almost by definition you’re going to have to restrain them, either physically or with sedatives, temporarily. While Le Packing may be a French peculiarity, it’s not like psychiatrists in other countries never resort to drastic measures.

ResearchBlogging.orgAmaral D, Rogers SJ, Baron-Cohen S, Bourgeron T, Caffo E, Fombonne E, Fuentes J, Howlin P, Rutter M, Klin A, Volkmar F, Lord C, Minshew N, Nardocci F, Rizzolatti G, Russo S, Scifo R, & van der Gaag RJ (2011). Against le packing: a consensus statement. Journal of the American Academy of Child and Adolescent Psychiatry, 50 (2), 191-2 PMID: 21241956

CATEGORIZED UNDER: autism, papers, woo
  • http://www.blogger.com/profile/07641347392794020333 seidos

    actually, this made me wonder if there was any attempt to study the effects of sensory deprivation tanks on autistic people. have you heard of any such study?

  • http://www.blogger.com/profile/08820607553556177222 SustainableFamilies

    This kind of made me sad. : (

    My adopted fathers mother died in a mental hospital in the 60s before I ever met her.

    I wonder what they did to her.

  • Anonymous

    Hmmm… scientist are unanimous in condemning this “treatment”? Sounds like it's gonna expand as rapidly as chelation therapy and gluten-free diets.

  • Anonymous

    Is there something similar in USA and UK? .. let's see… there is: http://en.wikipedia.org/wiki/Holding_therapy Unfortunately, similar therapies exist in other countries as well.

  • http://ajp.psychiatryonline.org/cgi/content/abstract/145/2/242 aek

    This is a retread of an old US psychiatric mainstream “therapy”. Patients were wrapped in cold sheets and left to rewarm themselves. The shivering was supposed to be therapeutic for calming mania and sedating patients.

    Link at my name to 1988 article.
    The cold wet sheet pack is a treatment that is seldom discussed anymore. The authors present results of a national survey which demonstrated that this treatment is rarely used in modern American psychiatry. They retrospectively review its recent use for 46 hospitalized psychiatric patients and conclude that the treatment is safe and has interesting and useful effects that go beyond the concept of simple restraint. Further study of treatment with cold wet sheet packs is recommended before it disappears altogether.

    We sure wouldn't want it to disappear, would we?

    The first graduate school of nursing, Teachers College at Columbia Univ. taught it in the 1930's.

    http://www.jstor.org/pss/3411733

  • http://sciblogs.co.nz/code-for-life Grant

    Isn't this similar to what Temple Grandin uses to calm herself? (Not saying it's right, just pointing at the possible similarity.)

  • http://www.blogger.com/profile/06370841996857073237 Alison Cummins

    This isn’t new. See “I Never Promised You a Rose Garden,” published in 1964 about schizophrenia treatment in the 1950s.

    I don’t have the book and can’t quote from it, but here’s something:
    http://www.bookrags.com/notes/ros/OBJ.html

    Cold Pack: The cold pack is a way to subdue the mental patients whenever they're violent or having a breakdown. The patient is stripped and rolled in wet sheets, then strapped to a bed with restraints. A cold pack is put under the neck and a hot water bottle rests under the feet, and patients are left there for four hours to help them calm down.”

  • http://www.blogger.com/profile/06370841996857073237 Alison Cummins
  • http://www.blogger.com/profile/05660407099521700995 petrossa

    That was the this is now:

    This guy is chained up in the Netherlands for having social interaction issues:

    http://edition.cnn.com/2011/WORLD/europe/01/22/netherlands.documentary/index.html?hpt=C2

    After the media storm it was found there are 40 other patients like this, and another 200 which are chained for short periods of time.

    2011, not 1811.

  • Anonymous

    Used to be called “The Water Cure” in the 18th century. What next trepanning for mental illness?

  • http://blog.setsights.co.uk David Lurie

    I've read about this before a couple of years ago. It's really disturbing stuff.

    Maybe the next time I'm coaching someone through a rough patch in their career I'll suggest “Le Packing” to them as a stress buster. Or nipple shaped pastry cutters. Potato Potahto.

  • veri

    Seems cheap, negligent and desperate. Should be banned immediately. Even beauty therapists require a licence to body wrap. This is fraudulent malpractice, they're breaking the law. There are proven techniques to wrap torsos so it won’t stop blood circulation and crush ribs. Make that medically endorsed techniques researched to the detail such as which materials to use, and done by trained health practitioners. Violent interventions such as a strait jacket I get. But prolonged consent to prevent blood circulation several times a week is remedial malpractice, negligent parenting and a danger to the child. It really calls into question the capacity of the caretaker. It's more than just an ethical issue, this is a criminal matter.

  • http://www.blogger.com/profile/14063256651397645507 DJ

    This is barbaric and it amazes me that they even do this. It's torture, plain and simple. Very similar to what I had to go through as a kid in the 70's with Lovaas style ABA.

    When are people going to wake up and smell the 21st Century??

    For the one who asked about Temple Grandin: she uses a squeezing machine which is like getting a hug. (A large tube that applies pressure – while the person inside is dry and clothed).

    That is far different from what they are describing here. With Temple Grandin's device, there is no stripping of a child to his underwear (or naked), no wrapping wet and cold blankets on him and no restricting his movement with the wrapping or strapping down if that is done too.

    K don't know how that calms a person down. It would make me scream even more if I were in that position.

  • Anonymous

    Isn't this similar to what Temple Grandin uses to calm herself? (Not saying it's right, just pointing at the possible similarity.)

