The Evolution of Autism – Part II: Refrigerator Mother

As instrumental as Leo Kanner was in forming the ‘Refrigerator Mother’ hypothesis (remember his statement on how children with autism were ‘kept neatly in refrigerators which did not defrost’ – see part I), it was Bruno Bettelheim who gave it widespread popularity. While he didn’t perform any studies, he wrote extensively on the subject throughout the 1950s and 1960s, popularizing the theory that autism was caused by maternal coldness towards their children.

Bruno Bettelheim was a renowned University of Chicago professor and child development specialist. From the late 1940s to the early 1970s he served as director of the University’s Sonia Shankman Orthogenic School, a residential treatment facility for children with behavioral disorders. Through his work at the school, Bettelheim built a reputation as a highly regarded specialist in the treatment of autism. Building off of Kanner’s work, he declared autism to be an emotional disorder that developed in some children due to the psychological harm brought upon them by their mothers.

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Bettelheim’s most notable contribution to the evolution of autism comes from his 1967 book The Empty Fortress: Infantile Autism And The Birth Of Self – written in response to Dr. Bernard Rimland’s, a psychologist with an autistic son, 1964 book Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior, which directly attacked the ‘refrigerator mother’ theory.

Bettelheim’s book represents the last grasps at maintaining the refrigerator mother theory as a credible hypothesis.

THE EMPTY FORTRESS’ BAD REPUTATION IN AUTISM CIRCLES
(AND WHY IT WAS WARRANTED)

Bettelheim’s concept of autism was rooted in Freudian psychoanalysis – he believed that early frustrations in life, specifically during the ‘oral phase’ (breastfeeding) and ‘anal phase’ (toilet training) caused autism. For example, if the mother pulls back her breast when her child reaches for it, the child will sense and internalize the parental rejection. It’s this rejection, coupled with the parents’ deep desire for their child to not be there, that are the causes of autism.

As far as the ‘anal phase’, he believed that autistic individuals had an undeveloped personality and lack of self – meaning that they weren’t complete humans. He believed the development of self happens in the anal phase through the act of purposely pushing out feces. This act teaches the distinction between self and non-self as the individual is externalizing something that was once a part of him. His hypothesis was that the child’s inability to do this is why they have trouble with pronouns. As an example, he described a nine-year-old boy on the spectrum that referred to himself as “you” and only began to use “I” for himself when he started using the toilet by his own decision.

Additionally, he considered autism as a severe form of childhood schizophrenia and a state of psychosis. In my opinion, the most memorable remark of his book (and probably the best evidence for how hard he was trying to keep his theory alive) was his comparison of an autistic child to a prisoner in a concentration camp – casting the parents as the guards.

“The difference between the plight of prisoners in a concentration camp and the conditions which lead to autism and schizophrenia in children is, of course, that the child has never had a previous chance to develop much of a personality.”

Since Bettelheim was a Holocaust survivor (having spent ten months in a Nazi concentration camp), many took this remark at face value.

LIES ON LIES ON LIES

There’s a lot of deception in Bettelheim’s claims of success in treating autism. The most obvious one comes directly from his book. As parents read his perspective on autism and his case studies, it becomes apparent that most of the “autistic” children he claimed to have treated were not actually autistic. By this time, the diagnosis had become recognizable due to its unique characteristics so it was apparent to many that very few of the children he treated displayed the syndrome. A few years later, it was found out that his credentials were not valid and further look into his other works showed that he never conducted any rigorous research on any of the topics he spoke on and plagiarized portions of his studies. After his suicide in 1990, claims of abuse began to surface from his former students. 

Bettelheim’s famous attacks on mothers of children on the spectrum were nourished by a culture wishing to find easy answers, but fortunately, the tides were shifting as medical professionals and parents joined forces to understand autism and provide treatment to those on the spectrum – continued in part III.

Sources:

• Bruno Bettelheim, 1969. (Credit: Jack Manning/The New York Times)
• Cooijmans, Paul. Thoughts on Bettelheim’s The Empty Fortress. paulcooijmans.com. Oct 2014.
• Laidler MD, James. The “Refrigerator Mother” Hypothesis of Autism. Autism Watch. Sept. 2004. 
• Simpson, David; Hanely, J.J., Quinn, Gordon. Refrigerator Mothers Film. History of Autism Blame. PBS Premier: July 16, 2002