Send “le packing” packing

“Le packing” is a treatment for autistic children used in France where, the August 25th Lancet notes, it is causing an “outcry.”

“Outcry” strikes me as a bit of an understatement, personally speaking: When I hear the word “packing,” the associations that come to mind are about sending some not welcome person “packing,” or about a certain industry involving meat, and keeping it refrigerated.

“Le packing” involves something similar. According to The Lancet (with some editorial comments by me):

The therapy, called packing, involves wrapping a child tightly in wet sheets that have been placed in the refrigerator for up to an hour. When children are encased in this damp cocoon—with only their head left free—-psychiatrically trained staff talk to them about their feelings. [I'm presuming this means that the staff get the children to talk about the children's own feelings though the sentence reads as if the staff talk to the children about the staff's own feelings] Typically, the treatment is repeated several times a week, and depending on the results and the severity of the child’s condition, it can continue for months or even years.

“Months or even years”?

“Le packing,” it seems, is not only being practiced on autistic children, but is being studied to see if it is effective. (Just from reading about what “le packing” involves, I will venture to say that I am not sure why it is being studied, much less put to use, at all.)

The man who pioneered packing for children, Pierre Delion, is head of the child and adolescent psychiatry unit at Lille Regional University Hospital in northern France. He says that it reinforces childrens’ consciousness of their bodily limits, which in some psychiatric conditions becomes fragmented. He recommends that the technique be used for three types of patient: severely autistic children who self-harm; psychotic children; and, more rarely, children with anorexia. Referring to the first category, he has written: “In our experience of packing, self-harming behaviour very often disappears.”

Well, if one is wrapped in wet and cold sheets, perhaps one might become numb—lose bodily sensations—stop moving…..

The Lancet continues:

Forms of wrapping or envelopment—for example, in mud or clay—have been used therapeutically for centuries. The idea of using it to calm violent patients was conceived in Germany in the 19th century, and packing was routinely applied at Chestnut Lodge—-an asylum in Rockville, Maryland—in the 1950s.

A decade later, American psychiatrist Michael Woodbury brought it to France, where it was embraced by the influential psychoanalytic movement, whose founder was Sigmund Freud. Psychoanalysts found that Woodbury’s philosophy dovetailed with ideas they had about children’s development [my emphasis]. One psychoanalytic theory holds, for example, that packing can help children to dismantle the defensive behaviours they developed at an early age, to protect themselves from a dysfunctional relationship with their mother.

“Psychoanalysts found that Woodbury’s philosophy dovetailed with ideas they had about children’s development”: Was the idea for “le packing” devised because psychoanalysts in France found that the procedure fit with their theories, but not necessarily with an actual child’s experience? Is this a case of “theory” that turns into “practise” that sounds more than a little like “torture” to me?

Views from France about “le packing” can be read on this Forum Autisme.

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    • Kathy

      It’s tantamount to child abuse Kristina!

    • http://club166blogspot.com Club 166

      Well intentioned idiots wrapped my son up in a rug when he didn’t want to be wrapped up (they extrapolated some autistics liked deep pressure sometimes to “We’ll give him deep pressure whenever we feel he’s misbehaving”). So I could possibly see where a stupid, but well intentioned researcher, might want to apply sheet wrapping as a therapy. But what could they be adding by putting the sheets in the refrigerator? What possible benefit could that have?

      Other than being abusive, of course.

      Joe

    • http://www.autismvox.com Kristina Chew, PhD

      It kind of provides a new “take” on the “refrigerator [someone besides parents]” theory.

    • David N. Andrews M. Ed. (Distinction)

      This ‘treayment’ is why I’d like to see autism well outside the domain of medicine. Especially psychiatry… which – despite all protestations so far – has never been scientific.

    • Howard

      Club 166 is correct…it is a spin on an old concept…Just one more “cure of the month”…Add this to the better mouse traps people are still trying to sell…all I have seen is big talk about minor changes in approach and then BS testimonies.

    • Howard

      Hey Kristina…Here is another way to put it;

      tan xin jin bin

    • http://maternal-instincts.blogspot.com Niksmom

      Ok, I’ll buy the *stretch* about deep pressure. But cold and wet…WTH??? Nik would go even wilder if anyone ever tried to wrap him in something like that! Cold and wet…his two least favorite sensations in the world! Seriously. He’d rather hit his head on the floor (from an accident, I mean) than touch cold and wet unless it is actual water.

      Oy vey, what’s next from these “well-intentioned professionals?”

    • http://mommydearest1514.blogspot.com/ mommy~dearest

      At first, I didn’t know whether to laugh or cry. As I read on, this is a totally disturbing “treatment”, that makes me wonder if the originator is psychotic himself, or just a masochist.

      It’s being studied to see if it’s effective? And these kids are the guinea pigs? I wonder staff have to undergo training in this, and get wrapped up in the frigid sheets themselves.

    • Patrick

      Incoming sarcasm (sorry)

      I think that anyone who beleives in this therapy is in themself a frigid wet blanket.

    • Regan

      Restraint…full stop. Never mind the outcry, this guy has to stop and stop promoting this so-called treatment–today. Psychiatry and Freudian psychiatry in particular too often resembles quackery and sophistry in my book. It certainly has a negative history in autism.

      As noted, wrapping the mentally ill up in wet sheets was considered psychiatric treatment back in the 50′s. I can assume that this works as well as that did then…which is not at all. One other danger is that children have been known to dislocate joints and crack bones struggling against the mechanical restraint. Is it possible that the kids are calming down because they can’t move while the restraints are on, that there might be some hypothermia going on, AND that there might be a reinforcement contingency in that the sheets/aversive is removed when the kids get quiet? Might be negative reinforcement going on here.

      The French, and I will generalize based on feedback that I have gotten first hand, are WWWAAAYYY behind the curve on intervention and education of autism. I love France, but I hate reading stuff like this.

      Kristina, thanks for posting this, but I wish that there wasn’t a story to publish.

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    • http://daedalus2u.blogspot.com/ daedalus2u

      Interesting, and completely and totally misguided.

      The “reason” wrapping in mud or clay has beneficial effects is due to the autotrophic ammonia oxidizing bacteria present in the mud or clay. Wrapping in cold sheets would not have that effect. Inducing hypothermia causes mitochondria uncoupling (to generate heat). This decreases NO levels still further and would exacerbate ASD symptoms in the short term.

      Wrapping in cold sheets would likely produce local skin hypoxia and ischemia, both from the cold and from the vasoconstriction in response to the cold. This causes local oxidative stress, which can then cause rebound reactive hyperemia, the redness that follows ischemia.

      There are structural neuroanatomy differences in ASD individuals. How is this wrapping supposed to modify that neuroanatomy?

      The only mechanism by which I could see this having any “therapeutic effect” would be via a “rebound” effect after it is stopped. Sort of like treating a headache by banging on the foot until the foot hurts more than the head. When you then stop banging on the foot, it is noticed that the head doesn’t hurt as much.

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    • http://motherofshrek.blogspot.com/ Casdok

      Im speachless!

    • Mary McKinney

      Le Packing = Le Torture? Why? It’s negative reinforcement. Hell I would say anything to not be wrapped up in a wet/cold blanket again. What the hell? If they did this in Gitmo, the Geneva Convention would kick them out! Yet, they get to do this to 10 year olds.