    No Grant, this is not-

    http://www.grandin.com/inc/squeeze-10.html

    Note the lack of molestation of human hands and cold or freezing water or machinery, and recommendations that it only be used under the supervision of an occupational therapist. Note that it isn't used to promote '”awareness of the body image”, or anything else that is meaningless and unproven. Note the lack of warnings by governments or heads of states advising against the use of the procedures.

    I certainly do not agree with Temple Grandin about everything, but from what I've read about the machine, there are at least some checks and balances, lack of torture-like conditions, and it is not promoted as a cure for the condition.

  • http://www.blogger.com/profile/14972394536850151087 jonathan

    simon baron cohen one of the signatories against packing has questioned whether or not certain forms of autism are disabilities.
    This sort of thing trivializes a horrific disease. If there were a legitimate cure for autism there would be no need for le packing.

  • veri

    To alleviate suffering is one thing, but to induce physical abuse to achieve a psychological outcome is a dark side of humanity reserved for extreme cases. They pack terrorists to get a confession, to silence screams. Sensory deprivation is not used to cure the senses. It's used as a last resort in inflicting psychological traumas to achieve a desired outcome for the protagonist. People have died from these methods. A towel is thick. The child could turn blue, contract hypothermia, embolism, swelling, breathing difficulties, seizures etc. Why not take the child to a beauty salon, get them a soothing clay mask. Simple luxuries quite often than not, can alleviate certain discomforts for an autistic child. They’re still children.

  • veri

    Jonathon, I'm sure many are doing very successfully in life without the label autism attached it. So to treat the full spectrum of autism as a debilitating disability seems ill-informed. I do believe that's something society should understand and take the effort to facilitate for, instead of barraging around for curing autism altogether. Top of the list should be finding a cure for negligent caretakers and ignorant folks. Like those packing parents, shame on them.

  • http://www.blogger.com/profile/14063256651397645507 DJ

    “Horrific disease”… excuse me? I'm not trivializing autism since I was diagnosed with it myself, but I do take offense to this sort of language. Why? Because this sort of attitude is the reason why so many people write us off when we try to get jobs, despite being able to do the work. This is the same kind of attitude that makes us grow up thinking we are lower than dirt. This is the same kind of attitude that makes people think that we are incapable of thinking, feeling or knowing the kind of horrible ways people refer to us.

    Unfortunately, it is also an attitude like this that continues to fuel the drive for people like this to continue torturing children and adults because they happen to be autistic. This is why JRC makes lots of money electro-shocking kids.

    Torturing people does not cure them of anything.

  • http://astridvanwoerkom.wordpress.com/ astridvanwoerkom

    I agree with those that condemn this “treatment”. This should be illegal and punished as child abuse.

    As for whether autism is a disability, I agree that it is, but it is not a “horrific disease”. Language like that promotes the use of unethical “treatments” to “cure” autism, because it is reasoned that autism is worse than the “cure”.

  • veri

    I'm of the opinion it is absolutely illegal, but obviously the public health council require a dead body and a media spectacle if they're going to tap into their under funded resources and conduct a proper investigation. If they were normal kids this would've been banned, but since they're autistic it's somehow justified. It's somehow ok to strip them naked in front of their therapist to who knows, suffocate them in wet towels several times a week. I just don't see the humanity in that. Maybe there's something discriminatory about the French.

  • http://www.blogger.com/profile/03834219386682067062 Jean

    This sounds like one of the abusive and damaging treatments from the past. Psychiatry, in whatever country, doesn't have a history to be proud of, but the past keeps repeating itself in one form or another. We need to look closely at what's going on today, in our own country as well as in other countries. Much still needs to be challenged and stopped.

  • Anonymous

    This is the same treatment advocated by the Harvard scholars Tillotson and Talbot …. in 1939.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Anonymous: Ooh, I didn't know that…. this site has some information.

    But in fact it's reminiscent of the “hydrotherapy” of the 19th century…

  • Anonymous

    Neuro,

    Back when I was a young Turk, I asked my attending about life before Thorazine. He described the aforementioned therapy as a means to handle agitation. According to him, the patient burned enough calories maintaining their temperature that they were done for the rest of the day.

  • http://www.blogger.com/profile/16952656340810478793 Grapes 2.0

    Isn't this similar to what Temple Grandin uses to calm herself? (Not saying it's right, just pointing at the possible similarity.)

    No Grant, this is not-

    http://www.grandin.com/inc/squeeze-10.html

    Note the lack of molestation of human hands and cold or freezing water or machinery, and recommendations that it only be used under the supervision of an occupational therapist.

    THere certainly is machinery involved in Temple Grandin's apparatus, and it's not at all used under the supervision of a therapist.

    I and many other parents of autistic children have found the use of a sort of willing containment useful: the child is not held against his will, but the bodily restriction does offer some comfort.

    When we're talking about a syndrome like autism (I refuse to use the word disorder) I find it the height of ignorance that people think they know it all, to the extent of writing laws about what may and what may not be done.

    None of us knows very much, let's be honest. The ones who shout the loudest probably know the least, in this as in so many areas of life.

    You're doing your children, and the children of others, no favours by being doctrinaire. Find it within yourselves to admit your own lack of a clue. That's how progress is made.

  • ATraveller

    Hmmm, this reminds me of attachment therapy, as practiced by Nancy Thomas, especially their 'rebirthing techniques.'

