Bruno Bettelheim, 1903-1990

One of the most prominent psychoanalysts of the post-World War II era, Bruno Bettelheim’s books spread the Freudian tradition in the United States and internationally at the high point of its popularity. He accomplished this by telling compelling stories about children whose disturbing, fascinating behaviors made normality stand out in sharp relief. Bettelheim was the most famous champion of psychogenesis. That theory placed the origins of autism in the toxic familial environments that denied the basic emotional needs of babies unlucky enough to be born into them. Bettelheim conceded that the parents of autistic children were often middle class, well-educated people who worried that their children were not developing normally. Those parents could not permit themselves to be consciously aware of their desires to abandon those children, but getting rid of them is precisely what Bettelheim believed they really wanted.

For Bettelheim, autism was an “empty fortress,” the title of his 1967 book on that subject. Children took shelter there from the cruelty and indifference of their parents—mothers especially—who were supposed to love them but instead denied their humanity. The cost was impossibly high. Forced into radical solitude behind walls that shielded them from the very people whose attention they craved, babies were frozen out of normal development. Without access to the dependence necessary to become independent persons, the growth process stalled before it ever began. No matter how bright or sensitive these children were, autism (often still called childhood schizophrenia or psychosis) was the result.

Bruno Bettelheim was born in Vienna in 1903. He grew up reading avidly about the psychoanalytic revolution that Sigmund Freud had started in that city and trained as a psychologist at the University of Vienna. In 1939, he became part of the émigré wave of intellectuals and professionals who fled Nazi Europe. Before making his way to the United States, Bettelheim was detained in two concentration camps, Dachau and Buchenwald. His observations about life and survival in these camps were documented in “Individual and Mass Behavior in Extreme Situations,” a 1943 article that brought him worldwide acclaim.

From 1944 to 1973, Bettelheim directed the Sonia Shankman Orthogenic School at the University of Chicago, a residential treatment center for disturbed children that continues to exist today. The many children with autism who lived at the school inspired Bettelheim to extend his analysis of “extreme situations” from German concentration camps to the interpersonal worlds of early childhood. Like prisoners, Bettelheim contended, autistic children faced extremity. No matter how tragic the results, their escape into autism was understandable. The Orthogenic School provided Bettelheim with the engaging case studies he presented in his writings. The work of scores of staff members at the school was the evidence he offered in favor of a treatment regimen that separated children from their families and immersed them in a “total therapeutic milieu” for years on end.

“Joey, the Mechanical Boy,” for example, showcased a young child whose autism was manifested in his efforts to look and behave like a machine—a metaphor that Bettelheim explored to great effect in the pages of Scientific American. Supplementing his description of Joey with drawings made by the boy, Bettelheim depicted a child who “wanted to be rid of his unbearable humanity, to become fully automatic.” For countless readers, Bettelheim’s cases were their first, most memorable encounters with autism.

According to Bettelheim, the great virtue of psychogenesis was its therapeutic optimism. Psychological explanations could be transformed into practical interventions, whereas theories about organic causes had nothing at all to offer suffering children. Nor was Bettelheim open to behavioral approaches to autism, such as those pioneered by Ivar Lovaas at UCLA, because “operant conditioning turns human beings into objects of manipulation in the belief that such is for the patient’s own good.” Behaviorists utilized physically coercive means to attain beneficial ends. Such ethical violations were, for Bettelheim, no more acceptable in work with autistic children than they had been in Hitler’s Germany and Stalin’s Russia. He bluntly equated behaviorists with murderous authoritarians and roundly condemned them all.

Bettelheim claimed that many of the autistic children treated at his school, although not all, recovered fully or partially from autism by regaining the autonomy they had been denied early in life. Through close relationship with a “need-satisfying” adult who “offers herself in the flesh as…a steady, ever-present object,” these children eventually exited the state of extreme aloneness into which they had been exiled. It was surely no coincidence that the persons responsible for recovery were female, just like the unconsciously hostile mothers that Bettelheim held responsible for instigating autism in the first place. Establishing emotionally healthy “object relations” was the therapeutic mechanism that allowed children with autism “to change their view of the world enough so that they wished to communicate with others in verbal ways.”

Throughout most of his career, Bettelheim’s views attracted great interest and respect in spite of his deliberate provocations and sometimes belligerent demeanor. His admirers pointed to his tireless work with severely disabled children as proof of his empathy and courage. Critics argued that Bettelheim’s insistence on an 85% cure rate was unrealistic, if not impossible. They also frequently noted a major shortcoming in the theory of psychogenesis: many autistic children had perfectly normal siblings, born to the very same parents whose unconscious hostility was supposedly the root of the problem. During the 1960s, psychogenesis lost ground to advocates of biogenesis, including Bernard Rimland, and angry parents pointed the finger at Bettelheim and others who had blamed them for their children’s autism. After his suicide in 1990, charges of physical abuse at the Orthogenic School surfaced and uncomfortable questions about Bettelheim’s professional credentials emerged. His reputation was permanently tarnished.

That such an icon of humanitarian treatment for autistic children could be thoroughly discredited by the time of his death illustrates not only the salient details of Bettelheim’s biography. It also underlines the larger controversies that have turned basic questions about autism upside down and inside out over time. What should count as valid scientific evidence? What does ethical treatment look like? What do children with autism, and their loved ones, really need and deserve?