Lauretta Bender, “The Autistic Child,” 1960

Lauretta Bender, “The Autistic Child,” September 23, 1960, Box 10, Folder 3. Courtesy of the Brooklyn College Archives and Special Collections, The Papers of Dr. Lauretta Bender.

Complete original source available here.

This excerpt comes from a lecture that Lauretta Bender gave at Patton State Hospital in San Bernadino, California in 1960. Bender directed the children’s inpatient service at Bellevue Hospital in New York between 1934 and 1956 before becoming Director of Research in the children’s unit at Creedmoor State Hospital in Queens, where she retired in 1964. Bender worked with thousands of severely affected children during her career, including many who would be diagnosed on the autism spectrum today. In this lecture, Bender offered extensive commentary on autism, a condition that Bender believed fit under the umbrella of childhood schizophrenia and psychosis or resulted from hospitalism. She explained why she did not subscribe to psychogenesis, argued that organic causes were at play, and that treatment should take physiological and pharmacological forms. Bender also offered some interesting comments about Leo Kanner, the psychiatrist usually credited with describing autism for the first time.

Lauretta Bender (courtesy of Brooklyn College Archives and Special Collections, Papers of Dr. Lauretta Bender)

The concept of autism in children was put into the literature by Leo Kanner, Professor of Psychiatry at Johns Hopkins. His first publication was in 1943 when he spoke of the primary autistic affective disorder in children. Dr. Kanner and I worked together at Johns Hopkins in 1929 and 1930…. In 1940, Dr. Helen Yarnell and I presented a paper at the American Psychiatric Association on 250 children under the age of six from our observation nursery at Bellevue Hospital. In this series we reported a few children with regressive phenomena which we could not account for… One group we called Heller’s Disease, because they seemed to develop normally to three or three and one-half years of age and then regressed without any known reason, such as an illness, or any neurological signs. The other group did not develop beyond the two-year level….

This attracted Dr. Kanner’s attention and he corresponded with me about it and said, “How did I ever find such children”; that he had read about them in the  German literature with which he was still acquainted, but he had never had any of these children referred to him…. I explained to him that if he would just not accept other peoples’ opinions about retarded and defective young children, he would probably soon be able to see some of these children….

Perhaps the majority of young children (under the age of six) that I have considered autistic were schizophrenic or I considered them schizophrenic…. And certainly it is also true that a child who has suffered very serious deprivation in the way of being institutionalized in an impersonal institution which does not give the child much individual attention, is likely to react with the same type of behavior and be considered an autistic child….

Of course, I am very much aware that in the State of California, Dr. Szurek’s point of view is dominant…. They [parents] somehow unconsciously project this conflict into the child so that he is not able to develop and the child remains fixated in an autistic state or what we call a schizophrenic pattern of behavior…. [I]t is not my theory and I am not dedicated to it.  In fact, I have some questions about this view. It does not explain why one child in the family becomes autistic or disturbed, while siblings do not….

…Kanner’s concept is that the parents were cold and unresponsive to the children…. He conscientiously followed this group of 30 children although he felt that they had been irretrievably damaged by the cold environment of their parents in which they had been raised…. [I]t requires, in my opinion, a professor or psychiatrist or someone of considerable academic or medical sophistication to find Dr. Kanner at Johns Hopkins University, to know about his work, and to arrange a consultation with Dr. Kanner, and so it was a selected group that he saw. He is also a chain smoker of cigars. My opinion is that no parent and no child—I don’t care what his nature is—can very well warm up to a chain smoker of cigars…. Dr. Kanner told them there was little hope for their child; the only thing they could do was to give it to a married couple, simple folk who are warm and with very little intellectual pretensions, out in the country somewhere, and to try and forget it….

I saw some of the parents with these children, and in getting their history, they gave me a picture of paranoid, schizoid, brilliant, gifted people. And they certainly “defrosted” in my office….

Unfortunately, of all the defenses, autism is the worst, short of actual suicide, and it is undoubtedly true that our institutions for the mentally retarded and our state institutions for the mentally ill, have an increasing number of individuals who were autistic children to begin with and who have not been able to respond to treatment. In my opinion, this is one of the most challenging problems in psychiatry…. This is because, unless they come out of their autism within the first few years, they are lost souls….

I  believe that one is not justified in postponing energetic treatment in a severely autistic or disturbed child unless milder treatment works very fast. Also, I recommend that such a child should be removed from the home for a period of treatment, because the family are so dreadfully involved and because certain behavior patterns have become set in both the sick child and his family…. Also immediately start with drugs; drugs will help the child and will not harm him…. I am in favor of using electric shock therapy to shorten the time of progress. I have found that electric shock is, in my experience, the best way of initiating maturation in such children and that it is not harmful….

It is my belief that childhood schizophrenia is a lifelong phenomenon. It am not sure that it is a disease. The clinical disturbances that we observe, autism for example, are defense phenomena against the anxiety and disorganizing effects that occur in some schizophrenics…. The incidence of schizophrenic parents in our young schizophrenic children is overwhelming. So I feel very strongly that there is a gene factor…. The breakdown in defenses causing a mental or emotional disorder is caused by some other physical or organic disorder in the individual. In children this may occur at birth or it may occur before birth….

The basic characteristic of schizophrenia in childhood, as I see it, is an embryonic plasticity in all patterns of behavior…. Perhaps the easiest and most obvious defense is withdrawal. In infants this may lead to apathy and miasmas….

None of us has perfect brains either. We all have a bit of cellular loss, brain damage, deviations here and there. This is something that is hard for people to accept. Somehow parents get offended or awfully upset if you say their child has brain damage. All of us have brain damage; it is a question of degree and how we handle the problems that arise….

My theory about the origin of object relationship in children is quite different from the psychoanalytic one and is based on the concepts of the actual development and evolution of children. The first of all sensory experiences in the human being is the vestibular system and the sense of gravity…. The autistic child will not change its tone and this is one of the earliest complaints that the mothers have to make. One of the complaints the mother expresses as being one of her first problems is that when she picks the baby up she is afraid she will drop it. It is like jelly in her hands and the baby does not seem to respond…. [I]t is as though their boundaries really melted into the boundaries of other people….  This is my concept of what the schizophrenic baby who reacts with autism is like. A treatment program should include a stimulus to which the child must respond…. At the same time we were giving the child drugs. The drug we gave at that time to these children was Benadryl. This was before the tranquilizers….

We should make diagnoses earlier and correctly and we should not subject families to this amount of dislocation in time, place and money…. We should be able to evaluate a child and give a reasonable period of treatment. A child who can respond will show some evidence of it. If he cannot respond, we should not expect the impossible from the child. It is not fair to the children themselves. They have a right to live their lives in peace without harassment, and certainly the families have that right.

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