For the documentary film, see Refrigerator Mothers.
Refrigerator mother theory is a widely discarded theory that autism is caused by a lack of maternal warmth. Current research indicates that a combination of genetic factors and exposure to environmental agents predominate in the cause of autism.
The terms refrigerator mother and refrigerator parents were coined around 1950 as a label for mothers and parents of children diagnosed with autism or schizophrenia. When Leo Kanner first identified autism in 1943, he noted the lack of warmth among the parents of autistic children. Parents, particularly mothers, were often blamed for their children's atypical behavior, which included rigid rituals, speech difficulty, and self-isolation. Kanner later rejected the "refrigerator mother" theory, instead focusing on brain mechanisms.
Origins of theory
In his 1943 paper that first identified autism, Leo Kanner called attention to what appeared to him as a lack of warmth among the fathers and mothers of autistic children. In a 1949 paper, Kanner suggested autism may be related to a "genuine lack of maternal warmth", noted that fathers rarely stepped down to indulge in children's play, and observed that children were exposed from "the beginning to parental coldness, obsessiveness, and a mechanical type of attention to material needs only.... They were left 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." In a 1960 interview, Kanner bluntly described parents of autistic children as "just happening to defrost enough to produce a child." In Kanner's original paper, however, only one set of parents were described as "cold", with many family members appearing to be from one neurological minority or another upon close reading of the text.
Although Kanner was instrumental in framing the refrigerator mother theory, it was Bruno Bettelheim, a University of Chicago professor and child development specialist, who facilitated its widespread acceptance both by the public and by the experts in the medical establishment in the 1950s and 1960s. In the absence of any biomedical explanation of autism's cause after the telltale symptoms were first described by scientists, Bettelheim and other leading psychoanalysts championed the notion that autism was the product of mothers who were cold, distant and rejecting, thus depriving their children of the chance to "bond properly". Bettelheim founded the Orthogenic School at the University of Chicago as a residential treatment milieu for such children, who he felt would benefit from a "parentectomy". This marked the apex of autism viewed as a disorder of parenting.
The theory was embraced by the medical establishment and went largely unchallenged into the mid-1960s, but its effects have lingered into the 21st century. Many articles and books published in that era blamed autism on a maternal lack of affection, but by 1964, Bernard Rimland, a psychologist who had an autistic son, published a book that signaled the emergence of a counter-explanation to the established misconceptions about the causes of autism. His book, Infantile Autism: The Syndrome and its Implications for a Neural Theory of Behavior, attacked the refrigerator mother hypothesis directly.
Soon afterwards, Bettelheim wrote The Empty Fortress: Infantile Autism and the Birth of the Self, in which he compared autism to being a prisoner in a concentration camp:
"The difference between the plight of prisoners in a concentration camp and the conditions which lead to autism and schizophrenia in children is, of course, that the child has never had a previous chance to develop much of a personality."
Some authority was granted to this as well, because Bettelheim had himself been interned at the Dachau concentration camp before World War II. The book was immensely popular and he became a leading public figure on autism until his death, but he became controversial after a biography, written 7 years after his death by a disgruntled cousin of a patient, claimed that he exaggerated his credentials and Dachau experiences. Also, three ex-patients questioned his work, characterizing him as a cruel tyrant.
In 1969, Kanner addressed the refrigerator mother issue at the first annual meeting of what is now the Autism Society of America, stating:
From the very first publication until the last, I spoke of this condition in no uncertain terms as "innate." But because I described some of the characteristics of the parents as persons, I was misquoted often as having said that "it is all the parents' fault."
Other notable psychiatrists
For Silvano Arieti, who wrote his major works from the 1950s through the 70s, the terms autistic thought and what he called paleologic thought are apparently the same phenomenon. Paleologic thought is a characteristic in both present-day schizophrenics and primitive men, a type of thinking that has its foundations in non-Aristotelian logic. An autistic child speaks of himself as "you" and not infrequently of the mother as "I". The "you" remains a "you" and is not transformed into "I".
