PACKING BLOG

Gent (Belgium), 12/1/2012

Dear professor,

As I have read some of your books and articles and seen a few  documentaries about you and your work, I have a special request for you as the designer of the ‘pressure machine’ which seem to be wholesome for autistic persons, making them feel quiet and peaceful. 

Several websites  I have consulted also mention ‘swaddling’ as a very relaxing method. Parents of authistic children (in the United States) seem to be enthousiastic about the results of this method. In the Netherlands the method (swaddling) is also applied to babies (non- autistic) who cry a lot and are difficultly to comfort. It makes them feel comfortable and gives them peace.

 An article was sent to me about the specific case of a Dutch boy with a multiple handicap that was swaddled on a daily basis, for a short time (30 minutes?)  during several months by his psychomotor therapists. They justified their method on the theory of sensory integration/processing disorder.  The results were good: contact between the child and his therapists was improved and the epileptic fits during meals diminished.

I will add an attachment with an article about swaddling with babies.

Also an article about another method, packing, which could be described as a kind of ‘wet swaddling’ and where you can read about the procedure . It starts cold (and wet) (as a cold shower on a sunny day, as is used in some new sporttherapies etc.), which induces a shiver on the skin of the child, after which it warms up very quickly (in 2/3 minutes – it is measured by the therapists)). I have added an article (Cohen) with the description of this process. In France, the method has been applied for several years in a large number of institutions. The method is applied in a very respectful way and also in close collaboration and with the approval of the parents. Also of the patient. Of course,  in the case of a very serious mental handicap this is somewhat difficult (the consense with the patient).

Indications for packing are intense fears which cannot be reduced in another way, fears f.i. for ‘decomposition’, for loosing or fall “through ones boundaries” (this is a metaphor, of course); also serious automutilation which cannot be treated in another way and recently also serious anorexia. Contraindication is f.i. claustrofobia. During the swaddling/ packing sessions, which are sometimes, but surely not always performed on a daily basis - each of the sessions lasting for about three quarters of an hour - only close and trustworthy people stay with the child. It is not used in moments of crisis or aggression. Purposes are: lestening the fears, automutilations, violent outbursts and also trying to improve the contact and exchange with the child. The method is not used at the moment of the symptoms itself, but rather as a recurrent therapeutic “workshop”. It is clear that it is not used as a “straitjacket”! If the child doesn’t stand the packing the procedure is adapted to the childs possibilities, for instance his arms or legs are left free up to the moment he can stand it. Sometimes, when the child is used to, he or she asks to swaddle his head (not his face, of course), or to sit close his feet or to impose pressure to  his feet. All this takes place in informed consent with the parents.

Many therapists, nurses and caretakers mention that they are genuinely impressed by the spontaneous reactions of even non verbal, mentally handicapped authistic children when the ‘packing moment’ is anounced. I have participated during two weeks in this therapeutic sessions, in the service of Prof. Delion when he worked in Angers (now in Lille, France). They all enjoyed it and they took actively part in accepting and preparing  the packing. All the children I assisted, calmed down, improve their eye contact, start to talk with the therapists (who stay with them in a close and sympathetic contact) or, if they don’t have acquired language, begin to invest the inner and outer space of their mouth zone, making bubbles and sounds, playing with their tongue and lips, smiling, be attentive to the people who are close to them. Essential part of this technique is the staying in close contact by at least two or three people who know the child well, who know what songs and rhythms their little patient is liking, who try to understand or not to forget the little sounds or words he is saying. Afterward they take a moment to talk about this experience, and this is repeated in teamsessions. It is a very time-consuming procedure.

One instance that is described by Prof Delion, from which I have learned during the last decennium about the complexity of autism (after I had first a behaviourist formation) is the following one: together with some other therapists he sits near the bed where a little boy is lying in his pack, who looks at him attentively. Delion sings some lullabies. Than the child who is nonverbal, says “ala”. When Delion talks afterwards with the mother, asking her if this little word “ala”, reminds her of something. The mother, very emotionally, says the preferred lullaby when he was a little baby was “Ala Claire Fontaine”.