    What possesses people to do things like this to children I will never understand.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    ATraveller: Oh my. That's actually even worse than Le Packing by the sounds of it, and with an even stupider rationale (make kids angry at you and they'll eventually love you.) Thanks for the link.

  • http://www.facebook.com/CFourA Cannabis4Autism

    There is a better way!

    http://www.facebook.com/CFourA

    Cannabis is the safest thing to stop us from freaking you all out. OK?

    (I'm autistic by the way)

  • Anonymous

    I have been Googling “journée de sensibilisation à l'autisme 2011″ (Autism Awareness Day) to try to find an event in France. There doesn't appear to be anything. Quelle surprise…

  • ki du

    Le packing is issued from hydrotherapies commonly used in the 19th century. Pr Delion who is head of pedopsychiatry service in CHRU Lille is the person who developped the use of packing in France. He learned this technique in the sixty seventy years from an american psychanalyst called M.A. Woodburry who came from Chestnut lodge and lived in the XIII arrondissement in Paris.
    At start, Pr Delion was interested in schizophrenia. In a recent interview with a journalist, he said that schizophrenia evolves towards a terminal autism, and that 's the reason why he was then interested in autistic children.
    One can see and ear him there
    http://psychomediamagazine.fr
    (it is the third video of the page, I do not know how long it will stay there)

    A paper about the packing has been published in The Lancet in 2007. The paper and two replies can be downloaded from these adresses.
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61322-1/fulltext
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60339-6/fulltext
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60099-9/fulltext

    To know the reality of the practice of packing, the best is to see that video. It is without comments.
    http://www.dailymotion.com/video/x1qp34_autisme-france-5_tech

  • ki du

    text of the video
    Une soignante : Notre ambition en fait, c'est que ces enfants puissent vraiment se mettre à parler.
    VOIX OFF : Stéphane, le psychomotricien sort des draps humides du réfrigérateur, ces draps, d'une température de 5 à 10 degrés vont servir au pack d'Omar (on entend Omar qui prononce quelques syllabes en i)
    Le pack, une technique utilisée depuis les années 50 sur des adultes et depuis plus de 20 ans en pédopsychiatrie consiste à envelopper l'enfant dans des draps humides et froids, mais sans jamais le forcer. (on emballe Omar qui crie 'maman')
    Sous l'effet du froid, le corps réagit, la peau se rétracte, les vaisseaux sanguins se dilatent, ce qui fait remonter la température du corps. Cette arrivée massive de chaleur détend l'enfant, apaise ses angoisses et lui permet de prendre progressivement conscience de son corps.
    Stéphane : d'un seul coup, on est un petit peu inquiet. (il fait répéter hiwiliwilili à Omar qui s'exécute)
    Stéphane devant la caméra : Le but du pack c'est de contenir là où ça fuit quelque part, il y a des enfants qui sont très agités ou dans une rage dans une des crises d'angoisse massive., On a envie de les prendre … Tout un chacun a envie de les protéger , de les prendre, de les tenir dans ses bras, c'est ce qu'on fait avec le pack sauf que l'on provoque quelque chose de fort avec le froid, on les tient, on les saisit. Il faut les saisir, ils ont besoin de ça. On a vu très rapidement des enfants s'apaiser, même des enfants les plus malades. Et on a réellement vu l'enfant derrière l'autiste, avec ce beau regard, et des fois, des sourires aussi.
    VOIX OFF : La technique du pack a été adoptée par La Pomme Bleue après plus d'un an de réflexion. Au départ, divisée sur son utilisation, l'équipe a finalement constaté qu'elle donnait de bons résultats. (Omar prononce quelques syllabes en i).
    Une fois par semaine, les 14 thérapeutes du centre se réunissent pour échanger leurs réflexions sur les progrès ou les difficultés de chaque enfant.
    'discussion dans la salle de réunion):
    On va passer au nouveau point de l'ordre du jour qui est Manon.
    On est un peu en difficulté avec elle au pack, et puis, je voulais qu'on en parle en général dans tous les ateliers. Comment ça se passe?
    Nous aussi, C'est vrai, nous à l'atelier contines, à l'atelier contes, nous sommes en difficulté parce qu'un jour, je ne sais plus si c'était à l'atelier contines ou contes, un autre enfant a éteint la lumière. On s'est retrouvé dans le noir, et là, vraiment, ça a été pour elle très difficile à gérer. Elle a pu dire qu'elle avait peur et depuis elle ne veut plus venir. Par contre, nous savons par les autres soignants quelle est derrière la porte, qu'elle écoute et que parfois elle participe la porte fermée. Et elle accepte maintenant de venir en décalage par rapport à l'horaire de l'atelier revisiter un peu la pièce de l'atelier contes et qu'on redise qu'on reparle de la lumière qui a été éteinte etc. Elle dit 'j'ai peur ' mais elle consent à y rester un peu.
    VOIX OFF : L'enjeu de ces réunions hebdomadaires est de recouper les informations recueillies par chaque soignant pour adapter la prise en charge à l'évolution de chaque enfant.
    Elle fait des personnages en pâte à modeler. Elle me demande de faire une petite fille et elle pack la petite fille, elle lui dit : 'c'est pour te soigner, il faut parler, c'est pour parler'.
    Stéphane : Elle fait une sorte de couverture?
    Ha non, c'est bien fermé, très serré mais délicatement. C'est vraiment bien fermé, très serré. Mais quand elle défait, on retrouve la petite fille à l'intérieur. Je trouve que c'est intéressant.
    Stéphane : Je trouve ça rassurant, parce que nous on, on galère

    (De nouveau Stéphane est seul devant la caméra.)

