|Bruno Bettelheim is best known today for his popular work on fairy tales, The Uses of Enchantment , and his book on the treatment of autistic children, The Empty Fortress: Infantile Autism and the Birth of the Self. He may be remembered more for the flaws in these works than for the popular interest that they held at the time of their publication.(1)The legacy of these two works does little to represent the weight that Bettelheim's books, magazine articles, reviews, and public presence carried during the 1950s and 1960s, during the height of his authority in America. Bettelheim was a visible and opinionated public intellectual and proponent of psychotherapy in a postwar America that was hungry for the vision of humanity offered by psychoanalysis, with its humanistic emphasis on what Freud had called “in essence, a cure through love.”(2) Magazine articles referenced psychoanalytic terms, popular books on psychotherapy and psychoanalysis enjoyed high sales, film plots featured virtuoso performances of psychoanalytic interpretation, and psychoanalytic professionals enjoyed a growing influence in public policy.(3) This psychoanalytic vision offered a view of human vulnerability, perhaps, but also of malleability. Ellen Herman has aptly characterized the American relationship with psychology as a “romance;” like other love affairs, it promised personal transformation and involved occasionally uncritical acceptance. Psychology and the specific practice of psychoanalysis spoke to the possibility of salvation through the caring, wise and sometimes austere compassion of an understanding therapist, and the possibility of some stable anatomy of human motives in a rapidly changing culture.(4)
In this sense, Bettelheim's public persona spoke to an entire set of desires, and Bettelheim acted simultaneously as a representative of modern views about techniques of the psyche and childrearing, and as a reminder, by virtue of his bearing, accent, and persona, of a vision of tradition and social stability drawn from an Old World devastated by war. In the years following Bettelheim's suicide in 1990 at the age of 86, accusations arose that he had substantially plagiarized his work on fairytales, that he had beaten and verbally abused both children and staff during his thirty-year tenure as director of the Sonia Shankman Orthogenic School at the University of Chicago, and that he had knowingly contributed to the cruel and damaging portrayal of mothers of children with autism as “refrigerator mothers,” refusing to alter his position even as evidence accumulated against the psychogenic theory of autism. Based on contemporary treatment methods for autism, his claims to have cured children with autism using psychoanalytic methods appear to be patently false.(5)This was indeed a traumatic decline in status for a man who had once been portrayed as “the man who cares so much,” and “A Hero Of Our Time.”(6)
Bettelheim's involvement with autism represents one of several tragedies in the history of autism in the United States. Although psychologists and psychiatrists were responsible for diagnosing and treating autism in other countries, the impact and authority of psychoanalysis was not felt as deeply, nor did public pronouncements on the psychoanalytic meaning of autism have such a pervasive and lasting effect. Despite the centrality of parents in the history of autism in the United States, parents are notably silent in this story; Bettelheim's uses of autism excluded parents from practical interventions while incorporating them in theoretical frameworks, exchanging culpability for participation in treatment. Bettelheim is himself a tragic figure, a man who was unable or unwilling to modify his views in the face of mounting evidence that they failed to adequately represent reality and might in fact have been causing real harm.(7) By exploring the professional, institutional and social context within which Bettelheim worked, I do not offer a defense of Bettelheim, but what I hope is an instructive narrative, one which might shed light on other instances of resistance to change in biomedical theories and practices.(8) Bettelheim's theories, and the largely uncritical public promotion of these theories in the press and by fellow psychologists led to inestimable amounts of suffering, but we may learn more by investigating the conditions of their design and the source of their appeal than by dismissing them as an unfortunate interlude. Psychoanalytic approaches to autism were not, themselves, a developmental stage through which treatment strategies had to progress before more effective approaches could be found, but neither were they an accident or aberration. They have existed alongside behavioral and medical approaches, sharing vocabularies, methodologies, and often, ideological commitments.
Bettelheim's tragedy is a cautionary tale regarding the role of commitments and explanatory matrices in biomedicine today, and the social and environmental contingency of the efficacy of any therapeutic modality, a situation that has been remarked by a number of historians of psychiatry.(9) Biomedical knowledge, despite claims for universality and objectivity, may be both situated and pluralistic, in practice. Both the paradoxical efficacy of milieu therapy and the profound impact of the psychoanalytic worldview in American culture resonate with the history of behavioral treatment as well as contemporary fascinations with genetic determinism, resemblances that might take us out of our current logic long enough to remind us how tentative such matters of consensus can be. Bettelheim's conviction that one might temper reason with love, and his insistence that emotion stood at the heart of rational scientific practice may have led to abuses. Still, we might consider his conviction that his methods worked and that affective work lay at the heart of their efficacy, that “[t]he daring heart must invade reason with its own living warmth, even if the symmetry of reason must give way to admit love and the pulsation of life.” While this might be a dangerous and even inappropriate demand, it remains an often accurate description of biomedical practice.(10)
As a disorder to “think with” in twentieth-century America, autism has functioned as a focal point for ideas about motherhood, childhood, and development. Bettelheim's writing on the Orthogenic School, and his work on autism in particular, were read as a philosophical interpretation of human experience and existential dilemmas as much or more than as an account of clinical treatment, “a passionate description of deliverance , as it may be achieved for one child and denied to another.”(11) It became part of a national conversation about “natural” forms of love, caring and bonding, as any popularized explanation of psychological or neurological disorders appeals to normative ideas about the nature of development and cognition. All of these, in turn, connect to significant decisions about funding for research programs, effective treatments, and the provision of services for affected families. Understanding this appeal inevitably involves the writing of a kind of psychohistory, not only of Bettelheim, but also of the other professionals who used psychoanalytic methods in treating autism.(12) In this chapter, I focus on the case of Bruno Bettelheim and the treatment of autistic children at the Orthogenic School as the context for later developments both in autism-related social movements and therapeutic strategies as well as later psychological literatures. In this context, as in the present, the actions and labor of experts and amateurs converged around this set of children, their bodies, and the ideas that they represented. Careers were made around the work of acting as a compassionate spokesperson and therapeutic proxy for children who did not speak.
This chapter is also about a vision of childhood as an enclosed and formative space, and theories about the psychology of children as representative of broader American cultural anxieties.(13) Americans have built an imagined modernity through the unit of the family. Postwar Americans, especially those in the middle class and beneficiaries of the GI Bill, entering college after the War, used the science of psychoanalysis when applied to children to dream about a controlled childhood in which development into a healthy and well-adjusted human being could be both managed and directed, where the process of inquiry itself could ensure a healthy future.(14) Psychoanalysts and popular promoters of psychoanalytic theories like Bettelheim provided a product suited to this demand to add to an already substantial collection of childrearing advice and parenting manuals.(15) This was certainly not the first instance in American history in which dreams of childhood rationalized through scientific knowledge were current; early twentieth-century theories of positive eugenics and “scientific motherhood” are only two examples: parenting “as a verb” has been a staple of expert discourse, as have periodic backlashes against the intrusion of experts into the family domain.(16) Psychoanalysis was also not the only movement to place massive, and often contradictory, weight on the influence of mothers' actions on the early development of children, or to offer conflicting statements about the degree to which good mothering was innate or an acquired skill.(17) By the 1940s, experts were cautioning against an excess of psychology in childrearing, such that in 1941, Leo Kanner wrote a short handbook In Defense of Mothers , and in 1945, Dr. Spock's Baby and Child Care was first published, opening with the soothing reassurance that “1. You know more than you think you do.”(18)Benjamin Spock was, of course, referring to the cumulative knowledge gained from everyday observation and “what good mothers and fathers instinctively feel like doing for their babies.” Bettelheim suggested, as counterpoint, that some less good parents might inadvertently cause traumatic damage through those same instincts.(19)
This image of childhood as a technically manageable process of development is the type of collective space of projection, like the idea of modernity or the visions of heredity offered by genetics, that social scientists have referred to as “imaginaries.” Charles Taylor uses the term “imaginary” to emphasize the social and inchoate nature of beliefs about society. Social imaginaries structure the practices of both experts and nonexperts in their daily lives.(20) This broader framework for the circulation of knowledge allows us to see the connections between different sites of everyday, commonsense theorizing, carried out not only by psychologists like Bettelheim, but by counselors, other psychologists working with their own clients, and parents. Postwar theories of childrearing affected the treatment of severe childhood disorders as much as parents' everyday understandings and interpretations of their children's actions. Theories correlated to practices, and these collective projections were not merely rhetorical, but provided real sets of strategies, in which Dr. Spock's Baby and Child Care shared shelf space with Love is Not Enough in the homes of families of both disabled and typical children.(21) The Foucauldian idea that power is enacted and reproduced through discourse, and in doing so, rendered seemingly inevitable, informs my approach to the history of the intellectual concepts associated with psychoanalysis and milieu therapy, while Pierre Bourdieu's theory of practice as both a set of acts and a conceptual framework structures my approach to autism as a socially defined entity on which productive interventions were and are nonetheless carried out.(22)
I locate Bettelheim's literary and personal appeal within this history of Cold War America, American childhoods and the forms of emotional labor called parenting and therapy. As such, this is part of the history of autism as love and labor: the work of Bettelheim's Orthogenic School counselors on the one hand, and the imputed failures at the labor of mothering on the other. In his status as the originator of a set of discursive practices surrounding autistic subjects and their families, Bettelheim has been remarkably durable. He remains both reference and foil for generations of parents of children with autism, and his statements resonate in contemporary psychological literature and in the corridor-talk of practitioners and policymakers.
Autism as a Metaphor: The Empty Fortress Enchants America
Recollections of an institution by former members are often partisan; whether the Orthogenic School is described by former students, staff members, or merely participants in the larger project of twentieth-century psychotherapy and psychology, most accounts reflect longstanding loyalties and commitments.(23) As with many cases in the history of therapeutic strategies for mental illness, we can only speak in limited ways about the extent to which the therapeutic activity within the milieu of the Orthogenic School was “truly” effective, judged against other types of intervention, during different time periods.(24) In the case of the Orthogenic School, as in other cases that I describe, the specific institutional location of therapeutic activity and interactions between practitioner and subject are crucial, as are the forms of social learning and tacit knowledge used to reproduce a particular intervention. As in other cases, therapeutic activity was organized by gender, and therapies were understood to alter both the subject and practitioner of therapy, as each became increasingly committed to the therapeutic program, a reciprocal influence not unknown in biomedical treatments.(25) Unlike the majority of modern diagnosis and treatment strategies, which derive much of their authority from the appearance of what Charles Rosenberg has called therapeutic “specificity,” psychotherapy as practiced by Bettelheim never placed much weight on diagnostic accuracy or on treatments tailored to a diagnostic group; the salient categories were the universal human psyche and the individual sufferer.(26)
The Empty Fortress is the major source of accounts of Bettelheim's claims for efficacy, the explanation of his theories, and descriptions of cases of autism treated at the Orthogenic School. When it was published in 1967, The Empty Fortress was a bestseller, featured in major national newspapers and magazines, from the Times and the Saturday Evening Post to the New Yorker and The New York Review of Books . Reviewers greeted it as a philosophical rather than a technical work, a meditation on the drama of childhood and the triumphant “search for self” that Bettelheim claimed to both facilitate and chronicle. A reviewer in the New York Times invoked Bettelheim's acclaimed account of German concentration camps, proclaiming that “. . .it is evidence that the informed heart is possible and that the alienations in our age – whether they are the planned dehumanization of the concentration camps or the unintentional dehumanization of modern mass society or the still largely mysterious dehumanization of individual psychosis—need not be accepted as the permanent condition of man.”(27) Other reviewers wrote of Bettelheim's evident compassion and generosity, of the mothers “who believe in him” and seek his advice, and of Bettelheim's “real love, warmth, understanding, and years of infinite patience and hope.”(28)
Bettelheim, with the encouragement of his publisher, Knopf, chose to orient The Empty Fortress to a broad audience, intentionally avoiding jargon and technical terminology for a comfortable, and resoundingly self-confident expository style.(29) The intended audience of this book were not looking to investigate treatment options for their own children or patients (some practitioners sought practical advice, with little success, within its pages), but were general readers seeking to comprehend their anxieties about their own, typically-developing children and contemporary changes in family structure, specifically the “problem of parental preoccupation and indifference” as a uniquely modern risk to child development.(30) For these readers, autism represented a metaphor for frustrated love and the most frightening possible outcome of childrearing in a nation of increasingly “anxious parents.”(31) Autism became a metaphor for American anxieties about childrearing and bonding, about changing women's roles and about the formative power of love and the compelling image of the autistic child as an exemplar of halted development – an appeal visible in the continuing research carried out on autism as a developmental and behavioral model throughout the twentieth century.(32) Despite his disclaimer that treatment was not fully successful for all of the patients, Bettelheim seemed to offer a series of salvation stories; a promise of a cure for the previously untreatable.(33)
Those parents of autistic children who read the book were not nearly so sanguine in their pronouncements. Amy Lettick, the founder of a residential program for developmentally disabled children and adults, asked the director of the Nassau Center for Emotionally Disturbed Children whether she had read the book yet: “Fascinating. I think this book alone is enough to have him committed. He has marvelous descriptions of autistic behavior, but this reasoning he ascribes to it is unbelievable. Wait till you read how 12 year old Joey cured himself by giving birth to himself out of a chicken egg. Myra Rothenberg should have rushed out to Chicago with her incubator!” (Mira Rothenberg was another noted promoter of psychotherapeutic techniques for treating children with autism).(34) Reviewers writing in the pages of clinical journals shared a perspective with parents, noting the failure of the book to present pragmatic advice or even specific treatment modalities, and Bettelheim's tendency to interpret any behavior through the lens of psychoanalysis, often in absence of detailed clinical descriptions of the behavior in question.(35) One frustrated reviewer noted that Bettelheim's complex interpretation of the unwillingness of children with autism to be treated by dentists failed to mention – and perhaps to recognize -- that such problems occur with other “non-verbal subnormal children,” and complained that Bettelheim's defense of his theory that the actions of mothers were perceived by the child as a “threat to his very existence” failed to explain why some mistreated children developed autism and some developed normally.(36)
By 1967, many of the ideas about autism upon which Bettelheim based his treatments had been abandoned by the mainstream psychiatric community, as Jacquelyn Seevak Sanders, a counselor and later director of the school, has noted.(37) Bettelheim produced the book after he had stopped treating children with autism at the Orthogenic School; the book was presented as the culmination of his work on a 1956 Ford Foundation grant to study autism. It was a synthetic work with sections devoted to theory, three case studies, and an extensive review of published literature on autism. The Empty Fortress deliberately situates autism as a theoretical problem within developmental psychology, including a discussion of typical human development and ego differentiation contrasted with the failures of ego development seen in the autism cases that Bettelheim describes.