Another example which I saw myself during the two weeks I was in Angers – with a month between those two weeks: for a boy L., who impressionably automutilated his ears (who were like cauliflowers), erred the whole day, had NO communication, was decided to augment the packing sessions to daily and to start with communication by signs (Makaton). When I came back a month later, the automutilations had diminished impressionably or even ceased, and the boy sat more regularly at the table for his meals. He could ask food by signing and it seemed that he had begun to develop a beginning “self” that he indicated by a gesture toward his body.

In the CHRU (Centre Regional Hospitalier Universitaire) in Lille, France a research has been started by a team directed bij J.L. Goeb, M.D and Prof. Pierre Delion, on the effects of packing. The research has the approval of the medical scientific council (of the university).

For some reasons which are not very clear, a militant group of parents have objected to the packing method. They disqualify it and talk even about maltreatment or even torturing.

It is assumed that the main reason for this objection is the fact that most people that are working with packing belong to the psychodynamic/psychoanalytic school that has had – in the past - a bad name as you know. Nevertheless I dare make the statement that I feel connected with a groupe of therapists that represent a kind of “neopsychoanalytical” school” that makes – in their work with autistic persons - active links with the cognitive way of thinking, especially where it focuses on the high sensitivity of the autistic person to physical sensations, which hinders them to fully develop a “normal” psychic inner world. They are psychoanalytical in the way that they try to understand and to treat the whole person and also they try to investigate how a “psyche”, an inner mental world, develops and is constructing itself. In nonautistic children this happens with the help of and in interaction and contact the environment, with the parents, in the first years as afterwards. These psychoanalysts who  accept the organic fundaments of the syndrome/handicap, try to understand how and why a handicap in the autistic spectrum hinders the development of a flexible mental life even when parents and therapists are highly engaged in trying to make contact with the child (contrary to the “refrigerator hypothesis”) and how this has influenced the interaction child (baby)- parents, and how child and parents can be helped. This encompasses listening attentively to the parents ànd the child, often together, because the parents ànd child are often very – differently - anxious which again can influence the relationship which becomes less flexible. This is what psychoanalysts call “autistification” of the relationship. They try to construct an environment adapted to the child. I can’t explain everything in this letter.

As a child psychologist and therapist I translated the doctoral thesis on semiotics in autism, written by Pierre Delion. (L’enfant autist, le bébé et la sémiotique/ The autistic child, the baby and semiotics, not translated in English, I translated it in Dutch), in which - starting with the semiotics of Peirce – he reaches  the hypothesis that the autistic child functions rather more in an iconic than in a symbolic way.

This group of psychodynamic/”neopsychoanalytic” therapists also has a special intrest in the neurologic substrate or superstrate of autism (f.i. Sylvie Tordjmann who investigated the endurance of pain by autistic people – she has published in English).

In fact, I have no particular “interest” in this letter. I just try to understand autism the last 32 years, as a psychologist. I have my personal reasons for this, as everyone who tries to understand whatever it is. Because I feel the attacks against psychoanalysis in general and packing more specifically  are so ‘unjust’ , I Liked to address to you. In fact I have no question, just that I hope you will read unprejudiced the information I send to you.

The question of the absence of control on the procedure seems important for you. I can imagine that it is rather fearful to deliver oneself to a manipulation by others. This is the very reason why a good contact with the therapists is extremely important.

The purpose of this letter is above all to ask your opinion about packing and whether you could understand the system of packing in relation to your experience with the ‘pressure machine’. 

I regret a lot that the international scientific forum seems to express an opinion about packing, maybe without fully have been in contact with the protagonists in France and even without having read the original French texts about packing, written by the “authors” of packing or by some testimonies of patients.

Sincerely yours,

Mileen Janssens

Swaddling a child with multiple handicap:

(http://www.emgplatform.nl/pages/nieuwsbrieven/nieuwsbrief%2031%20juli%202005%20.pdf / an article in Dutch, but you can look at the photo at p. 5)

Swaddling with babies:

http://www.umcutrecht.nl/NR/rdonlyres/63D68A32-8534-496B-B568-8CF0B6906A84/1740/comparisonofbehavior290906.pdf

“Brazelton” and swaddling of babies:

http://books.google.be/books?id=mD0xhLIrV5QC (look for “swaddling”)

Program of the congres feb. 2011(it is uniquely in French):

http://www.psy-enfant-ado.com/fr/packing-2011/programme/index.html