  • ki du

    sorry, I copied the wrong langage
    A HEALTH CARE: Our aim in fact is that these children can really start talking.
    VOICE OFF: Stéphane, the psychomotor takes off damp sheets from the refrigerator, these sheets, a temperature of 5 to 10 degrees will be used to pack Omar (Omar is speaking, pronouncing a few syllables i)
    The pack, a technique used since the 50s on and adults for over 20 years in child psychiatry is to wrap the child in sheets damp and cold, but never force it. (Omar is packed crying 'Mama')
    As a result of the cold, the body reacts, the skin shrinks, blood vessels dilate, which raises body temperature. This influx of heat relaxes the child, soothing his anxiety and allows him to gradually become aware of his body.
    Stéphane: all of a sudden, we're a little worried. (He says hiwiliwilili and Omar repeat)
    Stéphane, in front of the camera: The purpose of the package is to contain where it is leaking somewhere, there are children who are agitated or in a rage in a massive anxiety attacks., You want to take them. .. Everyone wants to protect them, take them, keep them in his arms, this is done with the pack except that it causes something hard with the cold, they are held, we seized them. We must seize them, they need that. We have seen children die down very quickly, even the sickest children. And we actually saw the child behind the autistic, with the beautiful eyes, and sometimes, smiles too.
    VOICE OFF: The packing technique was adopted by la pomme bleue (the name of the institution) after more than one year of reflection. Initially, divided on its use, the team finally found it worked well. (Omar said a few syllables i).
    Once a week, 14 therapists from the center meet to share their thoughts on the progress or difficulties of each child.

    'Discussion in the meeting room):

    We will move to the new point on the agenda which is Manon.
    It is a little difficulty with her in pack, and then, I wanted us to talk about in general about her in all workshops. How does it work?
    We, too, is true, we contine to the workshop, workshop stories, we are in trouble because one day I do not know if it was in the workshop or storytelling, another child turned off the light. We found ourselves in the dark, and there, really, it was very difficult for her to manage. She could say she was scared and since she does not want to come. We know from other caregivers that she is behind the door, she listens and sometimes participates with the door closed. And she agrees to come now out of step with the timetable of the workshop to revisit a little piece of storytelling workshop and that we repeat to talk of the light was turned off and so on. She says 'I fear' but she agrees to stay a bit.
    NARRATOR: The challenge of these weekly meetings is to integrate information gathered by each caregiver to adapt to support the development of each child.
    She figures in clay. She asks me to make a little girl and she pack the little girl, she said: 'it is to heal yourself, you must speak, to talk about it'.
    Stephane: It is a kind of coverage?
    Ha no, it is closed tightly but gently. It is really closed, tight. But when she takes it off, we find the little girl inside. I find it interesting.
    Stéphane: I find it reassuring, because we are, we galley

    (Again Stéphane is alone in front of the camera.)
    Stéphane: Group work here is very important because it can stand, we are not alone. Otherwise, we are alone with the pathology of the child, the emotional resonance that to us, and that's very violent.

  • ki du

    text of the video
    VOICE OFF: Stéphane, the psychomotor and Catherine, the psychiatric nurse prepare the pack for Manon. For months, Manon came to these sessions with pleasure, but for some time, she expressed new fears.
    Stéphane to Catherine: It is hot today, to see
    Stephane: It's almost ready for you
    Manon: I do not want, I'm afraid
    Stéphane: If you do not want to, then, well then, we listen. I can sit close to you ?
    (Stéphane sit on the bench)
    Stéphane: small Manon (he takes her shoulders, pressing her back and chest)
    Stephane: And then she talks about the pack all the time, so what we gonna do (Manon seems paralyzed with fear). We can talk about fear if you want, (the voice becomes serious and slow), fear … to be in it …. Maybe it is the fear of emotions.

    VOICE OFF: Although Manon refuses to enter into the sheets, caregivers take to comply with the timetable. The regularity of the workshops is a cornerstone of care. This is a critical benchmark in the construction of the child. And it is also the opportunity to work on his anxieties and fears.

    Stephane: Can be with you? (Stéphane tries to take control of Manon who withdraws)
    Manon: I do not want
    Stéphane: you don't want
    Stéphane: Sheets, you come, come touch, just, you do not go into it if you don't want. Just touch, come. (Manon moves forwards and looks at the bed)
    Stephane: Do you remember when you were in, wrapped you remember ?,.
    Catherine: tight
    Stéphane: tight, yeah, with a? around on the skin. You remember ?.
    Manon sits up and looks out. The voice of Stephane becomes authoritarian.
    Stéphane: Outside, there are other children, but we, we are in it.
    Manon: we will stop
    Stephane: Yes, it will stop later, yes. Do you want us to stop now?
    (Shout) Manon: yes
    Stéphane: you want us to go away now?
    Manon: swing
    Stéphane: Ha the swing, let it , the swing is outside.
    VOICE OFF: Manon does not support the frustration. Stéphane is also there to teach her smoothly to accept the rules, but without causing new anguishes which would make her regress, question of fingering.
    Manon: I go (Manon, who was very quiet until now is beginning to get excited)
    Stephane: Oh, she is not happy, holala, it is not happy, she is not happy. Come on. (He takes her in his arms, she is struggling) I'll hold you tight, strongly. We're not happy, not happy. Hooooh, I hold her.
    VOICE OFF: Like all children, Manon must learn to take into account the realities and constraints of the outside world. An effort particularly difficult for the little girl who is gradually emerging from her Autism and alternates moments of openness to the world and withdrawal into herself.