Bettelheim traced his interest in autism to an experience with an autistic American child brought to stay with him and his wife in Vienna after Anna Freud had recommended that the child's only hope was a “psychoanalytically organized environment.”(38) In a book on childrearing, Bettelheim explained how “the severe pathology of her case permitted observing a phenomenon also seen in normal behavior but as if it were under microscopic enlargement, or thrown into bold relief by a bright light.”(39) Writing in 1987, Bettelheim recalled that he “carefully respected her wish to be left alone, while still trying to take careful, loving care of her, before she moderated her total isolation and permitted occasional approaches, although she did not respond to these in any discernable way.”(40) After a year and a half of games of Peek-a-Boo and Where's the Baby, which “enabled her to find herself and at the same moment to find the world of other people,” the once-mute child spoke her first sentence in perfect English, “Give me the skeleton of George Washington.”(41) Bettelheim interpreted this as a pithy encapsulation of the child's fatherless upbringing, rejection by her mother and resulting autism, and consequent adoption of “the father of her country as a solution to her problem. Since the unknown father was, Betteheim explained to the reader, ‘the skeleton in the closet' of her life, she asked for his skeleton.”(42)
To the contemporary reader of Bettelheim's work, Bettelheim's relentless psychoanalytic interpretation of behavioral, physiological and perhaps even biological symptoms is both perplexing and compelling. Bettelheim describes “twiddling,” pronominal reversal, rocking, dietary restrictions, obsessions with order and with organizing time, sensory abnormalities and head-banging.(43) In a paper on physical symptoms in emotionally disturbed children, Bettelheim wrote that through the “process of personality integration” at the School, “Psychosomatic manifestations of long standing – such as allergies, neuro-dermatitis, ocular-motor disturbances, mucous colitis and other disorders of the digestive tract – also disappeared spontaneously.”(44) For readers encountering the text at the time of its publication, these interpretive feats were the focus of admiration rather than skepticism. Peter Gay, a noted biographer of Freud, wrote admiringly that:
Obviously (Bettelheim is enough of a Freudian to be convinced of this) all aspects of autistic behavior are meaningful; all of it – the twiddling, the peculiar modes of defecating, the silent rocking, the refusal to eat – is a kind of language, even if it is directed at no one. But since symptoms vary so enormously, and since the therapist has no way of checking his hunches with the patient, as he does in psychoanalysis, the interpretation of the ‘language' autistic children have available to them demands the utmost concentration, intelligence, empathy, and persistence.(45)
Despite his willingness to rely on psychoanalytic interpretations of autistic behaviors, Bettelheim had read widely in not only the psychoanalytic literature but in child development as well. His characterizations of autism are best understood in terms of a matrix of theories regarding the interactive processes underlying development. In addition to Sigmund Freud, who Bettelheim adopted as his inspiration (and if he never explicitly claimed that he had studied with Freud, he did his best to imply it), Bettelheim was inspired by John Dewey, and the psychoanalysts Erik Erikson, August Aichhorn and Anna Freud.(46) Regarding abnormal ego development, Bettelheim turned to Rene Spitz's studies of institutionalized children.(47) The devastating effects of failures of appropriate stimulation also were recorded in Harry Harlow's experiments on infant monkeys. Harlow's studies, which established for scientific colleagues and a public reading Life magazine the relations of “natural” childrearing, also served as a source for Bettelheim: Harlow's ability to produce what appeared to be innate disorders of temperament through extreme sensory deprivation seemed to support for Bettelheim's psychoanalytic theories. Images of baby monkeys clinging to terrycloth mothers represented an icon of innate instinct; the failures of these monkeys to develop normally illustrated for Bettelheim the necessity of the “dialectic of hope” between mother and child. (48) These ideas resurface in ethological theories of autism, written almost ten years after Bettelheim, and there are contemporary echoes of Bettelheim's cold mothers in observations about the difficulty of relating to children with severe autism which surface in the advocacy literatures, not to mention continuing work in psychology.(49)
Bettelheim's argument is often misremembered as comparing mothers of children with autism to guards in concentration camps; in fact, the concentration camp metaphor enters his argument as premise and justification for milieu therapy. Bettelheim's claim was that personality change could be effected through the institution of a total environment, his claims based on his observations of his fellow inmates in a labor camp.(50) He does, however, argue that the stunted ego development of the child with autism resulted from a mortal fear, a response to the child's unconscious sense of a deep ambivalence on the part of the mother. Perhaps, Bettelheim conceded, the mother's rejection was itself a response to a child who had failed to bond; the failed relationship is seen as a failure of reciprocal bonding, a delicate balance that can be undermined at any point: “All children are born with differential sensitivities and react differently to their environment[. . .]in the realm of interaction, it really matters little who makes the first move, who begins the interaction, or even the nature of the action. What counts is whether the action is interpreted correctly and meets the appropriate response,” a delicate choreography in which a single failure at breastfeeding might precipitate a cascade of developmental maladies.(51) This dyadic shaping of development recurs in contemporary psychological discourse on autism. Although most critics find only hatred for mothers in Bettelheim's explanation, Nina Sutton, a sympathetic biographer, writes that
. . .if one places The Empty Fortress in the context of its time, one finds he was, on the contrary, the first author to stress the mutual nature of the mother-child relationship, pointing out that there is no such thing as a perfect mother (which is fortunate since otherwise children would never need to learn the ways of the world), and stating clearly that the problems of the autistic child cannot be blamed on an external cause (the mother's behavior). . .Indeed, in that book he constantly refers to the (unconscious) death-wish that a mother can feel for her child.(52) Following the case studies in the book, Bettelheim provided two literature reviews, explaining that they are not “systematic,” but replicate his own reading into the “nature of the disturbance” in the children that he has treated.(53) The first section, “Etiology and Treatment,” begins with Leo Kanner's 1943 monograph and proceeds to Bernard Rimland's Infantile Autism , published just a few years prior to Bettelheim's work. Infantile Autism serves primarily as a refutation of the psychogenic theory of autism, and Bettelheim treats it as such: a challenge to his views, worth a somewhat perfunctory dismissal:
Rimland holds that the source of the autistic disturbance is to be found in the reticular formation of the brain stem. But a careful study of the evidence presented in his book failed to convince me that autism has anything to do with an inborn dysfunction of this or any other part of the brain. And even if a specific neurological dysfunction should some day be found to correlate highly with the syndrome of infantile autism, it would still be compatible with the psychogenic hypothesis.(54)
Bettelheim did not entirely dismiss the possibility of organic correlates to the behaviors of autism; rather he wrote that “[w]hile I do not accept the hypothesis that autism is due to an original organic defect, I do not feel I can rule out its later appearance. On the contrary, I tend to believe that far from being organic in origin, infantile autism, when persisting too long, can have irreversible effects.”(55) He observed that if “certain neural systems are not appropriately stimulated within a specific period of life, they may suffer permanent impairment,” a suggestion that his opponents might have agreed with in content if not in tone.(56) However, his second point, that “we were able, through psychotherapeutic treatment, to reverse the course of the disturbance,” would have met with vehement opposition from Rimland, as would his dismissal of the behavioral treatment methods developed by Ivor Lovaas (advocated by Rimland) as yielding “conditioned response actions. Which means that autistic children are reduced to the level of Pavlovian dogs” or “more pliable robots” with new symptomatic behaviors.(57) Only because Rimland “did not study autistic children carefully with the intention of deciphering the messages of their autism” that he could maintain that their language was primarily echolalia.(58) Writing at Bettelheim's death in 1990, a former counselor at the school explained that the book “met with resistance in the American psychological and psychiatric communities because it did not deal in depth with the possible neurological concomitants of autism,” but that “Bettelheim's view was that until mental health professionals came up with a specific neurological disorder that was responsive to medication, psychotherapists had little choice but to continue with treatment efforts.”(59)
The Empty Fortress represented both a synthesis of Bettelheim's experience with autism at the Orthogenic School and one work in a corpus that Bettelheim clearly regarded as interconnected. Throughout the text, he refers to his books on the structure of the Orthogenic School, Truants From Life (1955) and Love is Not Enough (1950), to explain the production of the therapeutic milieu. Likewise, he makes reference to his work on authoritarian aspects of contemporary society in The Informed Heart (1960) and his research on childrearing and personality development on the kibbutz (published later as Children of the Dream, 1969) . The work in The Empty Fortress claimed to describe the outcome of work done on children with autism as an “experimental system” for understanding the course of typical human development, and the Ford Foundation grant was specifically for this purpose. For Bettelheim, claims about children with autism were intimately connected to claims about the efficacy of his school and the theories behind it. Likewise, the counselors at the School were referred to, in The Empty Fortress as in Bettelheim's other accounts of the school, as “participant observers,” simultaneously acting as Bettelheim's protégés, his technicians, and his instruments of observation.
The Empty Fortress is structured around four lengthy case studies, although Bettelheim writes of treating a cohort of nearly forty autistic children at the Orthogenic School, given clinical diagnoses by Bettelheim. Of his cases, perhaps the best-known chapter concerned “Joey: The Mechanical Boy,” published earlier in Scientific American . Joey's predicament was appealingly legible: his autism presented metaphorical products that nearly interpreted themselves. “Machine-like” in his movements and speech, Joey produced images of machines and imagined himself to be mechanical. Joey was presented as a success in the treatment of autistic students in the Orthogenic School; his watercolors, delicate but preserved in the Bettelheim archives, still feel like a kind of material evidence of internal change. Joey's private world was presented in Bettelheim's work as internally coherent, a verbal and visual representation of his internal struggle for selfhood. Joey's elaborate constructions of electrical and mechanical systems around his bed and body served to provide power sources and regulate input and output for Joey; his obsessions with his bodily emissions and his fear that he lacked an internal ability to generate life and activity were poignant and strange. Contemporary writers have suggested that the metaphorical richness of Joey's language indicate just the kind of symbolic reasoning that children with autism are now understood to lack; alternately, one might note Joey's tendencies of pronominal reversal, his insistence on routine, his difficulties with eating and discomfort associated with elimination as well as his lack of an emotional vocabulary as characteristic of what would now be called high-functioning autism.(60) For Bettelheim, Joey represented the class specimen of childhood autism, his specific fears of uncontained aggression and unregulated inputs the expression of his maternal deprivation.
Bettelheim describes Joey's perseveration on words and strings of phrases as comprising a private code or rebus: he is almost gleeful in an account of the discovery that the “Connecticut papoose,” a game of Joey's, represented “Connect-I-cut,” a set of ideas interpreted by Bettelheim as a symbolic account of Joey's ability to give and receive affection. Joey's emerging ego and personality development culminated in an interview between Joey and Bettelheim upon Joey's graduation from high school three years later. The interview itself is evidence of a certain psychoanalytic subjectivity: Joey, prompted by Betttelheim, speaks of how he was afraid to express his emotions, and recounts how important his intimate connections with the staff were, in particular the fact that counselors had held him and fed him in the School's dining room. The reader is left uncertain whether Joey has mastered the psychoanalytic vocabulary and view of the self, or has indeed been cured by the actions and choices of Bettelheim and the counselors. Within the context of the Orthogenic School's milieu therapy, the acceptance of the interpretation and the cure are closely allied transformations.(61)
In his discussion of “Laurie,” Bettelheim elaborates his theory of the origins of autism, writing that “[t]hroughout this book, I have stated my belief that the precipitating factor in infantile autism is the parent's wish that the child should not exist. While the same wish may not cause the same disturbance in other children, and while at some future time we may learn that some organic factor is a precondition of autism, the fact is that almost all organic conditions that have so far been linked to this disease are also present in nonautistic children.”(62) Furthermore, in the case of the “already autistic child,” it is natural to respond with ambivalence to their lack of “positive responses.”(63) For Bettelheim, autism became an incessant feedback between infant withdrawal and inadequate parental response. It is clear that the responsibility lies with the parents, but only psychoanalytic insight can make them aware of their participation. He explains that in the case of the child with autism, a “liminal action of the autistic child – and most of their actions are liminal or subliminal – evokes ambivalence, or a negative response in the caretaker. To this the child responds with massive withdrawal.”(64) Bettelheim recounted Laurie's “collapse,” or “total withdrawal from the world,” precipitated by a counselor's ambivalence, akin to the ambivalence that must have been experienced by Laurie earlier in her development. For Bettelheim, this inappropriate response occurs when a child's intentions are “misread – because of the caretaker's bondage to her own needs and desires.”(65) Mothering becomes the management of libidinal impulses and drives, because their expression can exact real harm on the developing child. The merest thought of rejection becomes a harmful act. Hence, mothers must be constant interpreters of their children's struggles, on the one hand for autonomy and on the other, for affirmation. Failures at reading become failures at love.
The Romance of Bettelheim: Motherhood, Ambivalence; Psychological Expertise
A number of recent biographies of Bettelheim provide useful syntheses of his life and work and a broad range of reactions to Bettelheim as subject. The biographies written by Nina Sutton and Theron Raines tend toward the frankly adoring, while Richard Pollock's book is strongly critical in tone.(66) All, as acts of interpretation, attempt to answer the significant questions raised by Bettelheim's evident dishonesty to both peers and public regarding his background and credentials, as well as the troubling problem of his claims to have treated autistic children in Germany and to have cured children with autism at the Orthogenic School.
Bettelheim represented a particular kind of American scientific public intellectual. As a public expert on psychoanalysis, cultural change in America, childhood and education, he represented a growing trend in social scientific expertise. Bettelheim had the credentials of his psychoanalytic practice, his claimed Freudian lineage, and an embodied and experiential form of authority represented by his experience of World War II, incarceration, and escape from Germany.(67) Positioned as both scientist and observer of the traumatic events of the present, he was uniquely suited to speak to the human condition in America, and the trials facing children and parents in a culture that he approached as both admiring outsider and engaged participant.
The majority of journals of psychoanalysis in America were founded during the 1950s, precisely when Bettelheim was beginning his American career. Nevertheless, Bettelheim published as much or more in the popular literature than he published in professional forums, sometimes borrowing liberally, and without attribution, from more academic sources (as Allan Dundes has demonstrated of Bettelheim's psychoanalytic interepretations of fairy tales).(68) Bettelheim published on the changing role of women in the home and workplace, the student antiwar movement, educational problems for normal children, and childrearing. The themes that predominated in his work were autonomy and the self-authorship of the child achieved through infantile desires for gratification and, later, self-conscious assertion. In life as in fairy-tales, through the satisfaction of desires, the self was born. Bettelheim's own self-fashioning was reflected in contemporary accounts, which frequently opened with a physical description and often included a photograph of Bettelheim's “bespectacled” visage. His bald head, prominent ears and the heavy frames of his glasses were immediately recognizable.
