Autism Bookshelf: The Devil In His Own Words

This is the first post in an occasional series, Autism Bookshelf, reviewing important books in the history of autism and autism intervention.

Whenever I hear an author’s ideas routinely reviled, I become very curious.   I always want to hear the devil in this own words and make up my own mind.   This is the impulse that led me to read Bruno Bettelheim’s The Empty Fortress: Infantile Autism and the Birth of the Self. 

So many conference presentations on autism begin with a capsule history of how autism has been understood in the past.  The short version goes that Leo Kanner identified it in the 1940s and hinted at the role of distant parents.   Psychoanalyst Bettelheim expanded this idea in The Empty Fortress and convinced the psychiatric world that parents were to blame.   Then Bernard Rimland came to the rescue and established autism as a neurological disorder in his book Early Infantile Autism.

That probably sounds familiar.  But as soon as I turned over the title page of The Empty Fortress I noticed that the sequence is wrong.  Bettelheim published this book in 1967, Rimland published his in 1964.   It turns out that Bettelheim had advanced the ideas that Rimland was de-bunking only in journal articles.   The Empty Fortress was his response to Rimland and his defense against the idea that autism could have any innate physical cause.

Bettelheim wasn’t only arguing with Rimland, either.  He was arguing with his fellow psychoanalysts.  He refers to this quotation from Leo Kanner’s original paper: 

We must, then, assume that these children have come into the world with innate inability to form the usual, biologically provided affective contact with people, just as other children come into the world with innate physical or intellectual handicaps.  (Note 1)  

He cites a 1965 paper on autism by psychoanalyst Margaret Mahler where she says: 

We have found in our study just as many cases in which the mother belonged to Winnicott’s group of ordinary, devoted mothers, and we could reconstruct in some cases such extreme, seemingly intrinsic vulnerability on the part of the child which even the most favorable environmental situations could not conceivably have counteracted.  (Note 2)

But Bettelheim will have none of it.  His answer is this:

The fact is that almost all organic conditions that have so far been linked to this disease are also present in nonautistic children.  This seems reason enough to seek in parental attitudes for the reason why organic involvement – if such a factor should turn out to be typical – leads to autism in only some children but not in others.  The more so, since in all cases known to us… conscious or unconscious attitudes were experienced by the child as the wish that he did not exist. (pp.125-126 in the original edition)

Bettelheim then goes on to make his case that children have retreated into their autism as a defense mechanism against a world that has utterly rejected them.  Their world threatens them at every turn.   He describes autism as a “position” that children have “assumed.”   It is an escape from harsh reality that is worse than suicide:

Suicide alone seems a more extreme position, but is not.  Because suicide involves a goal-directed action that the autistic child seems even less capable of performing than the suicidal person.  Infantile autism might be viewed as a position of despair where even the requisite energy to end it all is lacking.   (p.90)

So there’s the devil in this own words.   It really is as absurd as I’d been told.  As the book goes along, the interpretations Bettelheim gives to common stim behaviors are amazing.   Did you know that when your child twiddles their fingers in front of their face it is for magical protection? (p.165)   That when they stare at the lights they are hallucinating? (p.116)  That if they refer to a fruit they are expressing a desire to return to the womb? (p.317)   For years my son had ‘the fan thing,’ so this interpretation is my absolute favorite:

The emotions these blades could create…were at once mysterious, overpowering and contradictory.  The noise of the air blast literally shook him up, as the emotions he directed at his parents should have shaken them but failed to do.   At one time these propellers created anxiety, at another relief.  If one and the same thing had the power to project us into great joy or deepest despair and if, because of the parents’ detachment toward Joey, nothing else does, then this infernal machine is indeed what regulates human emotion.  Hence his fascination with rotating blades, the need to understand them and perhaps in this way acquire their power. (p.246)

By mid-way through, this book was consistently making me laugh out loud.   I can certainly recommend it for comic value.   But what made The Empty Fortress so influential and important for such a long time?  I think the answer is it provided hope.   Bettelheim reviews the literature on autism at that time and correctly notes there was virtually nothing available about effective treatment.   He says that the very belief that autism is inborn creates a defeatist attitude about treatment. (p.401)   His cases studies, which he presents as ‘data,’ were hopeful since he described improvement.   This view, unfortunately, held sway well into the 1980s, as Catherine Maurice describes in Let Me Hear Your Voice.

One of Bettelheim’s concluding statements, though, proved to be true.  Describing a small study, he says “One may assume that opinions about the treatability of autistic children would change radically, if larger numbers of them were to receive intensive treatment of appropriate duration.” (p.406)  Twenty years later, Ivar Lovaas published that study.

Wil Gehne

Notes:

 (1)  Kanner, Leo.  Autistic Disturbances of Affective Contact, Nervous Child, 2:217-250 (1943). 

(2)  Mahler, Margaret, On Early Infantile Psychosis.  Journal of the American Academy of Child Psychiatry, 554-568 (1965)