  • ki du

    sorry, it seems, I am not very talented in posting
    this is the begining of what I wanted to say.
    Le packing is issued from hydrotherapies commonly used in the 19th century. Pr Delion who is head of pedopsychiatry service in CHRU Lille is the person who developped the use of packing in France. He learned this technique in the sixty seventy years from an american psychanalyst called M.A. Woodburry who came from Chestnut lodge and lived in the XIII arrondissement in Paris.
    At start, Pr Delion was interested in schizophrenia. In a recent interview with a journalist, he said that schizophrenia evolves towards a terminal autism, and that 's the reason why he was then interested in autistic children.
    One can see and ear him there
    http://psychomediamagazine.fr
    (it is the third video of the page, I do not know how long it will stay there)

    A paper about the packing has been published in The Lancet in 2007. The paper and two replies can be downloaded from these adresses.
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61322-1/fulltext
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60339-6/fulltext
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60099-9/fulltext

    To know the reality of the practice of packing, the best is to see that video.
    http://www.dailymotion.com/video/x1qp34_autisme-france-5_tech

  • ki du

    my first post doesnot appears :this is it again

    Le packing is issued from hydrotherapies commonly used in the 19th century. Pr Delion who is head of pedopsychiatry service in CHRU Lille is the person who developped the use of packing in France. He learned this technique in the sixty seventy years from an american psychanalyst called M.A. Woodburry who came from Chestnut lodge and lived in the XIII arrondissement in Paris.
    At start, Pr Delion was interested in schizophrenia. In a recent interview with a journalist, he said that schizophrenia evolves towards a terminal autism, and that 's the reason why he was then interested in autistic children.
    One can see and ear him there
    http://psychomediamagazine.fr
    (it is the third video of the page, I do not know how long it will stay there)

    A paper about the packing has been published in The Lancet in 2007. The paper and two replies can be downloaded from these adresses.
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61322-1/fulltext
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60339-6/fulltext
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60099-9/fulltext

    To know the reality of the practice of packing, the best is to see that video.
    http://www.dailymotion.com/video/x1qp34_autisme-france-5_tech

  • ki du

    Le packing is issued from hydrotherapies commonly used in the 19th century. Pr Delion who is head of pedopsychiatry service in CHRU Lille is the person who developped the use of packing in France. He learned this technique in the sixty seventy years from an american psychanalyst called M.A. Woodburry who came from Chestnut lodge and lived in the XIII arrondissement in Paris.
    At start, Pr Delion was interested in schizophrenia. In a recent interview with a journalist, he said that schizophrenia evolves towards a terminal autism, and that 's the reason why he was then interested in autistic children.
    One can see and ear him there
    http://psychomediamagazine.fr
    (it is the third video of the page, I do not know how long it will stay there)

    A paper about the packing has been published in The Lancet in 2007. The paper and two replies can be downloaded from these adresses.
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61322-1/fulltext
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60339-6/fulltext
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60099-9/fulltext

    To know the reality of the practice of packing, the best is to see that video.
    http://www.dailymotion.com/video/x1qp34_autisme-france-5_tech

  • ki du

    To know the reality of the practice of packing, the best is to see that video.
    translation of the text is above.
    It is without comments
    http://www.dailymotion.com/video/x1qp34_autisme-france-5_tech

  • ki du

    The unusual and uncomprehensible thing about packing is that it is legal and that it is well diplomed doctors who prescribe it.
    It is said that parents have been their child taken off from familly accused for mistreatment because they refused that therapy.
    Because he feel himself agressed by parents, Pr Delion wrote an open letter which is on these sites :
    http://www.balat.fr/Pierre-DELION-LETTRE-OUVERTE.html

    Here is the translation of one mother'answer. (can be found on that site) The day_hospital is special place where children are supposed to be teached but can has well have medical threatment.

    Hello, I am a mother of autistic boy of five years. Last year we have been the subject of a report because we withdrew our child from the “establishment” Indeed, we could no longer support abuses of all kinds from the day_hospital : first, it has never been possible to discuss clearly with the director to build all of our therapeutic strategies for children from beginning to end, I was left aside and felt that I was taken for an incompetent. And I denonce the insidious aspect of these deplorable attitudes that destabilize parents. Whenever I asked questions about my son, I received general cold and impersonal answers. We had parent / child meetings at the same hours as the sessions pecs of my son . A copybook of correspondence was established and was of no use (I should point out that the specifications of one of my son's comrades remained empty for a year and a half, even ! and the record of that child was almost empty, the mother noticed it when changing the setting). I saw my son left in the yard for about fifteen minutes without any educator responding to his absence.
    What hurts me is that I agreed to sessions packing, because I trusted the sense of responsibility of doctors, and now I regret what happened, the fact is that explanations of the Director for the packing were too evasive, I realize now I'm not afraid to say that I was manipulated. Nothing more, nothing less I pulled my child of this center and we found ourselves before a judge August 13, 2008. My son was described as severely autistic by the Director … Ridicule prevailed when the judge found a little boy in front of her calm, wise, just listening.

