978-1572305441

128 A MIND APART
disorder, a very perceptive observation. At that point in American medicine,
however, the field of child psychiatry was dominated by the
psychoanalytic orientation, so this observation of clinical similarity between
parent and child was interpreted to imply that the social impairments
in the parents, particularly the mother, caused the same social
impairments in the child. In other words, the disorder was caused by
impaired mother–infant bonding. At one point Kanner appeared to
share this view, but he quickly repudiated it and returned to a more biological
explanation. However, the die had been cast, and several hundred
papers were written on how mothers cause autism by ignoring
their children and treating them badly. The term “autism” fell into disfavor
and the term “childhood psychosis” was used instead to reflect this
orientation. The possibility that the original observation could be more
parsimoniously explained by genetic factors was overlooked. Children
with autism were subjected to psychotherapy, and the parents were
taken into treatment and encouraged to explore their feelings of aggression
toward their child. Special schools were set up, most notably by
Bruno Bettelheim in Chicago, who coined the phrase “refrigerator
mother.” He was later found to have falsified his qualifications when
coming to the United States and was accused of abuse by some of the
children resident at his school. Not surprisingly, the disorder was found
very difficult to treat given these methods.
In the late 1960s and ’70s the tide began to turn against this view.
Scientists from outside the psychoanalytic camp began to report that
children with autism were more often male than female, frequently had
epilepsy, often suffered from profound developmental delay, had socalled
“soft neurological signs,” electroencephalogram (EEG) abnormalities,
and were the children of perfectly normal parents, not some
pair of cold fish. None of these findings could be accounted for by the
refrigerator mother model of autism. By the mid-’70s, autism was seen
finally as a disorder of brain development by most credible authorities.
It had taken thirty years, but the science of child psychiatry moved
slowly in those days! Now it is hard to keep up with the ever-expanding
literature on the biology of ASD.
It is very instructive to read these early theories about what causes
autism in light of what we know today. What is most striking is the certainty
with which the experts spoke. They knew what caused the disorder.
The possibility of error was never considered. Even though today
we have a better understanding of what causes autism, we are also
acutely aware of the limits of our knowledge, the possibility and inevita-