Leo Kanner, “Problems of Nosology and Psychodynamics of Early Infantile Autism,” The American Journal of Orthopsychiatry 19 (1949):416-26.
Complete original source available here.
In this article, Leo Kanner reported on 55 additional children he had seen since publishing “Autistic Disturbances of Affective Contact” in 1943. He suggested using the term “early infantile autism” and argued for its coherence as a clinical syndrome. Kanner’s observation that the parents of autistic children had both successful careers and unemotional marriages was at least as significant as the evidence he offered for autism as a psychiatric diagnosis. His characterization of familial atmospheres as chilly “emotional refrigerators” provided support for psychogenesis, the theory that identified inadequate parental love as the cause of autism.
To satisfy the need for some terminological identification of the syndrome, I have come to refer to it as “early infantile autism.”
Briefly, the characteristic features consist of a profound withdrawal from contact with people, an obsessive desire for the preservation of sameness, a skillful and even affectionate relation to objects, the retention of an intelligent and pensive physiognomy, and either mutism or the kind of language which does not seem intended to serve the purpose of interpersonal communication….
Now that early infantile autism has a well-defined symptomatology and the syndrome as such can be recognized with relative ease, it is ready to apply for a place in the existing psychiatric nosology….
Early infantile autism bears no resemblance to Heller’s disease or to any other organic condition….
The extreme emotional isolation from other people, which is the foremost characteristic of early infantile autism, bears so close a resemblance to schizophrenic withdrawal that the relationship between the two conditions deserves serious consideration….
The basic nature of its manifestations is so intimately related to the basic nature of childhood schizophrenia as to be indistinguishable from it…. [O]ne can hardly speak of an insidious onset of early infantile autism, except perhaps with reference to the first semester of life…. Early infantile autism may therefore be looked upon as the earliest possible manifestation of childhood schizophrenia…. I do not believe that there is any likelihood that early infantile autism will at any future time have to be separated from the schizophrenias, as was the case with Heller’s disease or with many instances of so-called dementia praecoocissima of De Sanctis.
Nosologically, therefore, the great importance of the group which I have described as early infantile autism lies in the correction of the impression that a comparatively normal period of adjustment must precede the development of schizophrenia….
There is no instance of schizophrenia, manic-depressive psychosis, or even senile psychosis among the parents, grandparents, uncles, and aunts of the autistic children.
It is even more remarkable that almost all adult relatives have been rather successful in their chosen careers. The fathers are scientists, college professors, artists, clergymen, business executives; there are a few psychologists and psychiatrists among them. Many of the fathers, grandfathers, and uncles are listed in some of the Who’s Who compilations or in American Men of Science. All but five of the mothers of the 55 children have attended college. All but one have been active vocationally before, and some also after, marriage as scientists, laboratory technicians, nurses, physicians, librarians, or artists….
My search for autistic children of unsophisticated parents has remained unsuccessful to date….
[A]side from the indisputably high level of intelligence, the vast majority of the parents of the autistic children have features in common which it would be impossible to disregard….
One is struck again and again by what I should like to call a mechanization of human relationships. Most of the parents declare outright that they are not comfortable in the company of other people; they prefer reading, writing, painting, making music, or just “thinking.”….
They describe themselves and their marital partners as undemonstrative….
The parents’ behavior toward the children must be seen to be fully appreciated. Maternal lack of genuine warmth is often conspicuous in the first visit to the clinic…. I saw only one mother of an autistic child who proceeded to embrace him warmly and bring her face close to his….
These people, who themselves had been reared sternly in emotional refrigerators, have found at an early age that they could gain approval only through unconditional surrender to standards of perfection….
The obsessiveness of the parents of the autistic children was a veritable boon to me with regard to the case histories. Few children have ever been observed by their parents with such minute precision. Every smallest detail of the child’s development, utterances, and activities had either been recorded in voluminous diaries or were remembered by heart….
But the same obsessiveness was a major contribution to the impersonal, mechanized relation with the children. The parents, apparently unable to derive enjoyment from the children as they are, work for the attainment of goodness, obedience, quiet, good eating, earliest possible control of elimination, large vocabulary, memory feats….
The children were, as modern phraseology usually has it, “planned and wanted.” Yet the parents did not seem to know what to do with the children when they had them. They lacked the warmth which the babies needed. The children did not seem to fit into their established scheme of living. The mothers felt duty-bound to carry out to the letter the rules and regulations which they were given by their obstetricians and pediatricians. They were anxious to do a good job, and this means mechanized service of the kind which is rendered by an overconscientious gasoline station attendant….
Most of the patients were exposed from the beginning to parental coldness, obsessiveness, and a mechanical type of attention to material needs only. They were the objects of observation and experiment conducted with an eye on fractional performance rather than with genuine warmth and enjoyment. They were kept neatly in refrigerators which did not defrost. Their withdrawal seems to be an act of turning away from such a situation to seek comfort in solitude….
It is also very tempting to ponder about the psychodynamic relationship between early infantile autism, schizophrenia of later childhood, and the “hospitalism” studied by Goldfarb. Further, do not the personalities of the parents indicate that there are milder degrees of detachment and obsessiveness which enable a person to function and even gain a certain type of success in a nonpsychotic existence?….