Bettelheim's credentials have been a matter of significant debate. It has been suggested that he allowed potential employers to understand that he held a degree in psychology rather than philosophy and aesthetics, and that he had completed an analysis as part of his training, which he had not (it was begun but never completed). This last factor was crucial in the credentialization of psychotherapists in the 1950s, a period in which certification practices for psychoanalysts were not entirely formalized, in some respects more important than formal psychoanalytic training or an academic degree in psychoanalysis.(69) Bettelheim eventually became a “non-therapist member” of the Chicago Psychoanalytic Society, a position that may have reflected his lack of formal training or the ambiguous position of child psychology during this period.(70) In addition to his uncertain credentials, Bettelheim either fabricated or was misleading about other components of his past, including his connections to Freud, and his treatment of an “autistic” child while in Vienna, and the duration of his internment in a concentration camp (a labor camp at the time Bettelheim was confined). However, Biographers also note that the generation of which Bettelheim was a member might have regarded this type of untruth as an exigency; among millions of displaced persons, each felt the need to make themselves as desirable to employers in the States as possible.
Bettelheim's personal witnessing of the devastations of World War II and Nazi Germany is a theme which links Bettelheim to Leo Kanner and both men to the pioneer of behavioral therapy, Ivor Lovaas. Bettelheim linked his claims regarding the malleability of the human psyche to his observations of fellow inmates in a labor camp.(71) As a survivor, Bettelheim enjoyed a unique, almost anthropological authority; as witness, he could speak to the motivations underlying fascism and authoritarianism; and as therapist, could claim a theory that transmuted the negative power of the camps into a positive therapeutic insight, just as Lovaas has suggested that witnessing fascism made him realized just how malleable the human psyche might be.(72) In an article on German internment camps prior to the war, Bettelheim claimed that, in contrast to other prisoners, he was able to avoid loss of personality and identification with prison guards by maintaining a scientific attitude of detached observation. As a clinical observer, Bettelheim claimed that he avoided the emotional experience of imprisonment and was instead able to record the gradual disintegration of his fellow prisoners.(73) Bettelheim's claims about the therapeutic possibilities of a “total environment” and the centrality of the development of human autonomy resonated with a contemporary movement toward milieu therapy as well as public interest in the role of social environment in the shaping of subjective experience. Bettelheim's popular works on the relationship between social environment and moral autonomy, such as The Informed Heart , fed a popular appetite.
If Bettelheim was a particularly appealing public figure, he was far from alone at a moment when American psychologists were seeking far-reaching public influence by “giving psychology away.” Ellen Herman has called this relationship a “romance;” this love story is the context for Bettelheim's tragic rise and the experience of betrayal expressed by his students and admirers.(74) Freud had come to America for his first and only trip in 1909, and in the intervening decades, Freudian psychology had been modified and adapted to the needs and tastes of an American population. Americans were more interested in ego psychology than in the unconscious, in the application of psychoanalytic theory to problems of human management, human development, and child development. Scholars have considered the ways that interest groups and activists adapted Freudian theories to provide support for a variety of issues, from autonomy and self-determination to women's liberation and movements for social equality. Individual experiences of psychotherapy, likewise, took place within an American – and frequently middle class – milieu, where individuals concerned themselves with the trajectories of their careers and questions of social performance.(75) Fred Matthews notes that in America in the 1950s, Freudian theory was increasingly wedded to behaviorism, linking drive theory to theories of conditioning -- these would eventually become the basis for the operant conditioning techniques developed by Ivor Lovaas, which Bettelheim argued stridently against. While Bettelheim bemoaned the loss of Freud's literary and interpretive tendencies apparent in the translation of Freud's work into English and his practices into American culture, his emphasis on autonomy and his optimistic belief that any illness might be addressed had a unique appeal to that same culture. While Bettelheim advanced a rhetoric of psychoanytic purity, he eagerly adjusted his persona and his textual offerings to an American audience.
Just as psychologists sought to become purveyors of expert advice during the 1950s, they also sought to expand their clinical influence to reach not only the emotionally disturbed, but the “nervous normal.”(76) Bettelheim's public intellectualism was particularly effective because he simultaneously embodied both of these personae. The treatment of war neuroses and preventative measures aimed at keeping troops psychologically healthy provided a means for psychological professionals to argue for their specialized skills during the war. Following the war, the reintegration of soldiers into American society was phrased as a problem in “readjustment,” the GI bill seen as a means for providing the tools for this reintegration into American society, and for filling the ranks of the mental health professions through specialized training.(77) While soldiers enrolled in campus courses in psychology, their wives looked to incorporate psychological expertise into their own work as mothers and domestic partners. Bettelheim ran a series of “Mothers Meetings” in the Hyde Park area near the Orthogenic School and University of Chicago, which were transcribed and edited as Dialogues with Mothers.(78) The transcripts show anxious mothers (and some fathers) eager to inspect their own interactions with their children. The mothers themselves seemed eager to utilize the psychoanalytic perspective in their childrearing decisions; concerns about normality were transformed into problems regarding tactics and strategies for developing healthy children. The interpretive framework of psychoanalysis could as easily be applied to typical children as to highly disturbed ones; Bettelheim's dialogues (called “diatribes” by some critics) encouraged mothers to scrutinize their own actions in order to determine the causes of their children's behaviors. A child's every action was a reaction, if only in response to the unconscious wishes and signals of the parent. Love was an intuitive technique, but one that could be honed, tested, and critiqued. Love was innate, but could be improved and refined, carried out reflexively, and on occasion, skewed or corrupted.
Despite this apparent need for massive introspection and clarity, with the constant threat of harm, Bettelheim claimed that harm was not inevitable. Bettelheim tempered his austerity with the recognition that all parents were subject to conflicting impulses, and the developmental trajectories were generally quite stable, and famously cautioned that one need not be perfect, but merely a “good enough” parent, in the title of his book on childrearing, inspired by a statement by D. W. Winnicott, the expert on child development.(79) Arguing against the perception that there existed a single, correct method of child-rearing guaranteed to produce desirable results, Bettelheim argued that “Whatever we do with and for our children ought to flow from our understanding of and our feelings for the particular situation and the relation we wish to exist between us and our child.”(80) Likewise, his columns in women's magazines spoke to a psychoanalytically literate culture, accustomed to understanding individual development as a series of moral achievements between parent, child, and broader culture, full of perils to be sure, but comfortingly within the realm of the everyday: battles over appropriate clothing, learning to read, and toilet training. Bettelheim conceived of the audience for his work as two separate groups, on the one hand, “intelligent and highly-motivated mothers of more or less normal youngsters,” and on the other, counselors such as the staff of the Orthogenic School, both of whom might benefit from insights in understanding the “ever-changing situations in which they find themselves as the adult raises a child and as the child reacts to being raised.”(81) The parents of children suffering from “severe psychological impairments” were curiously absent as an imagined audience for Bettelheim; the treatment of these children was the domain of those properly trained.
Bettelheim's theories can be linked to broader trends in psychoanalysis and public psychoanalytic discourse, toward “mother-blaming” as a pervasive trend in psychological and other forms of scientific and expert writing of the 1950s.(82) Scholars have noted the reciprocal relationship between ideals of “scientific motherhood” on the one hand, and increasing recognition of the conflicts between the many roles that women were expected to fill during the post-war period in America.(83) The ambivalent relationship between American women and psychoanalysis has been given thoughtful treatments by a number of authors. At one extreme, Philip Wylie's “momism” imagined mothers as a suffocating menace to the autonomy of their sons, but despite these portrayals, women also embraced psychoanalysis.(84) Elizabeth Lunbeck has explored the ways that female psychiatric social workers, in their daily practices, were a central force in the proliferation of a psychoanalytic worldview during the early twentieth century. Ellen Herman has argued that as much as psychology was used as a support for discriminatory practices against women before and during the postwar years, it also gave to feminist movements a variety of rhetorics, theories and techniques. Feminists at once argued against the incriminating and suffocating images of women and mothers portrayed through psychoanalysis and proposed alternative techniques, from “consciousness raising” to feminist psychoanalysis, as correctives for both psychology and society at large.(85) A number of theories from within psychoanalysis were proposed as correctives to Freudian notions of gender founded on castration anxiety and historically contingent gender roles. Perhaps most central to my purposes for the moment are arguments that turn on the relationship between the rise of a public culture of psychoanalytic discourse even as “traditional” women's roles were increasingly strained by the entry of women into the workplace, including psychological professions.
Just as Bettelheim's theories might be situated in the context of a receptive public and a profession with ambivalent attitudes toward women's roles, the practice of recommending psychoanalysis for parents – mainly mothers -- of children diagnosed with autism extended beyond Bettelheim and his theories regarding the psychogenic etiology of autism. A 2002 documentary centers on the experience of these “Refrigerator Mothers.”(86) Many of these women were placed in psychoanalysis following their child's diagnosis, and many still bear emotional scars from this ordeal. Parents submitted to psychoanalytic treatment because they believed what they were told: that the best way to improve the welfare of their child was to be treated themselves. Presented with an incomprehensible being, the best mode of treatment seemed to be treatment of those closest to the child. The stories of these parents has yet to be told in full. A mother quoted in a 1979 article mused that
They never were interested in really seeing the child, but they had my husband and I come in forever – really doing the trick on us. We both thought we loved each other before we went there, and after that things have never been the same—even though it was fifteen years ago. . .but I never accepted Bettelheim. No. Nobody ever loved anything or anybody like I love this kid. I would gladly, at a moment's notice, give my life for the slightest improvement in him—I mean that. I'm doing it every day.(87)
The Therapeutic Milieu: Developing Children, Constructing Counselors
While the concept of milieu therapy was used in other settings during the period of Bettelheim's directorship of the Orthogenic School, Bettelheim chose to explain his approach as an outcome of his life experiences and observations of “total environments,” connecting his therapeutic strategy to theoretical and philosophical approaches to human behavior in the face of powerlessness and fear.(88)Bettelheim claimed that this insight could be used for treatment: an environment that encompassed all aspects of life could be used to produce psychological change, a “concentration camp in reverse” in the words of one supporter, where the children were free to wander outside, but outsiders were barred.(89) Contemporary readers have inferred from Bettelheim that the hypothesized pathological milieu of the home had a similar impact, that the home was the “total environment” of which Bettelheim wrote and from which children must be removed. His actual justification for the milieu was more nuanced, if not innocent:
A total therapeutic setting implies a separation of the child from his family and protection against those influences coming from the outside which led to that mortal anxiety which caused the child to withdraw to the autistic position. It also demands careful study of his behavior in order to understand the hidden motives which cause it and a therapy based on this understanding.(90)
Bettelheim was not unique in claiming inspiration from the tragedy of World War II in Europe: Ivor Lovaas also claimed that his experiences taught him to reconsider ideas about the innateness of evil or personality, and to conclude that any harmful or beneficial activity could be learned or conditioned. (91)
Although Bettelheim advertised his unique rationale for this intervention, the Orthogenic School as an institution predated Bettelheim's tenure as director, and the concepts that he espoused were current in the psychoanalytic profession. Karen Zelan, a former counselor at the school, writes that the inspiration for the psychoanalytic milieu was largely drawn from the work of August Aichhorn, as was the insistence that children be removed from the home environment.(92) Bettelheim's own unconventional psychoanalytic training may have made it seem to him that his ideas grew out of his own experience, but the concept of milieu therapy was popular during this period, and there were multiple centers in the United States and United Kingdom that were structured around this philosophy. The decline of this movement, an archivist of therapeutic communities in Britain has suggested, was less due to the failure of the model than to the high upkeep associated with such institutions and the difficulty of conveying the nature of their work to external agencies and sources of financial support: the training and devotion of the staff had to be monumental.(93) Contemporary group homes and community care for the mentally disabled represent a different institutional, political, and therapeutic model; where milieu therapy represented a holistic vision of education of practitioners and healing of children, community care represented an attempt at creating a humane alternative to lifelong instutionalization for individuals understood to be incurable. In contrast, institutionalization following a stay at the Orthogenic School was seen as a failure of care.
At the time of his appointment to the directorship of the School and shortly afterwards, Bettelheim coauthored a number of articles with Emmy Sylvester (who directly preceded him as director) on the education and training of staff at the school and on the treatment of children within the school framework, situating his own approach as an enrichment of but not a significant deviation from the established methods of treatment at the School. However, the decision to admit children diagnosed with autism as part of a research program was Bettelheim's. Prior to this, the school's admissions policies had not been overly concerned with specific diagnoses, mandating only that children have emotional disturbances as opposed to “organic” psychoses or feeblemindedness. Bettelheim saw the opportunity for a research program built around the unique constellation of symptoms that constituted autism and chose to exploit this.
Richard Pollock recounts an instance in which Bettelheim, years after the death of both Pollack's autistic brother and his mother, maintained that the brother had committed suicide while at home on vacation, in response to his mother's hatred. “'What is it about these Jewish mothers, Mr. Pollock?' He asked. I was stunned by this casual anti-semitism, coming as it did from a Jew who had suffered in the camps, and by the ferocity of his antagonism two decades after Stephen's death.”(94) Pollock recounts the accident in which his brother fell from a hayloft, an incident that left Pollock himself filled with guilt and determined to exonerate his mother from the charge of coldness and his brother from the moral ambiguity of suicide. Bettelheim maintained until his death the conviction that children with autism suffered from a deficit of affective contact on the part of their mothers.
Bettelheim's claims regarding the etiology and treatment of autism have come under attack in recent years, most notably in Richard Pollack's memoir, but also in the response directly following Bettelheim's suicide, when counselors came forward to critique his violent disciplinary techniques. However, as Jacquelyn Seevak Sanders has suggested, autism “in the field at large” was not so different from autism at the Orthogenic School, as either clinically recognized entity or structured set of treatment practices. It was Bettelheim's refusal to alter his position in the mid-1960s that rendered his approach stubbornly marginal. Sanders suggests that it is crucial to understand in some depth the context in which Bettelheim and his staff attempted to treat children with autism and other severely emotionally disturbed children.(95) These interventions, directed at children -- who to the contemporary reader appear to be so clearly suffering from neurological disorders -- were carried out with the utmost seriousness.Former counselors at the Orthogenic School have retrospectively attempted to situate both Bettelhejm's beliefs and their own in the context of the therapeutic milieu developed at the Orthogenic School, their psychoanalytic training, and the commitments of Bettelheim's Ford Foundation grant. Jacquelyn Sanders worked as a “counselor and assistant” for fourteen years and directed the school for an additional twenty years, entering the school as a young woman and eventually receiving a doctorate in psychology.(96)Sanders worked at the Orthogenic School for half of Bettelheim's tenure, and has argued that it is crucial to understand how “the actual experience of autism at the Orthogenic school related to this dramatic change in external professional and public perception” of the practices at the school. Sanders describes her experience vividly:
In November of 1952 I began my first intensive engagement with an autistic child. My first memory is of his back as he leaned over the drinking fountain and Joanne, a senior counselor, spoke gently to him while I watched with admiring fascination, both the counselor and the child. At that time what autism meant to me was simply the extreme of my own deeply introspective tendencies, coupled with a refusal to engage in communication. I was convinced that guided by my empathic understanding I would overcome that refusal. I was one of a group of unrealistic but devoted optimists. Jules Henry, an eminent anthropologist, during his two years' study of the Orthogenic School, wrote a poem about me and the first of my autistic youngsters. I was the Orpheus who had the power to lead my beloved out of hell if only I didn't look back. Though the analogy was grossly flawed, it was very romantic and, therefore, especially coming from a highly respected scientist, extremely flattering to a very naïve and very young worker.