  • ki du

    this is the description of the packing in one of Pr Delion's book

    it consists in wrapping a child or adult, naked or in underwear in towels soaked in cold water. Experiment has shown that, when the initial temperature of towels is less than 10°C (50°F), the gradient of warming is greater and therefore more efficient in the gathering of the body image. Each member of the patient is surrounded by a towel, then both legs are surrounded altogether in a larger towel which goes from the feet to the navel in order to keep both legs tightened by another large towel. Both arms are held against the trunk with another large towel. A sheet ensures the cohesion of the whole. Then, a plastic or rubber enveloppes the patient's body up to the neck, finally, one or two warm blankets are wrapped around him ….. The envelopement must be done quickly, possibly by four caregivers …. Sometimes it may be useful that a caregiver stand by the feet of the child who has strong fears of falling, flowing, precipitation (Houzel) to reassure him. The duration of the packing is thirty to sixty minutes.

  • ki du

    Obviously for me, that therapy is a torture, both physical and psychological. Psychologically, it put the child in an uncomprehensible situation, but also, as the post of Seidos suggests, there are also similarities with sensory deprivation : (this is my own point of view)
    I suspect cold and immobility to induce deprivation of touch.
    But I have also read (I do not remember where): “As for the view, the light is dim, the decor of the room absent.”
    One can find in the internet site where Pr Delion's book is sell : http://www.did.asso.fr/les-cyberscopies/97-pierre-delion-le-packing-avec-les-enfants-autistes-et-psychotiques.html
    (clic on the link : compte rendu du chat du 18 avril 2000)
    “In any case, we cultivate a well-tempered silence, which means that we are not talking to fill the atmosphere, we expect some sign from the patient, and it helps us to pay attention to our internal thoughts, of more we try the best of our ability to care for the environment: color, warmth, silence optimal …This issue of the sound environment has allowed us in many clinical situations to work on the hallucinations of children.”
    Thus, what happens during sensory deprivation, also happens during the pack. That is : hallucinations induced by small stimuli.
    Note that the effects of sensory deprivation can be reinforce because of medication, since most children who are packed also have medication.

  • ki du

    An argument of Professor Delion to justify this treatment is that it concerns children who are especially self-injurious or violent. The number of children who drastically self injure is small and certainly does not explain the use of that practice in about 300 institutions in France.

    After 30 years of practice, there are no data on the benefits of packing. In 2009, a paper was published [Neuropsychiatrie de l’enfance et de l’adolescence 57 (2009) 529–534]. It presents a graph summarizing the evolution of the scale evolution Aberrant Behavior Checklist for 10 children and adolescents before and after undergoing three months of packing (1 and 5 sessions per week). However, it is recognized in the same paper that “the ratings have been carried out by teams who made the wraps, through quotations are of course possible.”
    This paper presents a future prospective multicenter study of 162 patients which is expected to last three years. In December 2010, the criteria for inclusion in the study and comparison criteria have been changed without any explanation being given. [http://www.psy-enfant-ado.com/fileadmin/documents/News_letter_1.doc]. It means that datas accumulated in 2 years are useless. Children age 3 can now be included in the study. On the other hand , in 2 years only 8 children from 5 years to teenage were sufficiently self-injured to be included in the study.

  • ki du

    This so called therapy is offered because, according to Pr Delion “the baby with [autistic] risk has the distinction of not being able to defend himself in a sufficiently satisfactory way of archaic anxieties.” The packing is then presented as a “therapeutic space”, which allows the child to “play and defeat at will, both the anxieties that overrun him, but also the methods he used to defend from them. It also allows him “to get his first psychic envelopes' “[ L’évolution psychiatrique 69 (2004) 641–650]
    One of archaic anxieties, is not to stop falling. “ These fears may trigger special defense mechanisms in these children, such as pathological grasping, which can be read as a pathological continuation of the grasping reflex “[ L’évolution psychiatrique 69 (2004) 641–650]. The pack belongs “to the group of wrapping techniques required to collect the body of a child who lacks capacity because of his pathology.” [http://bibliothequeopa.blogspot.com/2009/04/proposition-pour-une-defense-des-soins.html]

    Thus, according to Professor Delion, since the moment he is born a child feels the weight, he is anxious not to stop falling, this induce the grasping reflex, normal for any baby and pathological for the at risk baby. In this reasoning, there are at least two flaws. First, the grasping reflex is involuntary and is not controlled by the central brain, so there is no reason why it reflects anxiety. Second, do not stop falling is to be in free fall, state in which one does not feel gravity. So again, there is no reason for a baby to be anxious of falling for ever?
    The symptom of that anxiety of not to stop falling is that the child has a tendancy to hang to any one who crosses his way.
    Sure, you do not beleive me, but read this text from Pr Delion :
    I often present the following example of a child that I usually see at the workshop tales and stories. I arrive at the day hospital at a time when he does not expect me. Sameness appears and he said _ he finally tells me not just “like, you are not at the usual time, I am disoriented, I had managed to distance my fears and archaic anxieties, because I'm perturbed in my habits, my archaic anxieties came back and I fall and I cling to the guy who passes by. It's me! He uses my neck as a climber uses a peak as if it was very vital for him not to let go.[http://bibliothequeopa.blogspot.com/2009/04/pierre-delion-conference-sur-la.html]

    Another anxiety is the anxiety of beeing dismenteled, the symptom is supposed to be muscular hypertonia which he call second muscular skin.