For Margaret Mahler and her colleagues, autism is a defense of children who cannot experience the mother as the living primary-object. According to them, autism is an attempt at dedifferentiation and deanimation. The symbiotic autistic syndrome used to be called the "Mahler syndrome" because Mahler first described it: The child is unable to differentiate from the mother.
Arieti warned that an autistic tendency is a sign of a kind of disorder in the process of socialization, and that when autistic expressions appear it should be assumed that there is a sort of difficulty between the child and his parents, especially the schizogenic mother. Children who use autistic expressions, Arieti observes, are children who cannot bond socially.
In Interpretation of Schizophrenia Arieti maintained that for a normal process of socialization, it is necessary for the parent-child relations to be normal. Loving or non-anxiety parental attitudes favor socialization. Arieti not only maintained that the parent-child relations are the first social act and the major drive of socialization, but also a stimulus to either accept or reject society. The child's self in this view is a reflection of the sentiments, thoughts, and attitudes of the parents toward the child. Autistic children show an extreme socializing disorder and do not want any sort of relationship with people. They "eliminate" people from their consciousness. For Arieti the fear of the parents is extended to other adults: a tendency to cut off communication with human beings.
Persistence of the theory
According to Peter Breggin's 1991 book Toxic Psychiatry, the psychogenic theory of autism was abandoned for political pressure from parents' organizations, not for scientific reasons. For example, some case reports have shown that profound institutional privation can result in quasi-autistic symptoms. Clinician Frances Tustin devoted her life to the theory. She wrote:
One must note that autism is one of a number of children's neurological disorders of psychogenic nature, i.e., caused by abusive and traumatic treatment of infants.... There is persistent denial by American society of the causes of damage to millions of children who are thus traumatized and brain damaged as a consequence of cruel treatment by parents who are otherwise too busy to love and care for their babies.
Alice Miller, one of the best-known authors of the consequences of child abuse, has maintained that autism is psychogenic, and that fear of the truth about child abuse is the leitmotif of nearly all forms of autistic therapy known to her. When Miller visited several autism therapy centers in the United States, it became apparent to her that the stories of children "inspired fear in both doctors and mothers alike":
I spent a day observing what happened to the group. I also studied close-ups of children on video. What became clearer and clearer as the day went on was that all these children had a serious history of suffering behind them. This, however, was never referred to.... In my conversations with the therapists and mothers, I inquired about the life stories of individual children. The facts confirmed my hunch. No one, however, was willing to take these facts seriously.
Like Arieti and Tustin, Miller believes that only empathetic parental attitudes lead to the complete blossoming of the child’s personality.
The refrigerator mother theory, widely discarded in the United States, still has some support in France and Europe and is largely believed in South Korea to be the cause of autism. The academic psychologist Tony Humphreys of University College Cork is a leading Irish proponent of the theory of frigid parenting, despite censure by the Psychological Society of Ireland.
The modern consensus is that autism has a strong genetic basis, although the genetics of autism are complex and are not well understood. Moreover, fetal and infant exposure to pesticides, viruses, and household chemicals have also been implicated as triggering the syndrome. 
Although recent studies have indicated that maternal warmth, praise, and quality of relationship are associated with reductions of behavior problems in autistic adolescents and adults, and that maternal criticisms are associated with maladaptive behaviors and symptoms, these ideas are distinct from the refrigerator mother hypothesis.
In 2003, Kartemquin Films released Refrigerator Mothers, a documentary that takes a look at American mothers of the 1950s and 1960s and the blame leveled by the medical establishment for the mothers causing their children's autism. The documentary gives voice to women who no longer accept the blame that was once common for mothers of autistic children. Making its television premiere on PBS'sP.O.V. series, Refrigerator Mothers was featured in a January 2010 issue of Psychology Today that focused on the racial and class stereotyping of autism.
- ↑ http://www.niehs.nih.gov/health/topics/conditions/autism/
- ↑ http://www.psychologytoday.com/blog/child-myths/201004/whose-fault-is-autism-historical-view-placing-blame
- ↑ Kanner L (1943). "Autistic disturbances of affective contact". Nerv Child. 2: 217–50. Reprinted in Kanner, L (1968). "Autistic disturbances of affective contact.". Acta Paedopsychiatr. 35 (4): 100–36. PMID 4880460.