This was characteristic of the atmosphere of the school: brilliant minds at work on a new frontier of greatest human significance, and with greatest hopefulness. The possessors of those brilliant minds expressed themselves as artists, and always with literary and historic allusion. And the least trained – the counselors (i.e. childcare workers) – were viewed as being pivotal in the success of this wonderful enterprise. It was thrilling to be a part of it.(97)
Nevertheless, Sanders watched “with breaking heart,” as after years of treatment child after child was sent to institutions, concluding that despite the remaining uncertainties about the etiology of autism, her optimism was unrealistic. It would be negligent to assume that the persistence of Bettelheim's practice was merely the result of an unwillingness to admit error. Rather, if it was an unwillingness to modify a viewpoint, it was a viewpoint that Bettelheim had practical reasons to maintain, and which encompassed all aspects of emotional disorder and treatment, a worldview, moral policy, and research program.
Indeed, many of the examples used in both Bettelheim's published accounts of the school and examples in Bettelheim's biographies cite the cases of the school's autistic children. Any attempt at interpretation of this phenomenon, whether in the case of retrospective evaluations or participant accounts, inevitably runs up against the question of the constancy of the biological entity, whether diagnosed in psychological terms as a case of “childhood schizophrenia,” or as “autistic tendencies,” as in the case of Joey. Karen Zelan, a counselor who worked with many of the children diagnosed with autism at the school, maintains that Betteleheim's criteria were consistent with Kanner's 1943 definition of autism, including children who were “symptomatic” but not mentally retarded.(98) As a system and organism, the school depended on the ability of the counselors to “put themselves in the position of the children”; the symbolic worlds of the children were treated as of the utmost importance. Thus, Karen Zelan was praised for adapting her footsteps to those of “Marcia,” an autistic girl who grew terrified of crossing a large street, and it was understood that Joey's elaborate system of motors and wires was not to be disturbed. Language problems were not understood as functional, but as the outcomes of emotional blockages. Pragmatically, this attention to the perceived symbolic meanings of behavior resulted in slowness and patience, an adaptive response on the part of the therapist. In other words, practice may have mattered more than theory, interaction more than a specific understanding of the mechanisms.
Bourdieu's theory of practice can elucidate some aspects of the historical entity of the Orthogenic School, despite the contrast between the textual accounts of the School and Bourdieu's ethnographic observations. Bourdieu describes the tendency to regard data on societies as examples of closed, and largely textual, systems, a form of interpretation that pays inadequate attention to the subjective experiences and explanations of the participants, and the contingent and unpredictable functioning of any rule-governed system.(99) Furthermore, he observes that the meaning of a set of actions as understood by an ethnographer and as experienced by the participant are of equal reality. These insights have added meaning for historians of the practices of a scientific community, such as psychologists, and especially a milieu environment, where the training of counselors and the treatment of students were seen as formally continuous. While psychoanalysis has lost status in recent years, there is no question that psychoanalysts in the 1950s and 1960s perceived themselves as acting within a discipline with an established body of theories and methodologies. Counselors came to work at Orthogenic School after turning down fellowships in nuclear physics; any number testify to their participation in the life of the school as a learning experience involving the gradual acquisition of expertise. That training for the psychoanalytic profession explicitly emphasized the self-shaping and modification that the practitioner must undergo in no way removes it from the company of other scientific professions; indeed, numerous scholars in science studies have commented on similar processes in other scientific professions.(100)
The shared vocabulary of the school was psychoanalytic; this is evident in the recollections of counselors years after they worked at the school and in the observations recorded in their daily reports. In his published descriptions of the school, Bettelheim utilized the language of love, one that shared terrain with the more technical psychoanalytic vocabulary. In functional terms, Bettelheim saw two components as crucial: the total devotion of the counselors in the creation of the milieu, coupled with psychoanalytic insight and a “consistent therapeutic philosophy.”(101) Counselors spoke of empathy, sacrifice and hours of work, adoration of the school and of Bettelheim, and of deep bonds with their charges. Love, within the discourse of the Bettelheim's books, was the currency and mode of operation, the solution and in some cases the origins of the crisis in which these children found themselves. All human activity seemed to originate with a seeking after or giving of love, expressed in terms of attentiveness, feeding, grooming, and other nurturing acts, but also in terms of the conviction that all behaviors, both those of the children and the counselors, demanded scrutiny and explication. Counselors spoke of learning to “really respect” the child's symbolic behavior.(102) Within the setting of the school, Bettelheim manufactured “a setting whose smallest detail was inspired by the recognition inspired by psychoanalysis that implicit meanings must be made explicit in terms of their significance for the lives of children.”(103)
The research program in autism grew out of a 1956 Ford Foundation grant to study Childhood Schizophrenia.(104) Infantile autism was presented by Bettelheim as a model for development: understand the halted developmental pathway in autism and the researcher would be capable of inferring from this to the progress of typical personality and ego development.(105) Within the psychological discourse and models of development current at the time, personality development proceeded in much the same fashion as physiological development, along a predefined course. Deviations from this course, whether as a result of heredity, faulty parenting, or injury, inevitably led to harmful outcomes.(106) The Ford Foundation sponsored a number of investigations of this kind during these years: the psychoanalytic research undertaken by Bettelheim appears in promotional pamphlets alongside primatological and biochemical research. These were the years that Harry Harlow carried out his notorious experiments on maternal-infant attachment and deprivation. The Ford Foundation grant of $342,500 (a significant sum for the School) lasted for five years, 1956-1962, and involved several components, including “formation of personality in autistic children,” and inquiries into the “family background” of the children. “But,” noted a Ford Foundation annual report during the term of the project, “the most important study will simply seek to learn what it is that this school does that works, so that its success in dealing with a tragic problem may be duplicated more readily elsewhere.”(107) Biographers of Bettelheim speculate that he was under pressure to present positive results, including research findings and treatment successes, to the grant committee in his yearly reports, culminating in The Empty Fortress in 1967. (108)Certainly, were he attempting to build a research program, a report that little or no progress was made would have been counterproductive, to say the least, especially given reports that the majority of children had recovered.
The total environment of the school, the instruction, commitment, and emotional labor required of the counselors, the emphasis on the ability of the environment to alter both students and teachers alike, and the holistic emphasis on daily life as an avenue to healing, all rendered the school a very specific kind of social and therapeutic technology, one which claimed the interest and support of many observers and participants. The approach of the school both predated Bettelheim and continued after him; Bettelheim's contribution was his charismatic personality and his attempt to transform the treatment of children with a specific diagnosis, autism, into a research population. Once thus transformed, this population became not only students but a clinical population of subjects for the purpose of generating information about reproducible treatment methods, but more importantly, about the course of typical human development. One biographer explained that “If[. . .]one was able to observe autistic children twenty-four hours a day as they emerged from their isolation, one would in fact be witnessing the process by which the ego becomes integrated in the first years of life under ordinary circumstances.”(109) As embodied metaphors for arrested psychological development, the children diagnosed with autism at the Orthogenic School seemed to have the potential to teach investigators about the role of nurturing and connection in human development in general.
There seems to be little doubt that the Orthogenic School was a unique environment for the care of disturbed children and the education of teachers to care for them, and former students have written warmly of the school.(110) Bettelheim wrote in justification of the theory behind a therapeutic milieu, that “[t]o live in an institutional setting which protects him against the vagaries of life, and in which contrary to his past experiences, those people important to him are characterized by a deep commitment to his physical and emotional needs – this in a slow process should heal his diseased mind.”(111) The school itself was first and foremost a unique physical space. Contemporary observers remark on the architecture of the grounds, the welcoming interior, comfortable furniture and fine china on which meals were served. There are echoes here of the finely appointed grounds at treatment facilities for the elite, but the philosophy behind this site was entirely different. Bettelheim believed that the attractive surroundings provided the children with an incentive to treat their environment with care, and to feel that they were treated with a respect that many had lacked in their previous lives. It was also an environment in which each aspect of the children's lives was monitored and seen as a site for therapeutic intervention. At the end of one hallway, a cabinet stood open, filled with candy. Children who had experienced deprivation could help themselves to candy whenever they felt the desire for it.
Bettelheim's series of books on the operation of the school, Love is Not Enough (1950); Truants from Life (1955); The Empty Fortress in 1967, and after his retirement as director, A Home for the Heart (1974), are organized around the trajectory of a day at the School. They recreate the experience of following a child through intake and first encounters with the school environment, and then consider the problems that are encountered at each stage of the day, from awakening to sleep and dreams. Data for the books were provided by “participant observers,” teachers who observed and recorded daily activities and therapeutic interactions and then recounted these to Bettelheim in daily sessions.(112) Love is hardly a submerged metaphor in these books: from their titles through their commentaries, Bettelheim explored a dynamic of trust and love as both instinct and specialist technique. In keeping with much postwar psychology, Bettelheim saw personal development as an achievement forged within an environment that ensured protection as well as utter autonomy. Too much control was as dangerous as neglect.
The therapeutic milieu produced a strange kind of asylum indeed, a fact that was not lost on contemporary observers, having roots, as it did, in the existing tradition of mental institutions, but with crucial modifications and inversions. The children were at all times free to leave the grounds, but visitors were locked out and required permission to enter, an architectural and institutional decision that effectively mirrored Bettelheim's therapeutic concepts. The child was protected from a threatening outside environment while encouraging autonomy in every instance, because threat was perceived, not actual. Such instances of architecture mirroring therapeutic ideology, of course, are not unusual, nor is the use of such visual rhetorics as means to draw philanthropic support or reassure families.(113) The therapeutic school functioned as much like the asylum had earlier in American history (and Bettelheim certainly drew on this tradition), but reshaped in the model of a more humane 1950s-era psychology.(114) The Orthogenic School, as Bettelheim remade it, echoed the grounds of MacLean hospital outside Boston in its relatively well-off clientele and emphasis on the creation of a normal-seeming environment in favor of the restraints and heroic methods of an earlier era.(115)
In order to understand the functions of the School at any level, it is crucial to attempt to understand the production of the social environment constituted by the milieu.(116) Bettelheim stood unquestioned at the center of the environment, exerting what by all accounts seems to have been an awesome force as parental figure, interpreter, disciplinarian, and architect, or “policeman and janitor,” as one student commented. A former counselor remembered that
Bettelheim functioned as a sort of superego. He expected every child to work hard to solve its problems. He oversaw the institution as a whole, for example, by making rounds every evening as the children were put to bed and by conducting daily staff meetings where he not only searched a child's behavior for meaning but also brilliantly instructed the child's ‘central persons'.(117)
Counselors lived in dormitories with students, were present from the moment that they woke, through school, playtime and meals, and they put the children to bed at night. Although students were given individual “sessions,” it was understood that therapeutic encounters could as easily occur at mealtime or in hallway interactions. For this reason, more than any other, the accounts following Bettelheim's suicide represent a strange kind of testimony, a fact alluded to by the authors of most accounts. Bettelheim's status as mentor and absolute authority did not lend itself to ambivalence; students tended either to be utterly loyal, crediting him with aiding in the formation of their present selves, or to reject him entirely – occasionally both in a single career.(118)
Counselors at the Orthogenic School were frequently young, unmarried, and female, adept at emotional labor. They were also desirous of approval from Bettelheim, with tendencies to regard their work as a necessarily transformative experience. In contrast, the majority of the students at the School were male. The counselors at the school frequently had little previous experience in the psychoanalytic or psychiatric professions; some, like Sanders, went on to get clinical degrees, others got married and left work, and others continued careers at the school. A provision of the Ford Foundation grant involved the training of counselors, and the total environment of the school was as much an educational environment for the teachers as it was a therapeutic environment for the students, and the lines between education and therapy were porous. A degree of controversy has centered around Bettelheim's practice of taking counselors as psychoanalytic patients. The problem may have been the distinction between daily debriefings with “Dr. B” and psychoanalysis -- a distinction that, given Bettelheim's psychoanalytic propensity to regard conflicts arising with the students as a dyadic process, may have been a thin one. Counselors were encouraged to ask themselves how their own emotional lives affected their interactions with the patients; as the “ego supports” for children whose ego functioning had “lapsed,” they were literally incorporated into the emotional and psychological structure of the school.(119) Bettelheim, as well as teachers at the school, suggested that transference, or the projection of unresolved issues in a counselor's unconscious life, onto Bettelheim, began inevitably from the moment of the initial employment interview.
Teachers were encouraged, in daily sessions with Bettelheim, to rigorously scrutinize their interactions with children in terms of their own anxieties and fears. In the course of their work, counselors were understood to undergo countertransference, or a transference onto the patient by the counselor; hence the reactions of the counselors to the students were seen as potential sources of the student's misbehavior. Almost all accounts feature instances of interpretive virtuosity on the part of Bettelheim or a disciple, where the teacher realizes that a student's aggressive action was in fact the result of their own failure to correctly restrain themselves and act in accordance with the children's needs. Bettelheim himself was by all accounts nearly relentless in his criticisms in this area; teachers measured his confidence in their performance by the harshness of his critiques. As with Bettelheim's analyses of pathogenic interactions in the family, counselors were encouraged to see conflict as a collaborative product, the outcome of a relationship shaped by both parties. The counselors and teachers at the school were chosen to achieve a perfect degree of emotional and technical fit with the project of the school; through daily debriefings and an encouragement to identify strongly with Dr. B, they became as much a part of the architecture of the institution as the china teacups and candy cabinets.(120) The children were not merely carriers of psychopathologies but active agents interacting with counselors with their own private conflicts and drives. This psychoanalysis of daily interaction, seen in mothers' meetings, popular articles, and debriefing sessions, focused on women as nurturers, vested with the burdensome and risky operation of relationships with developing children.
