The theory that autism had psychological origins was called psychogenesis. (Its antithesis was biogenesis, which indicated organic causes.) Before the 1960s, psychological explanations, many of them focused on the interpersonal drama of early life, were culturally influential. That, and the  fact that autism was a term invented to describe adult schizophrenia, made autism synonymous with emotional disturbance and mental illness. During the 1960s, pioneers like Bernard Rimland toppled psychogenesis. They accused its advocates of being unscientific and inhumane and pointed optimistically toward an alternative: a brain-based theory of human development and behavior. Since 1970, the neurosciences have led the way toward new discoveries and treatments. Today’s scientific consensus identifies the tangled roots of autism in complex combinations of pre- and post-natal genetics, neurology, and biochemistry.

Sigmund Freud

Before the turn toward biogensis, Freudian perspectives on development shaped psychogenesis. In 1914, Sigmund Freud himself advanced a theory of “primary narcissism” which described something like autism as normal in the earliest stages of life. Freud suggested that all babies were born feeling supremely independent, self-involved, and entirely without needs for other human beings. Primary narcissism was entirely illusory, of course, since even the most imperious infant—“His Majesty the Baby,” as Freud called him—lived in a state of abject dependence.

Even if autistic aloneness marked a natural stage for all newborns—and there was much controversy on this point within the psychoanalytic community—it was fleeting. No one believed that it was normal for babies to remain permanently oblivious to the people (analysts called them “objects”) all around them or detached from the intimate emotional ties (“object relations”) that populated children’s mental worlds as well as their daily lives in families, schools, and communities. Men and women were equally represented among parents, of course, but gender conventions dictated that women and mothers (rather than men and fathers) were held largely responsible for the care of young children.

Observers of childhood psychosis and schizophrenia, diagnoses which preceded autism, and researchers interested in the hospitalism that plagued children confined to institutions, were influenced by Freud’s theories about the many things that could and did go wrong in the course of normal childhood development. They were among the first physicians and psychologists to speculate about the role of infant emotion in the etiology of developmental disorders and try to intervene in that process. C.F. Oberndorf, founder in 1925 of a psychiatric service for New York’s Hebrew Sheltering Guardian Society, noticed that by 1935, the orphans originally admitted to his institution in Pleasantville, New York, had been replaced by “psychoneurotic” and “psychopathic” children.

The conduct disorders these children presented, including uncontrollable tantrums and extreme social isolation, were far more difficult to treat than the “normal grief” of children who lost parents. Members of the institution’s staff redoubled their efforts “toward satisfying the child’s need for love and recognition, so essential to emotional growth.” They experimented with art, play, and occupational therapies, and even had the children sit in chairs while their therapists lay on couches in hopes that the children would project their problems in the form of questions. These techniques all presumed that psychological harm had been done to the children’s emotional development and that repair was needed to prevent long-term damage. Did the interventions work? The results of a study that correlated 50 children’s treatment with their post-graduation outcomes showed no consistent patterns.

Clinicians interested in the dynamics of maternal presence and absence also pushed psychogenesis forward during the 1930s and 1940s, simultaneously building the foundation for the attachment paradigm that triumphed after World War II. David Levy, for instance, directed the research unit at the New York Institute for Child Guidance, a short-lived but important organization that existed between 1927 and 1933. Levy’s best known work highlighted “maternal over-protection.” If overprotective mothers were too present, the damage done by “emotional hunger for maternal love” was caused by mothers whose presence was inadequate or who were not present at all.

To illustrate the developmental wounds of “primary affect hunger,” Levy offered cases of four children separated from their birth parents at or shortly after birth. These children were either moved from one foster family to another before finding permanent families or placed with adoptive parents after spending their first few years in orphanages. The consequence of disrupting or failing to establish nurturing emotional ties by age three was calamitous, ranging from “negativistic behavior” to “emotional deficiency.” Levy’s implication was clear. If children’s psychological needs went unsatisfied during the early months and years of life, future development would be warped or worse. Why did Levy and others believe that the earliest emotional attachments had such enduring influence? They believed that children deprived of sustaining relationships in the first months and years of life were also deprived of the drive to grow and connect, even after those relationships were restored or replaced.

Transforming early nurture into a powerful engine of personality growth was central to psychogenesis. It followed that mothers were both potential heroines and villains in the drama of human development. That bonds formed in the earliest weeks and months of life were portentous meant that calibrating emotional interaction correctly was necessary for normal development but also easy for mothers to get wrong. Whether mothers were stingy or generous, neglectful or smothering, the atmosphere into which new human beings were born directed and even determined lifelong outcomes. Mothers and mothering became targets in the effort to expose the roots of autism.

Margaret Ribble’s 1943 book, The Rights of Infants, demonstrates just how pivotal mothering was at the moment when autism became visible as a clinical syndrome. Ribble, a physician and psychoanalyst, argued that maternal emotion literally completed postnatal physiological integration and instigated infants’ mental and emotional growth. Because newborns were wholly dependent and their nervous systems extremely immature, Ribble wrote, “the baby is a potential person.” Dangers lurked everywhere. Separating mothers and babies posed enormous developmental risks and amounted to “psychological abortion.” Babies had “the right to a mother” because, simply put, they could not make the leap from potential to actual persons without one.

Placing relational capacity at the center of developmental concern made autism at once easier to see and underlined its most disturbing feature: relational incapacity. As early attachments became the drivers of growth for children’s bodies and minds, their absence spelled new risks and ominous outcomes. Prominent proponents of psychogenesis, including Bruno Bettelheim, were famous for popularizing the iconic “refrigerator mother,” so cold and unavailable that her baby’s only option was to retreat into autism.

René Spitz’s 1952 film, “Psychogenic Diseases in Infancy,” concluded by summarizing the theory of psychogenesis.

Psychogenesis differentiated between mother as noun and mothering as verb. The reproductive capacity to give birth was one thing. The psychological capacity for mothering was a more precious but scarcer resource. Psychogenesis was therefore an important concept in the history of women and family life as well as the history of autism.

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