- ↑ Kanner L (1949). "Problems of nosology and psychodynamics in early childhood autism". Am J Orthopsychiatry. 19 (3): 416–26. doi:10.1111/j.1939-0025.1949.tb05441.x. PMID 18146742.
- ↑ "The child is father". TIME. 1960-07-25. Retrieved 2007-07-29.
- ↑ http://garfield.library.upenn.edu/classics1979/A1979HZ31800001.pdf
- ↑ Millon, Theodore; Krueger, Robert F.; Simonsen, Erik, eds. (2011). Contemporary Directions in Psychopathology. Scientific Foundations of the DSM-V and ICD-11. New York City: Guilford Press. p. 555. ISBN 1-60623-533-8. ISBN 978-1-60623533-1.
- ↑ Finn M (1997). "In the case of Bruno Bettelheim". First Things (74): 44–8.
- ↑ Feinstein A. "'Refrigerator mother' tosh must go into cold storage". autismconnect. Archived from the original on 2007-09-27. Retrieved 2007-07-29.
- ↑ Arieti S (1974). Interpretation of Schizophrenia (2nd ed.). Northvale, NJ: Aronson. ISBN 1-56821-209-7.
- ↑ Mahler MS, Furer M, Settlage SF (1959). "Severe emotional disturbances in childhood: psychosis". In Arieti S. American Handbook of Psychiatry. 1. Basic Books. pp. 816–39. OCLC 277737871.
- ↑ Rutter M, Andersen-Wood L, Beckett C, et al. (1999). "Quasi-autistic patterns following severe early global privation. English and Romanian Adoptees (ERA) Study Team". J Child Psychol Psychiatry. 40 (4): 537–49. doi:10.1017/S0021963099003935. PMID 10357161.
- ↑ Tustin F (1991). "Revised understandings of psychogenic autism". Int J Psychoanal. 72 (Pt 4): 585–91. PMID 1797714.
- ↑ Miller A (1991). Breaking Down the Wall of Silence: The Liberating Experience of Facing Painful Truth. Dutton. pp. 48–49. ISBN 0-525-93357-3.
- ↑ Heurtevent, David (January 2, 2012). "Introduction to Autism in France: A Really Silly Psychiatric System !". Support The Wall – Autism. Retrieved 25 February 2012.
- ↑ Cohen D (2007-01-23). "Breaking down barriers". The Guardian. Retrieved 2007-07-29.
- ↑ "Controversial autism article should be retracted – Psychological Society of Ireland". The Journal.ie. 2012-02-09.
- ↑ Abrahams BS, Geschwind DH (2008). "Advances in autism genetics: on the threshold of a new neurobiology". Nat Rev Genet. 9 (5): 341–55. doi:10.1038/nrg2346. PMC 2756414. PMID 18414403.
- ↑ http://www.scientificamerican.com/article/autism-rise-driven-by-environment/
- ↑ Smith LE, Greenberg JS, Seltzer MM, Hong J (2008). "Symptoms and behavior problems of adolescents and adults with autism: effects of mother-child relationship quality, warmth, and praise". Am J Ment Retard. 113 (5): 387–402. doi:10.1352/2008.113:387-402. PMC 2826841. PMID 18702558.
- ↑ Refrigerator Mothers :: Kartemquin Films
- ↑ "Bias, Bettelheim and Autism: Is History Repeating Itself?". Soraya, Lynne. Psychology Today. 10 Jan. 2010. Retrieved 25 Jan. 2011.
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The Refrigerator Mother
By Neuroskeptic | September 20, 2010 9:15 am
Autism is biological: that’s the one thing everyone agrees about it. Scientific orthodoxy is that it’s a neurodevelopmental condition caused by genetics, in most cases, and by environmental insult, such fetal exposure to anticonvulsants, in rare cases. Jenny McCarthy orthodoxy is that “toxins” – usually in vaccines – are to blame, not genes, and that the underlying damage might be in the gut not the brain: but they agree that it’s biological.