Jules Henry, the anthropologist who came to observe the staff at work in the Orthogenic school as part of his research on “ideo-emotional” factors in institutional membership, and who Jacquelyn Sanders remembered from her early years at the school, saw the social structure of the Orthogenic School as a welcome antidote to the detachment of staff members in the “contemporary psychiatric hospital.”(121) Henry's project was commendable: he saw the milieu model as a remedy for the disinterest and detachment chronicled by observers of state institutions of the period, one of the many broad-ranging critiques of the state hospital system that contributed to the academic (if not the economic) justification for deinstitutionalization in the following decade.(122) The conclusions of his research, ironically, foreshadowed many of the reasons that reformers chose to close state hospitals rather than alter the patient-staff dynamic. Henry concluded that a successful therapeutic relationship at an institution like the Orthogenic School required absolute emotional and personal commitment to the therapeutic project, an involvement that left little distinction between patients and therapists, a commitment more familiar in descriptions of familial relations than therapeutic exchanges. He lauded the emotional commitments of staff members, noting that the intense involvement of staff members in the lives of their patients was the only thing that could explain their long tenures at the school, with its low financial compensation and relentless emotional and psychological demands:
Another consequence of the deep mutual involvement of counselor and child is that most of the counselor's energies go into the children. The following question must now be answered: Given the exacting nature of the counselor's task, from where does she derive the necessary strength and incentive to carry on? Put another way, the question is, how does a task-oriented organization in our culture fill its positions when the task is more exacting than most of those performed in the culture, and when, at the same time, the pecuniary return is small?”(123)
Henry answers that the rewards are the growth of autonomy in the counselor through the process of “self-seeking;” the energy comes from the “ need to solve her own problems in working to become and autonomous human being.”(124)The school forms a system, in which children, director and counselors are seen as essential working components, and “In the School the children are in the center of the therapeutic and emotional interest; for the successful counselor the child remains the focus of her emotional life for a long time.”(125) Like Bettelheim, Henry sought broader approaches to culture and family in the predicament of children with autism. His book-length treatment of mental illness demonstrates a commitment to Bettelheim's approach: each chapter describes a pathogenic family environment, in which the ambivalence of parents generates emotional disturbances in their offspring.(126)
Jacquelyn Sanders, writing years after Bettelheim's tenure at the Orthogenic School, described the functioning of the educational aspects of the school under her guidance in terms drawn substantially from Bettelheim's own accounts of the school.(127) In the introduction to her book, evocatively titled A Greenhouse for the Mind, Sanders suggests that the pragmatic nature and theoretical commitments of the daily work of the school were interrelated, writing that “[w]e created a world for them based on our understanding of the theory of psychoanalytic ego psychology, on anything else that any of us might know, and on the dictates of our hearts.”(128) For Sanders, love was instructive; techniques emerged intuitively, based on evolving self-understanding and close observations of the counselor's own interactions with troubled children. Like Bettelheim's earlier accounts of life at the school, Sanders' descriptions focus on aspects of the creation of a classroom environment ideal for milieu therapy at the Orthogenic School. All aspects of daily life had therapeutic import, and developmental disabilities now commonly regarded as neurological always represented an emotional and psychological blockage, such that children worked through their inability to perform in school or ‘refusal' to read at grade level. The therapeutic process was long-term; children established close relationships with single teachers, with whom the therapeutic relationship progressed at any time of the day or night. Psychoanalytic discourse was the language in which both students and teachers were steeped; this was less a language of expertise than a worldview.
The Politics of Treatability
Bettelheim's choice to make autism stand metaphorically for both childhood disorders in general and for modern forms of psychopathology meant that he considered concessions regarding the neurological basis of autism to potentially undermine his entire research program, including his Ford Foundation grant. His commitments were not only to his theory of autism, but to a psychoanalytic perspective on development and survival in general. If autism was organic, it was also fixed and inalterable, a failure of neurons and not attachment. For Bettelheim, the options seemed exclusive; even in cases where he conceded that a vulnerability might exist, he offered his treatment successes as confirmation of the profits of a psychogenic interpretation. Hence, Bettelheim wrote in 1967 that “[i]t is only when, after years of frustrated attempts, these children begin slowly to respond to treatment based on psychoanalytically oriented hypotheses on the nature of the disturbance, that the psychogenic explanation becomes more and more convincing.”(129)
Nonetheless, Bettelheim confronted resistance to his descriptions of autism, most notably in a revealing exchange with Bernard Rimland, the founder of the National Society for Autistic Children, later the Autism Society of America. Bernard Rimland, an experimental psychologist whose child was diagnosed with autism, collated the existing research relating to the neurological and genetic factors involved in autism in his 1964 book Infantile Autism, which marked a turning point between the psychogenic and neurological explanations for autism.(130) Rimland himself was to become a major figure in the history of autism in America, an entirely different type of authority than Bettelheim and one who came to define himself by the heterogeneity of his theories and practical commitments than by his adherence to a single approach. As Rimland explored the uses of behavioral therapy, psychoanalysis, megavitamin therapy, and detoxification, Bettelheim seemed unaware of or unconcerned with the uses to which his theories were being put within the broader psychoanalytic community and by general practitioners.
For Rimland, the dispute was important on more than theoretical grounds. Psychotherapeutic treatment was in competition with behavioral treatments and biomedical research for resources and professional attention. In a lecture presented to chapters of the National Society for Autistic Children during 1967-1970, he detailed the conclusions of a number of experts that parents were not the cause of learning and behavioral disorders, and that psychotherapy failed to help children with autism. He pointed out that a number of psychiatric experts, including Michael Rutter, the author of a number of landmark studies in autism and the scholar largely responsible for shaping the contemporary diagnostic category of autism, and Carl Fenichel, the director of the League School for Emotionally Disturbed Children in Brooklyn, had concluded that while a “structured educational environment,” or an “educational milieu” were essential to success, there was “little evidence that psychotherapeutic treatment of a child influenced prognosis,” according to Michael Rutter in a 1965 study.(131) Rimland asked the audience
Why have I spent so much time on these topics? Simply because these theories have been widely subscribed to by most professionals who deal with the children and the result has been DISASTER for tens of thousands of children, and for their families. The psychogenic theory has cast blame on the parents, and thus immobilized the child's strongest ally in what should be his struggle to recover. It has caused stagnation in research – which biochemist wants to analyze a ‘fractured oedipus complex?' It has caused educators to shrug their shoulders and leave the problem in the hands of the psychiatrists, psychologists and social workers. It has cost families untold fortunes in money, time, convenience and human dignity. And, worst of all, it has cost far too many children their lives. Such children are not medically dead – just psychologically dead, existing like human vegetables in institution after institution.(132)
Rimland and Bettelheim had corresponded prior to the publication of The Empty Fortress : Rimland sent Bettelheim a version of his “Diagnostic Check List for Behavior Disturbed Children,” a device initially designed for diagnostic purposes, but intended to eventually guide treatment.(133) The checklist, as Bettelheim's successor as director of the Orthogenic School has noted, signaled a shift in the value of “personal clinical impression,” the authority that Bettlheim relied on for his own diagnoses.(134) He asked Bettelheim for help in obtaining blood samples of children diagnosed with infantile autism, a request that Bettelheim refused: “I regret to inform you that I am very critical of the approach that you are using to study infantile autism. In my opinion, your book contains gross errors and misstatements. I therefore shall give you no help in a study of autistic children which I consider ill-conceived and based on erroneous and biased judgments.” In response to another letter, he told Rimland that “since you seem committed to the convictions that infantile autism is an inborn disease and incurable, no matter what the contrary evidence may be, I see little point in discussing treatment results. Suffice it to say that better than eighty-five percent of our former students have made an adequate adjustment to life, including some who are your and my colleagues as Ph.D.'s in psychology.”(135)
Rimland wrote to Bettelheim in 1966 with an offer: “I propose that we set the precedent – pretty nearly unheard of in polemics – of granting each other a small section of response room at the end of each of our forthcoming books” (Rimland was at work on a book on treatments for autism).(136) Bettelheim wrote an angry letter in response, one that stands in marked contrast to numerous instances of considered correspondence with parents and former patients: “The idea that after you have written a book, I should write something within its covers to detract from it is repellent to me. You see, feelings are unimportant to you, and to me they are the most important thing in dealing with human beings. But the most important reason is that I abhor arguments. I firmly believe that scientific progress is best made by each man stating his opinions and allowing the present and future generations decide on their merits.”(137) In a reference to Rimland in The Empty Fortess, Bettelheim conceded that there was no reason to blame parents for harm that they were destined to cause “they did as they did because they could not help themselves to do otherwise. They suffer more than enough in having such a child. To make them guilty will only add to the misery of all and help none.”(138)
The question of why Bettelheim refused to alter his position with respect to autism is a difficult one to answer. Bettelheim oversaw an apparently productive research program in autism at a moment when psychology was struggling to create an identity for itself as a scientific profession. This program successfully reproduced itself for a period of time through a unique environment and set of gendered laboring practices; it provided an empirical resource for Bettelheim's prolific writing. And it had a certain efficacy, both upon the subjects of knowledge and upon the producers of knowledge. This reciprocal efficacy is central to our understanding of Bettelheim within his own milieu. I do not attempt to apologize for Bettelheim or to dismiss the pain that his theories caused; Bettelheim has his defenders. If Bettelheim ruled harshly, his realm was still very small, and others bear responsibility for the wider application of his theories. Almost every account by the teachers at the Orthogenic School emphasizes the therapeutic component of instruction and the transference associated with Bettelheim's daily debriefings; these episodes are also the source of some of the concerns voiced retrospectively by teachers. Bettelheim's authority and charisma, from a distance, felt too complete. This pragmatic aspect of communities organized around a set of therapeutic techniques recurs in the contemporary event of a parents' social movement organized around pragmatic biomedical interventions. Social and therapeutic activity assumes the material aspects of discourse, but material interventions propagate differently than speech and texts alone, and speech allied to therapeutic interventions has different effects upon bodies.(139)
At the meeting of the National Society for Autistic Children in 1969, Leo Kanner referred to Bettelheim's work as “the empty book,” and emphasized his own initial statement that autism was an “innate” disturbance; Bernard Rimland relates that Kanner was adamant: “I herewith acquit you parents,”(140) Although it would still be a number of years before autism was reclassified from a Severe Emotional Disturbance, parents had come to understand their children's altered subjectivities as outcomes of brain functioning and not a psychological disturbance. In the 1970s, the terrain of struggle had changed; the potential efficacy of any therapeutic modality had to be proven against an assumption that damage to brains was unalterable. This transition, from a psychoanalytic interpretation and practice to a neurological and genetic one, represented an entirely new way of relating to these children and speaking about them and about interventions on their behalf. The gradual decline of psychoanalytic thought in American culture makes it difficult to imagine a context in which inquiring and observant adults could claim efficacious treatment of autism through milieu therapy, while the claim that the parents of autistic children were in need of psychoanalytic treatment sounds like a kind of willed blindness. The possibility that a child might only need to eat from his counselor's hand or benefit from the sympathetic interpretation of his private terminology was, nevertheless, a perfectly comprehensible interpretation within the context of Bettelheim's school. In retrospect, the pathologization of mothers of children with autism appears both sexist and nonsensical. Nevertheless, discussions of the emotional strain involved in parenting a child with autism often veer into similar language.
There are other reasons that it is crucial to understand the role of Bettelheim, the popular appeal of his work, and the social organization of the Orthogenic School. Bettelheim can act as a stand-in for the psychological perspective on autism during the first two decades of the existence of the diagnosis, and more broadly, for a pervasive attitude toward the mothers of children with autism that is present even today and which inflects contemporary activities of parent advocacy groups. Unlike other disorders more clearly marked as genetic or due to pre- or neonatal injury (cerebral palsy is one example), parents of children with autism have an acute social memory of the stigma attached to them through the 1950s, 1960s and much of the 1970s. To a degree, this stigma remains, although subtly altered: parents' claims are discredited due to their manifesting some kind of form fruste autism, a milder point on the “spectrum,” and seeking after cures is seen as so much “perseveration.” Alternately, they are portrayed as somehow less capable of raising their vulnerable children, as they themselves are seen as suffering from a deficit of social skills and are therefore poor models. The possibility remains, in psychoanalytically inflected interpretations, that parents are, indeed, unresponsive, if only as a result of their child's own detachment. Their obvious “symptoms” -- rage, distress, desperate seeking after cures, amassing volumes of information, self-education -- are rendered explicable and neutralized as meaningless gestures of “adjustment” under the rubric of implied mental disorder. If the explicit vilification of mothers has certainly decreased, the legacy of mistrust of the psychiatric and medical establishment remains.
Other Psychotherapies, Other Autisms
The psychoanalytic perspective on autism neither began nor ended with Bettelheim and the Orthogenic School, and the focus of attention on Bettelheim has in some ways obscured the pervasiveness of the psychoanalytic and psychogenic perspective on autism in the United States, a perspective that predated Bettelheim, extended beyond him during his period of greatest authority, and persists in the present, incorporated into a variety of contemporary perspectives. A brief survey of this literature might make note of the progressive tendencies of many of these accounts, which attempted to situate mental pathology in environment, conceived as the family system, rather than in temperament or heredity. For theorists like Gregory Bateson, writing in the early 1970s, psychoses represented the attempt of a vulnerable human to integrate conflicting messages, the classic “double-bind” presented by a mother who simultaneously rejects and demands unwavering devotion.(141) Bateson's fusion of communication theory, anthropological accounts of cultural transmission, ethology, animal behavior studies, and psychodynamic theory was an attempt to bring the apparently illegible behavior of schizophrenics into the domain of communication, and an attempt to treat them with a degree of respect and dignity. Bateson's theories, originating from progressive, environmentalist and – for the time – empirical strains in psychological thought was meant as a truly revisionist account of psychoses. Unlike other members of the antipsychiatry movement (most recognizably, R.D. Laing and Thomas Szasz), Bateson and his coworkers did not deny the suffering of their patients and subjects, and, like Bettelheim, they seemed to provide convincing accounts of treatment.
Nor were Bettelheim's accounts the only popular accounts of therapeutic success in treating autism to enjoy a wide audience during the 1960s. Virginia Axline's account of the therapeutic process in Dibs in Search of Self (1964) had similar popular appeal.(142) Dibs, while never given an official diagnosis, is described as possibly mentally retarded, brain damaged, or suffering from autism. Axline, the author of a definitive text on play therapy, frames her account in a familiar psychoanalytic trajectory, as the search for a sense of independent selfhood and human dignity. Dibs is suffering from “severe emotional deprivation” as the result of the limitations of his parents, who are suffering as much as he: Dibs was an unwanted child, whose mother perceived him as the cause of her failed career, and who had, she claimed, rejected him from birth. Dibs, when we are introduced to him, is passive, reverses his pronouns, and is unable to connect affectively or to express his needs and desires. Axline describes her first visit to Dibs's house, described as a sterile environment where there were “no signs that anyone really lived in this house.” The mother says that “We have accepted the tragedy of Dibs,” and tells Axline that “We do not expect any changes in Dibs; but, if in studying this child, you can advance the understanding of human behavior even a little, we are more than willing to cooperate.”