  • ki du

    In the pack, one begins by a thermal shock and then, the child suffers a prolonged immobilization. The child must provide a lot of energy but the lack of movement does not help breathing. In addition, a plastic film can induce a lack of breathing through the skin.
    Note that the clothes can contain 2 kg (4,4 pounds), may be 4kg of water at 15 °C (59°F), the child needs to heat that water to 35 ° C(95°F).
    There is no need to be a doctor to ask some questions:
    Is the brain of the child oxygenated?
    What is his level of oxygen in the blood?
    Is the child conscious?
    What is heart rate?
    Simple and non-invasive measures could provide the answer to these questions. It seems that no measurements have never been done to answer these questions.

    For the warming duration, there are conflicting data,
    First, it is stated that the warming is rapid in [Neuropsychiatrie de l’enfance et de l’adolescence 57 (2009) 529–534], it is said : “the skin warms rapidly (about five minutes according to skin temperature measurement with a thermometer)”. In the report HCSPRpage4 [http://www.hcsp.fr/docspdf/avisrapports/hcspr20100202_packing.pdf] , it is also said, “Warming is fast.”
    On the other hand, the Express journalist who attended a packing [http://www.lexpress.fr/actualite/sciences/sante/autisme-le-traitement-qui-choque_768175.html] will say : “Within minutes, the skin temperature drop from 36°C (97F) to 33°C (91F).” In the report HCSPRpage14 “It is a tight wrap, wet (usually cold) followed by heating, accompanied by a multidisciplinary team, consisting of one to several sessions per week for a period 45 minutes. “This last sentence, although confused, seems to say that the warming lasts 45 minutes. In the recent article of psychomédia, [PsychoMédia, n°29, mai-juin 2011, p. 61-65], one can found that the warming lasts one hour: It is said : “The blood supply becomes much more significant due to vasodilatation and warming occurs, so that what was cold on the skin warms up gradually. [] There is a warming mechanism which makes that, after one hour, when developing the packing, the wrapping is usually very hot. “

  • ki du

    The practical conditions of the packing vary from one document to another, and can even be contradictory.
    There are for example about the temperature of sheets:
    Page 11 of the book 'The packing with autistic and psychotic children': [éditions Érès, 1999] “when the initial temperature of the towels is less than ten degrees, the gradient of warming is greater and therefore more effective is the gathering of the body image. “
    On a forum, by Pierre Delion [http://www.afg-web.fr/Reactions-face-au-D-U-d-approche.html]: “the temperature of ten degrees, which is proposed for the lowest temperature corresponds to basal physiological data (so that for there is a warming, it must start from a low temperature (10 °C) towards 37 °C) “
    Video TV5 [http://www.dailymotion.com/video/x1qp34_autisme-france-5_tech ]: between 5 and 10 °C
    Open Letter [http://bibliothequeopa.blogspot.com/2009/04/proposition-pour-une-defense-des-soins.html] “tap water temperature: around ten degrees C”
    During the open doors at day hospital mosaiques [http://www.nordeclair.fr/Locales/Lille/ ... isme.shtml]: 15 °C
    [Neuropsychiatrie de l’enfance et de l’adolescence 57 (2009) 529–534]: 10 to 15 °C
    Report HCSPR [http://www.hcsp.fr/docspdf/avisrapports/hcspr20100202_packing.pdf] “cloths soaked in cold water,” without specifying a numeric value.
    On the other hand, the amount of heat that must provide the child is obviously proportional to the mass of water retained in the sheets and towels. Meanwhile, there is, to my knowledge, no indication of the amount of water that must hold the textiles.

    Another remark about the quantity of heat to provide : one would naturally expect that the mass of water to heat depends on the weight of the child. This is not the case since the quantity of sheets and towels is well defined [Neuropsychiatrie de l’enfance et de l’adolescence 57 (2009) 529–534].

    Similarly, there is no way of knowing whether children should be naked or in underwear.
    Page 11 of the book 'The packing with autistic and psychotic children' “nude or in underwear”
    internet site where one can buy the book [http://www.did.asso.fr/les-cyberscopies/97-pierre-delion-le-packing-avec-les-enfants-autistes-et-psychotiques.html]: “It consists of wrapping the naked body of the patient”
    Report HCSPR : “he keeps his underwears or has a bathing suit.”
    Open Letter : “children who keeps his underwear.

  • ki du

    Some caregivers say that during the pack, children are able to look at them, eyes into the eyes.
    Some documents about that :
    “The “recovery” of the look is enhanced by the system” [http://www.cra5962.org/images/DOCTELECHARGEABLES/METHODESOUTILS/METHODES/packing.pdf]
    “one can see the child behind the autist, with their beautiful eyes” as Stephane says in the video TV5 [http://www.dailymotion.com/video/x1qp34_autisme-france-5_tech].
    Professor Delion writes [PsychoMédia, n°29, mai-juin 2011, p. 61-65]: “at that time, in most cases, they can watch us and interact, while, often persons with autism are avoiding gaze.”
    In the report HCSPRp12 [http://www.hcsp.fr/docspdf/avisrapports/hcspr20100202_packing.pdf], it is also said, “a gaze which, from floating becomes more alert and more fixed on the faces of those around him.”
    The reporter of the Express observes: “Long minutes passed before he turns his head towards J D, the psychomotor sitting at her bedside, and plant his eyes in her's, for the first time since the begining of operations . The adult and the child begin then a curious form of dialogue, which will continue for three quarters of an hour “[http://www.lexpress.fr/actualite/sciences/sante/autisme-le-traitement-qui-choque_768175.html].

    If the pack gave the child the ability to communicate with the eyes, this capacity would continue after the pack, yet this does not seem to be the case.
    Insteed of asserting that children are able to communicate through eye glance during the pack, one can suppose that children are in such a state of exhaustion that they are not really aware of what they see.