However, it hasn’t always been this way. From the 1950s to about the 1980s, there was a widespread view that autism was a purely psychological condition. Bruno Bettelheim is the name most often linked to this view. Bettelheim spent most of his career at the University of Chicago’s Orthogenic School, an institution for “disturbed” children, including autistics as well as “schizophrenic” and others.
His magnum opus was his book The Empty Fortress: Infantile Autism and the Birth of the Self, in which he outlined his theory of autism illustrated by three long case histories. His ideas are now referred to as the “refrigerator mother” theory.
For Bettelheim, autism was a reaction to severe neglect. Not of physical needs, which would be fatal, but of emotional relations. In his view, the most common underlying cause of this neglect was when the mother (and to a lesser extent, the father) did not want the child to exist. They cared for him, but they did so in a mechanical fashion, treating the baby as a mouth to feed and a nappy to change, rather than as a human being.
Hence the “refrigerator” – it provides food, but it’s cold.
The result was that the child never learned to interact with the mother on anything other than a mechanical level; and for Bettelheim, as for most psychoanalysts, our relationships with our parents were the model on which all our other relationships were based.
The mechanical mother thus left the autistic child unable to relate to anyone, indeed, unable to conceive of the existence of other human beings, and thus lacking a sense of “self” as opposed to “others”.
The repetitive behaviours and obsessive interests characteristic of autism were seen as an active, even heroic, coping strategy. They were the child’s way of asserting what little self they had, by doing something for themselves, albeit something “pointless”. But they also had symbolic meanings: “Joey’s” interest in fans, propellers and other rotating objects was interpreted as a representation of the “vicious circle” of his life. And so on.
Today the “refrigerator mother theory” is routinely cited as a cautionary tale of how deeply one can misunderstand autism. Ironically, Bettelheim’s only reference to that term in The Empty Fortress is a quotation, from none other than Leo Kanner, the man who coined the term ‘childhood autism’ in 1944. Kanner referred to the “emotional refrigeration” he observed in the families of autistic children, although it’s not clear that he thought of it as causing the autism.
There is no doubt that Bettelheim’s approach was unscientific. He repeatedly claimed that the fact that many children improved after three or four years at the Orthogenic School proved that their autism was psychological, because if it were biological it would be permanent.
Yet there is no reason to assume that children with a neurodevelopmental disorder would never change as they grew up. There was no control group, let alone a placebo group, to show that the children wouldn’t have “grown out of” some symptoms anyway. (Edit: In fact, Kanner himself had written about improvement with age way back in 1943, in the first ever paper about autistic children! So there was simply no excuse for Bettelheim’s flawed argument.)
Bettelheim’s attributing the cause of autism to family dynamics was post hoc: for each autistic child, he looked back into their family history (i.e. what the parents reported) and found that they “consciously or unconsciously” didn’t want the child to exist.
Yet all this proves is that it is possible to interpret a parent’s behaviour in that way, in retrospect, if you want to. The “or unconsciously” caveat creates endless scope for over-interpretation.
But even if we now see autism as a neurodevelopmental disorder, there is something attractive about Bettelheim’s book: it seems to be a serious attempt to understand the autistic experience “from the inside”, and to appreciate the autistic child as a person rather than a disease. This is something that we rarely see nowadays.
Bettelheim’s problem was that he tried to understand autistic behaviour from the assumption that the autistic child was, deep down, entirely “normal”. Hence his interpretation of, say, Joey’s fascination with rotating objects as symbolic of his life situation (and also as reflecting the fact that his father was often flying away in propeller-driven aircraft, which he was).
Yet couldn’t it be that Joey was just fascinated by spinning fans per se? There’s nothing interesting about rotating objects. They must have a hidden meaning. Otherwise it makes no sense – to someone who isn’t autistic. But all that means is that trying to understand the autistic child is rather difficult if you don’t bear in mind that they are autistic.
CATEGORIZED UNDER: autism, books, history, woo