Axline is horrified:
It was incredible. Here she was, in the best scientific manner, offering me some raw data to study. Not a child in trouble. Not her son. Some raw data. And she made it very clear that she did not expect any changes in the data. At least, no changes for the better. I listened as she told me very briefly the vital statistics of Dibs. His date of birth. The slow progress. The obvious retardation. The possibility of organic involvement. She sat in her chair, almost without moving. Tense. Terribly controlled. Her face was very pale. Her grey hair was parted in the middle and pulled back into a knot at the nape of her neck. Her eyes were light blue. Her lips were thinned into line. Occasionally, she bit her lip nervously. Her dress was steel grey, classically simple. In a cold way, she was a very handsome woman.(143)
Dibs's mother asks Axline if she would conduct the play therapy sessions planned for Dibs in the playroom at the family home, but Axline refuses. As the therapy progresses, Dib's mother asks Axline for an appointment, and reveals that Dibs had been an accidental pregnancy, with complications that left her ill and led her and her husband to resent the limitations that it imposed on their lives together. Her husband, “A brilliant man! But remote. And very, very sensitive,” became increasingly inaccessible, but her life had changed even more.(144) Before she became pregnant, she had been a surgeon and devoted to her work, perfecting “two very complicated heart operations. My husband was proud of me. All our friends were very brilliant, successful, interesting men and women. But then Dibs was born and spoiled all our plans and our life.” She gave up her career, and did not tell her friends about her son's troubles: “Oh, they knew about my pregnancy. But not about Dibs.”(145)
Eventually, she confesses to Axline that a psychiatrist that she had consulted had in fact told her that Dibs was “not mentally defective or psychotic or brain-damaged, but the most rejected and emotionally deprived child he had ever seen. He said that my husband and I were the ones who needed the help. He suggested treatment for both of us. It was the most shocking experience we had either of us ever had.”(146) The previous day Dibs' father had brought him home from school upset, and told her that Dibs was “babbling like an idiot,” but when Dibs heard his father say this, he screamed “I hate you! I hate you!,” and ran up to his father and kicked him until his father carried him upstairs, after which the father came downstairs and cried. At this point, Dibs' mother realized that, despite his remove, her husband was just as frightened as she was.(147)
Axline concluded that the mother's initial resignation concerning Dibs' disability was in fact a defense, a way of denying her complicity in the matter:
As for Dibs' mother, it seemed to me that it was highly unlikely that she could have been unaware of her child's intellectual endowment – at least to some degree. Out of her total experience, intellectual achievement alone had not been a very satisfactory answer. Her failure to relate to her child with love, respect, and understanding was probably due to her own emotional deprivation. Who can love, respect, understand another person, if they have not had such basic experiences themselves? It seemed to me that it would be more helpful for her to have learned in this interview that she was respected and understood, even though that understanding was, of necessity, a more generalized concept which accepted the fact that she had reasons for what she did, that she had capacity to change, that changes must come from within herself, that all changes – hers, her husband's, Dibs' – were motivated by many accumulative experiences. How had she phrased it? ‘Two frightened, lonely, unhappy people with their defenses crumpled and deserted. . .a relief to know that we could be human, and could fail and admit that we had failed.(148)
At the close of Axline's account, Dibs, now cured, returns to the playroom one last time and writes the lines for which Axline's account has become famoius. He selects a clean index card from Axline's file and writes a message of thanks and farewell, which he asks her to read: “He reached for the card. ‘I want to add something,' he said. He printed something on the back of the card and handed it back to me. Three lines he had written: ‘As you said you wanted it. As I said I wanted it. As we said we wanted it.”(149) This statement of autonomy, interpersonal connection, and shared experience became a model for the successful imagined outcome of psychotherapy with autistic children during the 1960s.
Karen Zelan, one of Bettelheim's most successful counselors, according to accounts of the Orthogenic School, has continued to defend his theories and methodologies.(150) Zelan's 2004 account of play therapy sessions with high-functioning autistic children is reminiscent of Axline's work. In place of a pathological family relationship, Zelan focuses on autistic symptoms as habitual responses, assessing Bettelheim's contribution as “his empathy with the supersensitive child bent on maintaining sameness, as well as in his understanding of the predicaments the autistic child faces in getting along in a social world. Young autists soon learn that the best way to protect themselves from emotionally overloading excitants is to dodge human contact, to turn to an inner world.”(151) Of her work at the Orthogenic School, she explains that “I had learned to view what young autists say as meaningful in some fashion.”(152) By placing causality to one side, Zelan allows herself to discuss symptoms, again, as meaningful behavior, metaphorically rich but representative not of suppressed family relations but an underlying fear of encounter and lack of selfhood. Psychotherapeutic autonomy is protected by Zelan's implicit belief that the contribution of therapy is in bringing individuals into autonomous selfhood through a “humanistic approach,” by granting a dignity to symptomatic behaviors as meaningful activities.
In 1964, Bernard Rimland published Infantile Autism , reinterpreting both Kanner's findings and the observations of psychologists as examples of possible hereditary dispositions in parents, rather than the liabilities of the intellectual life or motherly ambitions foiled by childbirth. Of course, Axline's version of respect and understanding is especially condemnatory, made only more certain by the fact that Dibs is cured, maturing into a well-adjusted and self-reliant boy. However, the procedure that Axline uses is not necessarily hinged to her interpretation: her building of trust and Dib's movement out of himself is a great achievement, and commendable on both sides, but the psychoanalytic interpretation is not mandatory – rather, it is a deep framework and mode of perception, through which generations of parents were told to view themselves.
The emphasis of the theory of the psychoanalytic milieu on the removal of harmful environmental factors has been displaced by therapies which take the home as a primary site of therapy; nevertheless, parents constructing behavioral treatments for their children are often encouraged to make a separate room for therapeutic practices: the inventors of the Option Method for treating autism describe therapy sessions in the family bathroom. More importantly, while behavioral treatments developed in the 1960s, 70s and 80s were based on an operant theory of human behavior, they came to incorporate significant elements of a psychoanalytic perspective, even as they rejected Bettelheim's claims about psychogenesis. The adoption and success of behavioral methods, Mark Blaxill has observed, was due in part to the fact that, unlike psychotherapy, they did not substantially conflict with a theory of genetic or neurological etiology.(153) Most important, perhaps, was a burgeoning interest in the manipulation of the environment, framed in terms of operant theory and pragmatically incorporated into a series of programs with markedly similar components, most importantly the transformation of the home into a therapeutic space for the purpose of facilitating learning and the functional analysis of behavior. The home, for families of children with autism attempting to invent therapies in the wake of psychoanalysis, became the clinic, when clinical approaches failed or could not hope to provide the amount of hours and commitment associated with success.
Nevertheless, contemporary approaches to autism – many of them – echo the psychogenic perspective. Catherine Maurice, the pseudonymous author of a memoir promoting Applied Behavioral Analysis, or ABA, describes her own vacillation between what she sees as two perspectives on the treatment of children with autism, perspectives that run through both the professional community and parent groups. For Maurice, writing in the 1980s, ABA becomes counterposed to psychodynamic approaches, in both the minds of caregivers and of professionals, each of which are drawn to the explanatory framework of psychoanalysis and to the pragmatic benefits of behavioral therapies. Maurice sees an
. . .essential conflict between two ways of looking at and working with autistic children, and even, in the larger context, with normal children. On the one side there is the behavioral approach, bent precisely on imposing many demands for change and conformity with standard acceptable behavior; on the other, there is a whole range of psychodynamic approaches, all heavily focused on ‘understanding,' analysis, bonding, and ‘insight.'(154)
After the diagnosis of her daughter, Maurice experimented with a variety of approaches, at one point consulting a doctor named Martha Welch, the creator of a technique called “holding therapy,” which involves prolonged sessions of close holding and a psychodynamic interpretation of the etiology of autism. Welch's own accounts of the therapy feature near-rapturous instances of connection between parents and formerly-remote children, and the airing of previously suppressed feelings of abandonment and resentment on the part of the children. Welch explains that during her initial work with mothers of autistic children, she asked them to “hold their autistic children, forcibly if necessary.”
The first patient to be held, an uncommunicative three-and-a-half-year-old named Matt, carried on for over and hour but finally calmed down. He had never been really calm before. In treatment, his mother held him daily for six weeks, and each time her son went through the same sequence: fighting and resisting, followed by calming and relating. Then one day this child—who had never said a single articulate word—looked stright at his mother during his therapy session and said, ‘Thank you for holding.' Of course I felt sure I was on the right track.
I theorized that developmental problems of children might well be caused by a break or disturbance in the mother-child attachment or bonding process, and that systematic and protracted holding might, in fact, repair that relationship.(155)
Welch's book on the subject has an approving foreword by Niko Tinbergen, who applauded the therapy as a cure for a “wide variety of ‘derailments' of human behavior development, even such common problems as tantrums, sibling rivalry, and the like,” and included accounts of Dr. Welch's work in his book on autism.(156) Tinbergen's account suggested that autism arose from parental rejection, although this time interpreted in terms of animal behavior rather than psychoananalysis.
A 2004 study suggests that the category of Reactive Attachment Disorder (RAD) has come to replace autism as the suspected outcome of inadequate “stimulation for emotional and cognitive development”; the paper noted that children with RAD had symptoms nearly identical to autism, and differential diagnosis was dependent on “the treatment response.”(157) In other words, children with RAD were to be distinguished by the presence of inadequate parenting and their more reliable response to treatment relative to the autism group. Treatment included psychotherapy for parents, where “[s]trategies for coping with guilt were introduced, and parents were educated about how a stable and stimulating relationship could be started.”(158)
Bettelheim's spectre haunts autism, because it was never exclusively Bettelheim's project. Not only did Bettelheim reflect a pervasive psychoanalytic attitude toward mental disorders, of which autism was understood to represent a classic case, but his desire to interpret autistic symptoms as meaningful, communicative behavior, and his concern with the dynamics of parent-child bonding are common to contemporary psychiatric approaches to autism. They are also a feature of postwar attitudes toward childrearing in general, which have overwhelmingly favored psychodynamic views of the development of selfhood and the growth of autonomy, and of the parent-child relationship as formative, over behavioristic interpretations positing innate tendencies and patterned responses.
For Bettelheim, and for the receptive public of peers and laypeople to whom he wrote, love was an activity that required work, even if it was “not enough,” the eternally insufficient impulse. Indeed, Bettelheim did not question whether parents loved their autistic children, he merely, devastatingly, maintained that they loved them incorrectly. At the end of this era, perhaps the most thoughtful analysis was provided by Jacquelyn Sanders, who repeated these views in her careful, moderate manner in a conversation over coffee in Hyde Park, in 2003. In her published work, Sanders remembered films that she watched of a treatment based on operant conditioning, “the therapist practicing a conditioning protocol would treat the youngster in very much the same way as we would at the Orthogenic School in terms of respect and empathic sensitivity, but again would report only on the conditioning techniques,” suggesting a difference of emphasis and perspective as much as of practice.(159)
As a comprehensive worldview, psychoanalysis provided both theory and evidence; less research program than interpretive schema, it offered an explanation for autism that worked until it failed to cure. Psychoanalysis failed as a biomedical theory and form of treatment; nevertheless it did indeed spawn research schools, generate funding, and offered a systematic means of comprehending the previously inexplicable, in this case severe disorders of development. The emphasis on the contingent, rather than determined, aspects of development, recurs in contemporary discussions of both gene-environment interactions and therapeutic modalities. Sanders notes that ‘. . .the accounts that describe reliable treatment are remarkably similar to the practices of the Orthogenic School with autistic children. Shock treatment, facilitated communication and the like come and go, but the need for an intense involvement of a whole environment over a long period of time remains.”(160) As Bettelheim noted, at a time when his work still represented the views of a number of his colleagues, love was “not enough” to create such intense involvement – techniques of empathic work and attentive labor were. Love was the metaphor, not the mode of activity. This environment, and the labor involved in its creation by therapists, childcare workers, and parents, is the topic that I turn to next.
1 Bruno Bettelheim, The Uses of Enchantment: the meaning and importance of fairy tales . (New York: Knopf, 1976), and Bruno Bettelheim, The Empty Fortress, Infantile Autism and the Birth of the Self . (New York: Free Press, 1967).
2 Freud's statement to Jung, quoted in Karen Zelan, “Bruno Bettelheim, 1903-1990,” in Prospects: the quarterly review of special education, (Paris, UNESCO: International Bureau of Education), vol. XXIII, no ½, 1993, p. 85-100, p. 98
4 On the place of psychoanalysis in American culture, see, for instance, Ellen Herman, The Romance of American Psychology: Political Culture in the Age of Experts. (Berkeley: University of California Press, 1995). On the gendered divisions of labor behind the making of psychological forms of reasoning as a form of American cultural common sense, see Elizabeth Lunbeck, The Psychiatric Persuasion: Knowledge, Gender and Power in Modern America. (Princeton, NJ: Princeton University Press, 1994). On the importation of psychoanalysis to American and the early history of the profession, see Nathan G. Hale, Freud and the Americans; the beginning of psychoanalysis in the United States, 1876-1917. (New York: Oxford University Press, 1971).
5 Not all accounts of Bettelheim's tenure are so critical. Both counselors and former students characterize their interactions with Bettelheim in ambivalent terms, often noting long periods in which they chose not to interact with Bettelheim, followed by changes in their feelings. Stephen Eliot writes that “Dr. B. would also joke about being the Big Bad Wolf. He knew that was his image and justified it to himself. He explained that we needed a strict framework to feel secure and to permit us to do the internal work necessary to get well while he would see to external regulations. I paid for that in ways I hope he didn't realize, because if he did, it made him a monster” (p. 53). Yet Eliot visited Bettelheim twice before Bettelheim died in California, and also credits Bettelheim with “surprising compassion,” concluding that “I think that I come down in the end to this: Here was a man, despite some of the wrongs he did, who re-created his life and helped make a life for numerous kids who had no hope in hell of surviving on their own” (p. 53).Stephen Eliot. Not the Thing I Was: Thirteen Years at Bruno Bettelheim's Orthogenic School . (New York: St. Martin's Press, 2002). Nina Sutton opens her biography of Bettelheim with a series of apparently conflicting accounts of Bettelheim's character, highlighting the confusion experience by even those who had known and worked with him. See Nina Sutton. Bettelheim: A Life and a Legacy. (BasicBooks, 1996).
6 See, for instance Robert Coles. “A Hero of Our Time.” The New Republic , or Peter Gay's assessment of Bettelheim and the counselors as “heroes” in Peter Gay. “Books: Per Ardua .” In The New Yorker. (May 18, 1968).