    By the way, the hability to look into the eyes is not a criteria for the multicenter study which is underway.

  • http://www.blogger.com/profile/06010913233563312189 Manoj Singal

    Hi Blogger! It’s nice visiting your blog. Design is perfect and content is informative as well. Congrats! Please do visit my website for semi automatic strapping machine, Skin Packaging Machine.

  • ki du

    majoi singal, there is no correlation between your post and that topic.

  • ki du

    a paper from Pr Delion, the promoteur of 'le packing' is avalable on line.Note that packing has been renamed in wrapping.
    http://www.sciencedirect.com/science/article/pii/S0928425711000350

    Journal of Physiology-Paris(In Press, Uncorrected Proof)
    Towards a dialogue between psychoanalysis and neuroscience: Connections that are both possible and necessary
    Pierre Delion
    Department of Child and Adolescent Psychiatry, CHRU, 59037 Lille Cedex, France
    Abstract
    The author, a child psychiatrist, calls for a dialogue between psychoanalysis and neuroscience (both from his clinical joint practices with neuropediatricians and on a theoretical level) to found a new approach to the questions of neurodevelopmental and psychopathological disorders. He briefly discusses two examples. The first example is developmental and concerns the links between the archaic grasping reflex and adhesive identification. He shows how the phenomena observed in the two fields can find a logical sequence. The second example concerns a therapeutic technique (wrapping) that is used to soothe self-injurious behaviours in children with autism. Here, again, both approaches are used to better understand the phenomenon in question. Bridges must be built to open new theoretico-clinical and therapeutic collaborations. One could imagine data integration from these two heterogeneous subdomains to form a new complex subdomain, from which productivity is guaranteed.

  • ki du
  • ki du

    THE WALL : psychoanalysis put to the test for autism
    This 52 minutes movie, in 5 parts, is the result of 4 years of investigation among 30 psychiatrists and psychoanalysts in France, that shows the way they see autism and deal with children with autism. Some of them are in charge of pedopsychiatry departments in hospitals today. 50 years of progress in science do not seem to have had any influence on their dogmatism.
    made by Sophie Robert and producted by Ocean Invisible Productions with the support of ” autistes sans frontières ”

    The wall can be seen with english subtitles at that adress

    http://www.youtube.com/user/magabrac#g/c/5CC7A73774FAF3F0

  • http://www.supportthewall.org Support the Wall

    The Wall is attacked by psychoanalysts and top politicians (Martine Aubry) openly support Packing proponents.
    You can follow our story in English at http://www.supportthewall.org and in French at http://www.soutenonslemur.org

  • Anonymous

    THey have 3-4 staff to ensure safety. WHat they are doing isn't far from what the rich and famous have done in high end spas, so pipe down people. ice therapy under neck is therapeutic and relaxing, especially when under extreme stress like these kids are. The warm blankets are further relaxing and would be considered sensory therapy not sensory deprivation, duh. Gosh, people can be so ignorant. I see nothing wrong with this therapy if it's done under strict supervision and tailored to the child's unique needs. It's meant to comfort not harm. Get over it.

    • Doug

      What studies show that it is of any benefit to patients?

  • Anonymous

    Hey I found the video (related to the “french scandal”) made by the association “Lea pour Samy” (now “Vaincre l'autisme”), check it out and tell me what you think :

    VAINCRE L'AUTISME : http://www.vaincrelautisme.org/content/le-packing-le-film
    YOUTUBE : http://www.youtube.com/watch?feature=player_embedded&v=4ghYPnXiETQ
    TWITTER : http://twitter.com/#!/Vaincrelautisme/status/176728634621575168
    FACEBOOK : http://www.facebook.com/188089237873384

    Subtitles are available on You Tube.

  • Anonymous

    It’s good that the situation is slowly changing in France. Unfortunately the situation regarding the related issue of Holding Therapy is still not widely known in the UK. A young man who experienced HT between the ages of 11-13 describes his experiences here –

    http://invisibleengland2.wordpress.com/2011/09/21/first-hand-account-of-holding-therapy-in-the-uk/

    A criminal investigation into the programme has been ongoing for 4 months now (the case is currently with the CPS) and Foot Anstey a major firm of solicitors, have been investigating a legal claim for 9 months. In spite of this, hardly anyone in this country knows that one of the largest and most systematic programmes of state-funded Holding Therapy in the world, takes place in the UK.

    Perhaps the campaigners against Le Packing and the campaigners against Holding Therapy can support each other in what seem to be very similar goals

  • Doug

    Nothing new. It was used at Chestnut lodge psychiatric hospital in Rockville MD during the 1960s and 70s (perhaps the 50s too?). They used blankets packed in ice water (a cooler full of crushed ice and water).
    They straightjacketed a person in an ice cold wet blanket from neck to feet wearing only their underwear for 2 hours each time.
    The theory was taken from swaddled native Americans having restraint -the swaddling would cause restraint. The cold was supposed to cause the blood to flow away from the surface to the internal organs soothing them and the body is supposed to warm the blanket in about 15 minutes (a little bit – it doesn’t get very warm)

  • http://www.seveballesteros.com/ CatherineMiglianoPhD

    I remember this. They used it in the 60′s on my mentally retarded cousin, along with the full ice bath in those bath tubes with the wooden covers w/a hole cut out for the neck so only their heads were out above the ice water. It was the alternate version of ECT. Like Peter Allen sings in his 80′s song, “everything old is new again.”

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Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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