7 Hayden White, Metahistory: the historical imagination in nineteenth-century Europe. (Baltimore: Johns Hopkins University Press, 1973). White suggests that although his intellectual history of historical genres is inevitably written in a reflexive, ironic mode, such reflexive acts might create a space for a return to a less distanced, if less reflexive, form of historical authorship. Such moves might enable more urgent and politically oriented or critical narratives to be produced.
8 On biographies as edifying narratives, see Thomas Soderqvist. “Existential Projects and Existential Choice in Science: Scientific Biography as an Edifying Genre,” in Telling Lives in Science: Essays on scientific biography . (Cambridge: Cambridge University Press, 1996).
9 One of the most interesting of these may be Jack Pressman's work on the history of psychosurgery. Although the technique came to be applied irresponsibly if not indiscriminately by some promoters, Pressman reminds us that it was first suggested for patients for whom other treatments had failed, as a “last resort.” Pressman, Jack, “Sufficient Promise: John F. Fulton and the Origins of Psychosurgery,” Bulletin of the History of Medicine. 1988, pp. 1-22.
10 Bruno Bettelheim, quoted in in Karen Zelan, “Bruno Bettelheim, 1903-1990,” in Prospects: the quarterly review of special education, (Paris, UNESCO: International Bureau of Education), vol. XXIII, no ½, 1993, p. 85-100, p. 90
11 Robert Coles, in his review of The Empty Fortress, wrote that “I want to say that it offers a glimpse of ‘damnation' or ‘redemption,' but we have been trained to shun such words when considering the particular kind of human experience that psychiatrists and psychoanalysts know and write about. Even so, I do not think Bruno Bettelheim will mind if his readers have such a relapse – and see his book to be a passionate description of deliverance, as it may be achieved for one child and denied to another.” Robert Coles. “A Hero For Our Time.” The New Republic . (Bruno Bettelheim Papers, University of Chicago Special Collections).
12 It is not particularly surprising that attempts have been made to write a psychohistory of Bettelheim himself. David James Fischer observed that “In our talks together, he frequently made a gesture of touching, almost massaging his head, when he spoke; his was a man who clearly had a narcissistic investment in the mind, and when he could no longer generate fresh and original ideas, he no longer wished to live.” David James Fisher. “Homage to Betteleheim (1903-1990),” The Psychohistory Review: Studies of Motivation in History and Culture. Volume 19, No. 2. (Winter 1991), 256.
13 The concept of the sociological “imaginary” has been strained almost to the point of breakage and utter poverty as a theoretical concept, and I use it with some hesitation here. However, I find Charles Taylor's writing about the concept of a social “imaginary” as distinct from “social theory,” framed as “. . .that common understanding that makes possible common practices and a widely shared sense of legitimacy” useful in its emphasis on everyday practices that contribute to common realties shared by large groups of people. Charles Taylor, “Modern Social Imaginaries,” in Public Culture 14:1 (Winter 2004).
14 On psychoanalysis as a “growth industry,” and the relationship between military applications of psychoanalysis (especially for problems encountered by returning soldiers) and an increasing comfort among Americans with the use of psychoanalysis and psychotherapeutic professionals for help with problems encountered in the course of daily life, see Ellen Herman, “The Growth Industry” in The Romance of American Psychology: Political Culture in the Age of Experts. (Berkeley: University of California Press, 1995). Herman also notes that the ranks of clinical professionals, including those with office-based practices, expanded significantly during the postwar period: “Increases in the sheer numbers of psychiatrists were startling in the postwar decades – professional association membership grew from 3,634 in 1945, at the end of World War II, to 18,407 in 1970. . .” (p. 259).
15 For discussions of the history of parenting advice manuals, see Peter N Stearns, Anxious Parents: a History of Modern Childrearing in America. (New York: New York University Press, 2003), as well as Julia Grant, Raising Baby By the Book: the Education of American Mothers. (New Haven: Yale University Press, 1998).
16 Rima Apple provides a good discussion of scientific motherhood in the nineteenth and twentieth centuries, arguing that the imperative that mothers turn to expert advice often conflicted with the mandate that they assume responsibility for the wellbeing of their families. Producers of consumer products often aligned themselves with medical authority to encourage mothers to rely on their products, with infant formula being perhaps the central example of this trend. See Rima D. Apple, “Constructing Mothers: Scientific Motherhood in the Nineteenth and Twentieth Centuries.” Social History of Medicine . 8 (2) pp. 161-178.
17 Psychoanalysis is not the only movement which has held mixed promises for mothers seeking to raise their children in accordance with scientific authority. The La Leche League was founded as a means to return control of women's bodies and infant feeding to mothers and as a movement against commercial and expert control of childrearing. However, its arguments against the employment of women and for the importance of mothering as an occupation ironically came to seem increasingly conservative in time and with changing emphases for the women's movement. See Lynn Y. Weiner, “Reconstructing Motherhood: The La Leche League in Postwar America.” The Journal of American History . Vol. 80, No, 4 (March 1994), 1357-1381.
20 Charles Taylor builds on the work of Benedict Anderson, Michael Warner, and Jurgen Habermas, theorists who have all explored the symbolic dimensions of the formation of communities. See Charles Taylor, “Modern Social Imaginaries,” in Public Culture, Volume 14, Number (Winter 2002). Benedict Anderson. Imagined Communities: Reflections on the Origin and Spread of Nationalism . (New York: Verso, 1983).
21 Clara Claiborne Park has written thoughtfully of the lessons that she found in Dr. Spock's work and other advice books for raising typical children, and of the surprising continuities between her typically-developing children and her autistic daughter. Park wrote that “Without guidance, through Elly's worst years, I brought up Elly as I had brought up my normal children, with no more knowledge of psychology than Dr. Spock affords an unpracticed mother.” Clara Claiborne Park, The Siege: A Family's Journey Into the World of An Autistic Child . (Boston: Little, Brown, and Co., 1967), p. 192
23 This is by no means a unique occurrence. Consider, for example, differing accounts of the life and career of Louis Pasteur, J. Robert Oppenheimer, James Watson, to take a few other examples from this past century alone.
24 For a discussion of the problem of retrospectively discussing therapeutic efficacy in psychiatric disorders, and the argument that “efficacy” must be understood not only in terms of biological mechanisms but also in terms of social, professional and institutional interests, see Jack Pressman. “Sufficient Promise: John F. Fulton and the Origins of Psychosurgery,” ( Bulletin of the History of Medicine. 1988, pp. 1-22.), as well as Joel Braslow. “The Influence of a Biological Therapy on Physicians' Narratives and Interrogations: the Case of General Paralysis of the Insane and Malaria Fever Therapy, 1910-1950.” ( Bulletin of the History of Medicine 70.4 (1996) 577-608).
25 See, for instance, Peter Kramer's speculations about the way that treating patients with SSRIs caused him to view the specifics of his patients' lives differently. Peter Kramer, Listening to Prozac: the Landmark Book About Antidepressants and the Remaking of the Self, Revised Edition .. (Penguin, 1997).
26 It is important to consider the ways in which Charles Rosenberg's arguments about the “therapeutic revolution” in modern medicine applies to therapeutic practices aimed at mental illness and cognitive disorders. Charles Rosenberg. “The Therapeutic Revolution,” in The Therapeutic Revolution: Essays in the Social History of American Medicine. (Philadelphia: University of Pennsylvania Press, 1979). Rosenberg describes doctor-patient interactions and measures of therapeutic efficacy and the adequacy of treatment as relying on a collaborative process between doctor and patient and a shared concept of disease. As medicine became increasingly connected to a scientific ideal, the idea of therapeutic specificity became increasingly important. However, in psychology at least, shared concepts of disease and dysfunction, and an emphasis on the role of general theory rather than an understanding of specific etiology seem to have remained important, even as medical training was incorporated into psychotherapy during the latter half of the century.
29 Despite his prolific output, Bettelheim was notoriously insecure about his writing abilities. The Empty Fortress was Bettelheim's first book with Knopf, after switching publishers several times. He continued to work with Knopf until his death. Bettelheim's supporters frequently mention this orientation: “he was determined not to get bogged down in highly technical and overly specialized questions, not to write in jargon. He developed a distinct style and a discernable voice in which he communicated on a visceral level with human beings, responding soul to soul, much of which emanated from a source of empathic sensitivity in his own psyche.” David James Fisher. “Homage to Betteleheim (1903-1990).” The Psychohistory Review: Studies of Motivation in History and Culture. Volume 19, No. 2. (Winter 1991).
30 Jacquelyn Sanders, who succeeded Bettelheim as director of the Orthogenic School, wrote in an obituary for Bettelheim that controversies about the book “clouded a more fundamental contribution to the study of personality development focusing on the significance of the relationship between parent and child for the child's development of self. Bettelheim also pointed to the problem of parental preoccupation and indifference which he and other critics believed unique to our own time, and which had important implications for the child's subsequent adjustment.” Bertram J. Cohler and Jacquelyn Sanders. “Obituary: Bruno Bettelheim, (1903-1990).” Int J. Psycho-Anal. 72, 155.
31 See Peter Stearns, Anxious Parents: a History of Modern Childrearing in America. (New York: New York University Press). Stearns uses published child-rearing advice to frame discussion of the growth of the concept of the “vulnerable child” during the twentieth century, through expert discourse about psychological risks, changes in economic organization, and the “transposition” of adult anxieties about their own lives. For change in economic organization, and especially labor and insurance policies that placed increasing prominence on the production of the physical wellbeing and protection of children from risks, see Viviana Zelizer, Pricing the Priceless Child: the Changing Social Value of Children. (New York: Basic Books, 1985).
32 Of course, Bettelheim's work is not alone in treating a medical condition as a metaphor, for human development and human relations. See, for instance Susan Sontag, Illness as Metaphor. (New York: Vintage Books, 1979), or Lawrence Cohen's description of the cultural and social politics of aging and dementia in India. See Lawrence Cohen, No Aging in India: Alzheimer's, the Bad Family, and Other Modern Things. (Berkeley: University of California Press, 1998).
33 The use of autism as a model for development continued beyond Bettelheim's work on the topic. A behaviorist treatment of the same set of questions would the ethologist Nico Tinbergen's collaborative work with his wife on autism as a failure of mother-infant bonding. Later work on the psychology of autism spectrum disorders, which incorporates theories of brain modularity and neuroimaging work, also implicitly addresses some of these same questions of the meaning of the ability to relate and gauge internal states of others, and more specifically, the formative role of early interactions in this regard. Elisabeth A. Tinbergen and Niko Tinbergen, Early Childhood Autism: An Ethological Approach. (Berlin: Parey, 1972).
34 Margaret Shodell wrote to accept a position as an advisor to Benhaven in a letter dated January 3, 1967. Lettick Papers, ACC 92-M-41, Box 2, “Shodell, M” An article describes the techniques used at the Nassau Center by Margaret Shodell, “Breaking Through to the Autistic Child.” Medical World News . (October 28, 1966). Mira Rothenberg was another noted promoter of psychotherapeutic techniques for treating children with autism, as chronicled in her book Children with Emerald Eyes: Histories of Extraordinary Boys and Girls. (New York: the Dial Press, 1960) . Letter from Amy Lettick to M. J. Shodell, dated January 11, 1967. Lettick papers, ACC 92-M-41, Box 2, “Shodell, M”
37 My discussion of Dr. Jacquelyn Sanders' reflections on the treatment of autistic children at the Orthogenic School relies on an article by Sanders (cited below), email correspondence with Dr. Sanders, and an interview conducted on 4/3/2003, in Chicago, IL. See Jacquelyn Sanders. “Autism at the Orthogenic School and in the Field at Large, 1951-1985” Residential Treatment for Children & Youth 14 (2) (The Haworth Press, 1996). .
43 Bettelheim's description of autism for a Collier's encyclopedia entry was similarly detailed: “Their thinking is illogical, their voice a screaming or utterly monotonous. They seem to be living in a shell, act as if other people don't exist. Either they do nothing at all, or engage in meaningless activities, such as tearing paper into the tiniest fragments, or turning endlessly the pages of a book without seemingly paying any attention to what is on them; they endlessly listen to the same records, repeat the same song, which might be a commercial.” Bruno Bettelheim, letter to Miss Barbara Crowell, Life Sciences Department, Colliers Encyclopedia, dated September 15, 1971. Bettelheim Papers, University of Chicago Library Manuscripts and Archives.
44 The article was coauthored by Emmy Sylvester, the director of the School directly before Bettelheim. Bruno Bettelheim and Emmy Sylvester, “Physical Symptoms in Emotionally Disturbed Children.” Reprint in folder marked “The Psychoanalytic Study of the Child.” (probably Psychoanalytic Study of the Child (New Haven: Yale University Press, 1948 or 1950). Bettelheim Papers, University of Chicago Library Manuscripts and Archives Collection.
45 Gay continued, “And, as Bettelheim freely admits, even a therapist with all these qualities may make costly mistakes, misinterpreting a gesture and sending the child into renewed depression and withdrawal. That is why those who treat autistic children must be absolutely permissive; it is not only that these little psychotics must experience a radically new environment in which they are loved and accepted but that it is essential to let them “speak” in the only voice they have. And therefore it is, I think, perfectly proper to call Bettelheim and his associates heroes: they accept, even invite, attacks on their persons; they witness without shrinking (in fact, they bring about) scenes that ordinary observers would consider intolerably dirty or unbearably pathetic—encouraging free elimination, feeding bottles to adolescent patients who are discovering the pleasures of early infancy, and, most impressive of all, working long hours, for weeks and months, without any visible reward from the patient. These people – psychoanalysts, teachers, and counselors – are magnificent.” Peter Gay. “Books: Per Ardua .” In The New Yorker. (May 18, 1968).
47 As recently as 2001, an eminent researcher in autism genetics listed “institutional autism” as an area which still required study and explanation. In other words, observed cases of withdrawal as a result of sensory deprivation are still reported, but largely as outlying cases than as continuous with other forms of autistic withdrawal. See Rene A. Spitz, Dialogues from Infancy: Selected Papers. (New York: International Universities Press, 1983).
48 Donna Haraway's compelling treatment of Harlow's experiments using terrycloth “false” mothers situates the peculiar cruelty of Harlow's experiments within the context of biological theories of both motherhood and gender as reproduced within primatology. Haraway also notes that it requires little interpretive creativity to recognize the sadism implicit in the experimental design: Harlow's commentaries are fairly explicit. Donna Haraway, “Metaphors into Hardware: Harry Harlow and the Technology of Love,” Primate Visions . (New York: Routledge, 1989)
50 Bettelheim claimed that he was immune from the transformations and alterations undergone by the other inmates because he chose to situate himself at a remove, as a social scientific observer of human nature under extreme conditions.
60 Within current accepted diagnostic criteria and screening instruments, an individual capable of some symbolic reasoning, who also displayed rigid and stereotypic behavior and a preoccupation with sameness might still be diagnosed with an autism spectrum disorder such as Asperger's Syndrome or PDD-NOS.
61 The man given the pseudonym “Joey” was later contacted by the author of one of Bettelheim's biographies, and guardedly affirmed that his treatment had indeed been successful. Critics have argued that Joey's sophisticated imaginary world suggests that he would not be given an autism diagnosis in the present.
66 Sutton, Nina Sutton. Bettelheim, a life and a legacy. Sharp, David, trans. (New York: BasicBooks, 1996). Theron Raines. Rising to the Light: A Portrait of Bruno Bettelheim. (New York: Knopf, 2002). Richard Pollock. The Creation of Dr. B: A Biography of Bruno Bettelheim. (New York: Simon and Schuster, 1997).
67 It might also be worthwhile to consider the role of Jewish scientific public intellectuals in America, as promoters of a particular ideology of secular rationalism as well as academic training and credentials. See David Hollinger, Science, Jews and Secular Culture: studies in mid-twentieth century intellectual history. (Princeton, NJ: Princeton University Press, 1996).
68 In particular, Alan Dundes, himself a psychoanalytically-minded folklorist notes that while Bettelheim might be credited with bringing the psychoanalytic treatment of fairy tales to “the attention of the general public,” Bettelheim both failed to consult relevant sources in the folklore literature, and failed to cite sources from which he borrowed substantially, specifically Julius E. Heuscher's A Psychiatric Study of Fairy Tales: Their Origin, Meaning and Usefulness , published in 1963. Dundes notes that while Bettelheim mentioned Heuscher in a footnote, he appears to have “borrowed” entire passages. Alan Dundes, “Bruno Bettelhem's Uses of Enchantment and Abuses of Scholarship.” The Journal of American Folklore. Vol 104, no. 411 (Winter, 1991), 74-83.
69 On training for psychoanalysis in America, prior to World War II, see Nathan G. Hale, “From Bergerasse XIX to Central Park West: the Americanization of psychoanalysis, 1919-1940,” Journal of the History of the Behavioral Sciences 14: 299-315. (1978). Paul Roazen writes of his experience with Bettelheim in the mid-1960s that “In those days it seemed a scandal that, despite all his work with disturbed children, the only standing he had with the Chicago Psychoanalytic Institute was as a “non-therapist member.” Organized psychoanalysis has had its features as a trade union, and membership categories continue to be jealously guarded lest outsiders be misled about the extent of anyone's license to practice.” Paul Roazen, “The Rise and Fall of Bruno Bettelheim.” The Psychohistory Review. Volume 20, Number 3. (Spring 1992), 233.
73 Paul Roazen notes that “Bettelheim's publisher for many years, The Free Press of Glencoe, reported on a later book jacket that General Dwight D. Eisenhower had made “Individual and Mass Behavior in Extreme Situations” required reading “for all military government officers in Europe.” Paul Roazen. “The Rise and Fall of Bruno Bettelheim.” The Psychohistory Review. Volume 20, Number 3. (Spring 1992). P. 225.
74 Paul Roazen describes his own relationship with Bettelheim and his writing in an attempt to explain how Bettelheim became “such an influential force.” See Paul Roazen, “The Rise and Fall of Bruno Bettelheim.” The Psychohistory Review. Volume 20, Number 3. (Spring 1992).p. 227.
75 See Sandor Gifford, “The American reception of psychoanalysis,” in Heller, Adele, and Rudnick, Lois, eds. 1915, the cultural moment: The new politics, the new woman, the new art, and the new theater in America. (New Brunswick: Rutgers University Press, 1991), as well as Fred Matthews, “The Americanization of Sigmund Freud: Adaptations of Psychoanalysis before 1917,” Journal of American Studies 1 (1967): 39-62.
77 On the place of psychoanalysis in American culture, see, for instance, Ellen Herman, The Romance of American Psychology: Political Culture in the Age of Experts. (Berkeley: University of California Press, 1995), 238-239. The official name of the GI Bill was the Soldiers' Readjustment Act of 1944. See also Wade E. Pickren, “VA Psychologists and Clinical Science in the 1950s,” (PsychNET, American Psychological Association, 2005). http://www.apa.org.science.psa.novhisprint.html (accessed 10/11/1005)
82 Of course, mother-blaming and the idea of “bad” mothers extends before and after the 1950s and 1960s in America. Molly Ladd-Taylor and Lauri Umansky argue that it is important to ask why mothers, in particular, have become the focus of public discourse about a range of social and economic problems. See Molly Ladd-Taylor and Lauri Umansky, “Introduction,” in Molly Ladd-Taylor and Lauri Umansky, eds “Bad” Mothers: the Politics of Blame in Twentieth-Century America. (New York: New York University Press, 1998).
83 Jennifer Terry's survey of “momism” in psychiatric discourse during the 1950s focuses specifically on the claim that dissatisfied or over-vigilant mothers caused their children to become homosexuals, but this might be applied to arguments about “failures of development” more generally, and certainly resonates with much of Bettelheim's line of argument. Terry writes that “According to popular writing of the time, Mom hastened moral corruption, surrounded as she was by modern appliances, trapped, frustrated, and neurotic, behind the double doors of her ranch-style dream home, suffering from the “problem that has no name” Betty Friedan later identified in more sympathetic terms in The Feminine Mystique. Terry points to Elaine Tyler May's observations of the 1950s suburban home as a symbol of surveillance and security against “foreign invasions” as another point at which monitoring and surveillance of children became at once an imperative and a threat in itself, where excess care could as easily become a kind of rejection. See Jennifer Terry. “'Momism' and The Making of Treasonous Homosexuals,” in Molly Ladd-Taylor and Lauri Umansky, eds. “Bad” Mothers: the Politics of Blame in Twentieth-Century America. (New York: New York University Press, 1998), pp. 169-191, as well as Elaine Tyler May. Homeward Bound: American Families in Cold War America. (New York: Basic Books, 1988).
84 See Wylie's rather vitriolic and psychologically inflected critique of what he perceived to be the effects of mothers who attempted to control their male offspring. Philip Wylie, Generation of Vipers . (New York: Rinehart, 1942).
85 Alternative formulations that have attempted to place a higher value on “feminine” psychologies have included Carol Gilligan's “ethic of care,” and Nancy Chodorow's female psychology, both of which emphasized forms of moral and psychological reasoning that placed relationships at the center of decisionmaking and selfhood, even as more recent feminist approaches have used psychological arguments to question the production of gender as a social rather than biological category, or strict separations based on gender as a binary category, as well as the psychological health and appropriateness of conventional gender roles.
88 Many scholars have considered the meaning of survivor accounts of the persons referred to as musselmen, and the degree to which these attitudes were physiological responses to deprivation, psychological strategies, or anxious representations by inmates like Bettelheim who sought to distinguish their own responses. For a more recent philosophical treatment of a similar subject, see Giorgio Agamben, Homo Sacer: Sovereign Power and Bare Life . Daniel Heller-Roazen, trans. ( Stanford, CA: Stanford University Press, 1998).
89 The term comes from an obituary for Bettelheim. Rudolf Ekstein. “Bruno Bettelheim (1903-1990).” American Psychologist . (October 1991). Bettelheim has been mistakenly cited as claiming that the mothers of autistic children were analogous to Nazi prison guards, but although his arguments about rejection were devastating in their own way, there do not seem to be any references to this.
93 Craig Fees, although writing from the perspective of Great Britain, locates himself in the context of a movement that crossed national borders, comparing his experience to that related by Jacquelyn Sanders in her first encounter with the therapeutic community represented by the Orthogenic School. Craig Fees, “'No foundation all the way down the line': History, Memory, and ‘milieu therapy' from the view of a specialist archive in Britain.” Therapeutic Communities: the International Journal for therapeutic and supportive organizations. Volume 19: Number 2 (Published by the Association of Therapeutic Communities, 1998) pp. 167-178.
95 It was only in the 1970s that autism was no longer classified as a Severe Emotional Disturbance (SED), nearly a decade after the majority of treatment programs were based on the premise that autism was the result of neurological damage.
105 According to Jacquelyn Seevak Sanders, “. . .the most widely accepted notion was that, though there may be some organic propensity or predisposition, there was a significant component of environmental etiology. The firmness of this assumption was reflected in the nature of the grant awarded to Bettelheim by the Ford Foundation. Its purpose was not an investigation into autism, but an exploration of normal development” Jacquelyn Seevak Sanders, “Autism at the Orthogenic School and in the Field at Large (1951-1985). P. 6. Residential Treatment for Children and Youth , Vol. 14 (2) 1996.
106 This representation of development recurs in contemporary brain research, in slightly altered form. The inevitable unfolding of brain development can only be halted by intervention from toxins or a faulty genetic instruction: contemporary findings of what are termed “fetal cells” (cells characteristic of earlier developmental stages) in higher proportions in brains of deceased autistic persons seems to echo this portrait of halted development. Many contests center around the degree of vulnerability inherent in development: some see developmental injuries as based entirely on genetic factors, while others concentrate on issues such as maternal infections, toxins, or other environmental factors.
110 See Stephen Eliot. Not the Thing I Was: Thirteen Years at Bruno Bettelheim's Orthogenic School . (New York: St. Martin's Press, 2002), as well as Tom Wallace Lyons, The Pelican and After (Prescott, Durrell, 1983).
112 As an attitude on the part of the teachers in the school, participant observation (called a “marginal interview” by Fritz Redl, a colleague of Bettelheim's) meant a kind of critical or interpretive distance that did not preclude interaction: “interpretive in character but does not need to interfere with the momentary activity of the group or individual.” Bruno Bettelheim. Love is Not Enough: the Treatment of Emotionally Disturbed Children. (Glencoe, IL: The Free Press, 1950). P. 35.
113 Tomes, Nancy. “A Generous Confidence: Thomas Story Kirkbride's Philosophy of Asylum Construction and Management,” in Madhouses, Mad-Doctors and Madmen: the Social History of Psychiatry in the Victorian Era. Philadelphia: University of Pennsylvania Press, 1981.
115 Bettelheim's books about the school contain descriptions of the environment, which is also remarked upon by biographers and memoirists. On MacLean in the 1960s, see Susannah Kaysen, Girl, Interrupted (Vintage, 1994).
117 Karen Zelan, “Bruno Bettelheim, 1903-1990,” in Prospects: the quarterly review of special education, (Paris, UNESCO: International Bureau of Education), vol. XXIII, no ½, 1993, p. 85-100 ., p. 86.
118 See the exchange between Jacquelyn Sanders and Robert Gottleib in the New York Review of Books , in which Gottleib quotes an interview between Sanders and Richard Pollack in which Sanders claims to have not spoken to Bettelheim for several years, and Sanders' response that she never made this statement – Gottleib concludes that it is “as if Goneril had metamorphosed into Cordelia.” Robert Gottlieb, “The Strange Case of Dr. B,” The New York Review of Books, Volume 50, Number 3 (February 27, 2003), and Jacquelyn Seevak Sanders, “Defending Bruno Bettelheim,” The New York Review of Books , Volume 50, Number 18 (November 20, 2003).
122 For an example of the sociological critique of state hospitals in the early 1970s (approximately a decade after Henry wrote about this, but conditions had only worsened), see D. L. Rosenhan, “On Being Sane in Insane Places;” finish for a retrospective consideration of the political economy of deinstitutionalization in the 1960s and early 1970s, see David Mechanic and David A. Rochefort, “Deinstitutionalization: an Appraisal of Reform,” Annual Review of Sociology, 1990: 16: 301-27.
127 Sanders writes of Bettelheim that “[t]he extent to which his ideas pervade my account of the School can perhaps be imagined when one knows that we worked very closely together for fourteen years.” Seevak Sanders, Jacquelyn. A Greenhouse for the Mind. Chicago and London: University of Chicago Press, 1989.
131 Michael Rutter, “The influence of organic and emotional factors on the origins, nature and outcome of childhood psychosis,” Developmental Medicine and Child Neurology , 1965, 7 , 518-528, pp. 521-522, quoted in Bernard Rimland, “Freud is Dead: New Directions in the Treatment of Mentally Ill Children,” address given as part of the Distinguished Lecture Series, University of California School of Special Education, University of Southern California, Los Angeles, July 7,1970. Adapted from a lecture presented to Chapters of the National Society for Autistic Children in various cities, 19676-1970., p. 44.
132 Bernard Rimland, “Freud is Dead: New Directions in the Treatment of Mentally Ill Children,” address given as part of the Distinguished Lecture Series, University of California School of Special Education, University of Southern California, Los Angeles, July 7,1970. Adapted from a lecture presented to Chapters of the National Society for Autistic Children in various cities, 19676-1970.
139 In cultural terms, this might be separated into the aspects of discourse associated with speech or textual production, thought, and practice: all of these are subsumed under the rubric of “discourse” in Foucault's later work, while his earlier discussions, as in Archaeology of Knowledge , concentrate more specifically on textual aspects of discursive formations. Joe Dumit pointed this out to me.
140 Bernard Rimland, “Freud is Dead: New Directions in the Treatment of Mentally Ill Children,” address given as part of the Distinguished Lecture Series, University of California School of Special Education, University of Southern California, Los Angeles, July 7,1970. Adapted from a lecture presented to Chapters of the National Society for Autistic Children in various cities, 19676-1970.
142 As some indication of the enduring appeal of Axline's account, I was first introduced to Dibs as a 3 rd grader, where it was storytime reading at my alternative elementary school in Palo Alto, California. The class, as I recall was enthralled with the story – Dibs was exactly our age – and we eagerly awaited each new installment.
150 Zelan and Bettelheim co-authored a book on learning to read, based on psychodynamic theories of pedagogy; in keeping with their premise that psychoanalysis and the insights offered in working with emotionally disturbed children might inform the education of normal children, they argued for more “meaningful” and emotionally satisfying primers and attention to the emotional and psychological content of apparent “misreadings.” Bruno Bettelheim and Karen Zelan, On Learning to Read: the Child's Fascination With Meaning . (New York: Vintage Books, 1981).
156 Martha G. Welch, Holding Time: How to Eliminate Conflict, Temper Tantrums, and Sibling Rivalry and Raise Happy, Loving, Successful Children . (New York: Simon and Schuster, 1988). P 129.
157 Nahit Motavalli Mukaddes, F. Nimet Kaynak, Gulsevim Kinali, Humeyra Besikci, Halim Issever, “Psychoeducational treatment of children with autism and reactive attachment disorder.” Autism . Vol 8 (1) pp 101-109. (Sage Publications and the National Autistic Society, 2004). p. 5
158 Nahit Motavalli Mukaddes, F. Nimet Kaynak, Gulsevim Kinali, Humeyra Besikci, Halim Issever, “Psychoeducational treatment of children with autism and reactive attachment disorder.” Autism . Vol 8 (1) pp 101-109. (Sage Publications and the National Autistic Society).p. 7